Moving Beyond G-CSF mobilization - Learning from a 15-year Experience of Different Stem Cell Mobilization Regimens in Plasma cell Neoplasms

Multiple myeloma is a blood cancer wherein abnormal proteins are produced from cancer cells and cause organ damage. After initial cancer control with chemotherapy, high dose chemotherapy and transplant is a common part of treatment in young patients. This helps in better control of cancer, as myeloma is considered incurable. For the process of transplant, stem cells are collected from blood, similar to the procedure of a regular blood donation in blood bank. Stem cells are parent cells in bone marrow which make all blood cells (red blood cells, white blood cells and platelets). Stem cells normally reside within the bone marrow. For ease of collection from the patient, we need to push them out from the bone marrow into blood. For collecting stem cells, multiple protocols are used. Common protocols have use of injections called “growth factors” which stimulate our stem cells to come out from bone marrow in blood, from where they can be collected easily. Other protocols use chemotherapy injections which creates a transient stress on the bone marrow. After few days, the bone marrow recovers from this stress, and in this process, a considerable number of stem cells are released into blood. Both the above procedures have the same common end-point of moving stem cells out from the bone marrow into blood, which enables their easy collection. There is no data from India which has compared the efficacy of chemotherapy-based protocols to growth-factor based protocols for stem cell collection from India. We wish to study this from our institute in patients with multiple myeloma. The above knowledge will help us understand appropriate benefits and drawbacks of these protocols in our setting, and thereby help future patients.