1.
Which is the best treatment strategy before autologous peripheral blood stem cell transplantation in POEMS syndrome?
Autore, F., Bramanti, S., Lessi, F., Innocenti, I., Galli, E., Rocchi, S., Ribolla, R., Derudas, D., Oliva, S., Stefanoni, P., et al
Haematologica. 2023
Abstract
Autologous peripheral blood stem cell transplantation (aPBSCT) provides optimal outcomes in POEMS syndrome but the definition of the best treatment before aPBSCT remains to be defined, because of the disease rarity and the heterogeneity of published case series. We collected clinical and laboratory data of patients with POEMS syndrome undergoing aPBSCT from 1998 to 2020 in 10 Italian centres. The primary endpoint of the study was to evaluate the impact of prior therapies and mobilizing regimen on outcome. We divided patients in three groups: patients who did not receive any treatment before transplant (15 patients, group A: front-line), pre-treated patients with other agents (14 patients, group B) and patients treated with cyclophosphamide as mobilizing regimen (16 patients, group C). The three groups did not show differences in terms of demographic and clinical characteristics. All 45 patients underwent aPBSCT after high dose melphalan conditioning regimen, with a median follow-up of 77 months (37-169 months). The responses were not statistically different between the 3 groups (p 0.38). PFS and OS rates at 6 years were 65% (49-85) and 92% (84-100), respectively and did not differ in the 3 groups. The cumulative incidence of transplant related mortality and relapse was respectively 4% and 36%. In conclusion, in a relatively large number of patients with POEMS syndrome, undergoing an autologous transplant, pre-treatment and disease status at transplant did not appear to have an impact on major transplant outcomes.
2.
Impact of lenalidomide exposure on blood cell collection for autotransplants in persons with POEMS syndrome
Cai, H., Bai, J., Li, J., Cai, H., Duan, M., Cao, X., Chen, M., Zhou, D., Zhang, W.
Archives of medical science : AMS. 2018;14(5):1048-1054
Abstract
Introduction: Lenalidomide is an effective therapy of POEMS syndrome. However, there is concern that exposure to lenalidomide may reduce the efficiency of blood cell collection in persons who may eventually receive an autotransplant. We studied the impact of lenalidomide therapy on subsequent blood cell mobilization and collection including frequency of blood CD34+ cells and CXCR4 expression before and after mobilization with cyclophosphamide and granulocyte-colony stimulating factor (G-CSF). Material and methods: Forty-three subjects with POEMS were assigned to receive lenalidomide and dexamethasone for 2-4 28 d cycles (n = 19) or no therapy (n = 24). All subjects then received cyclophosphamide and G-CSF. Neither cohort had substantial numbers of blood CD34+ cells before mobilization. Results: Mobilization increased blood CD34+ frequency in lenalidomide-treated subjects and controls similarly (0.25% (95% confidence interval (CI): 0.03-1.39% vs. 0.32%, 0.04-1.47%), p = 0.472). Increases in blood CD34+ numbers were also similar (10 x 10(6)/l) (5-77 x 10(6)/l) vs. 14 x 10(6)/l (6-101 x 10(6)/l), p = 0.312). Mean CXCR4 fluorescence intensity on bone marrow cells from controls decreased from 58 +/-34 (mean +/- SD) to 31 +/-16 after mobilization (p = NS). In contrast, mean CXCR4 intensity on bone marrow cells in lenalidomide-treated subjects increased from 55 +/-43 to 89 +/-40 (p = 0.017, comparing the deviation between two groups). Median numbers of CD34+ cells collected in lenalidomide-treated subjects and controls were 2.3 x 10(6)/kg (0.6-6.8 x 10(6)/kg) and 2.810(6)/kg (1.0-8.9 x 10(6)/kg; p = 0.521). Conclusions: Brief lenalidomide treatment for POEMS did not reduce numbers of CD34+ blood cells collected but increased CXCR4 expression on bone marrow CD34+ cells.