Stem cell mobilization chemotherapy with gemcitabine is effective and safe in myeloma patients with bortezomib-induced neurotoxicity

Vinorelbine chemotherapy with granulocyte colony stimulating factor (G CSF) stimulation is a widely applied non myelosuppressive mobilization regimen in Switzerland for myeloma patients but its neurotoxic potential limits its use in patients with bortezomib induced polyneuropathy. In this single center study we alternatively evaluated safety and effectiveness of gemcitabine chemotherapy with G CSF for mobilization of autologous stem cells. Between March 2012 and February 2013 all bortezomib pretreated myeloma patients planned to undergo first line high dose melphalan chemotherapy received a single dose of 1250?mg/m2 gemcitabine with G CSF started on day 4. The 24 patients in this study had received a median of four cycles of bortezomib dexamethason based induction. Bortezomib related polyneuropathy was identified in 21 patients (88) by clinical evaluation and a standardized questionnaire. Administration of gemcitabine mobilization did not induce new or aggravate pre existing neuropathy. Stem cell mobilization was successful in all 24 patients with a single day of apheresis being sufficient in 19 patients (78). The median yield was 9.51×10(6) CD34+ cells/kg. Stem collection could be accomplished at day 8 in 67. Our data suggest that single dose gemcitabine together with G CSF is an effective mobilization regimen in myeloma patients and a safe alternative non myelosuppressive mobilization chemotherapy for myeloma patients with bortezomib induced polyneuropathy.