Higher efficacy of oral etoposide for mobilization of peripheral blood stem cells in patients with multiple myeloma

This study compares the efficacy, toxicity, hematopoietic recovery, and cost of stem-cell mobilization using intermediate-dose cyclophosphamide (IDCy) plus granulocyte colony-stimulating factor (G-CSF) compared with etoposide (VP-16) plus pegylated granulocyte colony-stimulating factor (PEG-rhG-CSF) in multiple myeloma (MM) patients. Two hundred forty-four consecutive patients undergoing mobilization with IDCy (3-3.5g/m(2)) plus G-CSF (n=155) were compared with patients receiving VP-16 plus PEG-rhG-CSF (n=89), including oral etoposide (n=65) and intravenous etoposide (n=24). Compared with IDCy, VP-16 use was associated with significantly higher median peak peripheral blood CD34+cell count (8.20 [range: 1.84-84]x10(6)/kg vs 4.58 [range: 0.1-27.9]x10(6)/kg, P=.000), and ideal CD34+cell yield of more than 6x10(6)/kg (56.8% vs 35.1%, P=.001), notably with a higher efficacy in oral VP-16 use compared with IDCy use (CD 34+cell counts: median peak peripheral blood 5.87 vs 4.58x10(6)/kg and >= 6x10(6)/kg [48.4% vs 35.1%]). The median number of apheresis courses was reduced from two in the IDCy group to one in the VP-16 group (P=.000). IDCy use was associated with significantly more frequent episodes of neutropenia (70.2% vs 35.2%; P=.000), intravenous antibiotic use (13.2% vs 11.4%; P=.672), and hospitalization (P=.000). The recoveries of neutrophils and platelets after autologous stem-cell transplantation were significantly faster in the VP-16 group compared with the IDCy group (P=.000). Our data indicate robust stem-cell mobilization in MM patients with VP-16 delivered either orally or intravenously. When compared with intravenous VP-16, oral VP-16 mobilization was associated with significantly more convenient, lower average total costs, and especially decreased the risk of hospital visits and exposure.