Bendamustine, etoposide and dexamethasone to mobilize peripheral blood hematopoietic stem cells for autologous transplantation in patients with multiple myeloma

Chemotherapeutic agents without cross-resistance to prior therapies may enhance peripheral blood stem cell collection and improve patient outcomes by exacting a more potent direct anti-tumor effect prior to autologous stem cell transplant. Bendamustine has broad clinical activity in transplantable lymphoid malignancies, but concern remains over the potential adverse impact of this combined alkylator-nucleoside analog on stem cell mobilization. We performed a prospective, non-randomized Phase II study including thirty-four patients with multiple myeloma (MM) (n=34; ISS stage-I[35%], II[29%] and III[24%]; not scored[13%]) to evaluate bendamustine’s efficacy and safety as a stem cell mobilizing agent. Patients received bendamustine (120 mg/m(2) IV d 1,2), etoposide(200 mg/m(2) IV d 1–3) and dexamethasone(40 mg PO d 1–4) (BED) followed by filgrastim (10 mcg/kg/d s.c.; through collection). All patients (100%) successfully collected stem cells (median of 21.60 ×10(6)/kg of body weight; range 9.24–55.5×10(6)/kg), and 88% required a single apheresis. Six non-hematologic SAEs were observed in 6 patients including: neutropenic fever (1, grade 3), bone pain (1, grade 3), and renal insufficiency (1, grade 1). In conclusion, BED safely and effectively mobilizes hematopoietic stem cells.