Effect Of Advanced Lytic Bone Lesions On Peripheral Stem Cell Mobilization In Patients With Multiple Myeloma

The purpose of this study was to identify incidence and predictive factors of peripheral blood stem cell (PBSC) mobilization failure in patients with multiple myeloma (MM). Retrospective data of 104 patients who received cyclophosphamide plus G-CSF or G-CSF alone mobilization were analyzed. The rate of mobilization failure using two definitions of failure < 2 and < 4 ´ 10⁶ CD34⁺ cells/kg following the first collection attempt was 16.3% and 33.7%, respectively. Predictors of mobilization failure were evaluated using logistic regression analysis including age, advanced osteolytic lesions, bone marrow cellularity before mobilization, platelet count, body mass index before mobilization, and mobilization method. Lytic bone lesion was assessed by conventional skeletal survey, and advanced osteolytic lesions were defined by lytic lesions more than three skeletal sites regardless of number of lytic lesions. By multivariate analysis, advanced osteolytic lesions (odds ratio mORn= 10.956, P = 0.001) and age ≥ 60 years (OR = 5.454, P = 0.017) were associated with PBSC yield lower than 2 ´ 10⁶ CD34⁺ cells/kg, and advanced osteolytic lesions (OR = 5.088, P = 0.006), WBC ≤ 4,000/mL before mobilization (OR = 4.724, P = 0.005), and G-CSF only mobilization (OR 10.526, P = <0.001) were associated with PBSC yield lower than 4 ´ 10⁶ CD34⁺ cells/kg. This data suggests that multiple osteolytic lesions as well as advanced age, WBC count, and mobilization method is a significant predictor of mobilization failure in MM patients.