Abstract
Objective: This study aimed to retrospectively analyze the impact of different induction regimens on autologous hematopoietic stem cell mobilization in the peripheral blood of patients with multiple myeloma in the new drug era. Methods: This study retrospectively analyzed the data of 140 patients with newly diagnosed multiple myeloma who underwent autologous hematopoietic stem cell mobilization at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2022 to November 2024. The patients were categorized based on their treatment regimens into the bortezomib-based group (V, 37 cases), bortezomib + lenalidomide-based group (VR, 28 cases), and daratumumab + bortezomib + lenalidomide-based group (DVR, 75 cases). The study compared the effects of different induction chemotherapy regimens in terms of hematopoietic stem cell mobilization, collection success rate, and quality rate. Results Among the 140 patients, 73 were males and 67 were females, and the median age was 58 (range, 34-71) years. The success rates of first-time hematopoietic stem cell collection were 94.6%, 82.1%, and 73.3% in the V, VR, and DVR groups, respectively (P<0.05). The quality rates of first-time hematopoietic stem cell collection were 70.3%, 50.0%, and 36.0% in the V, VR, and DVR groups, respectively (P<0.01). Multivariate logistic regression analysis revealed that lenalidomide use for ≥2 cycles was an adverse factor affecting collection success (OR=0.25, 95% CI: 0.08-0.78, P<0.05), whereas daratumumab use for ≥2 cycles was an adverse factor for collection quality (OR=0.40, 95% CI: 0.20-0.82, P<0.05). A premobilization platelet count ≥150×10(9)/L (OR=7.89, 95% CI: 2.43-25.62, P<0.001) and a CD34(+) cell count of ≥2/μl on the day before collection (OR=14.85, 95% CI: 4.67-47.16, P<0.001) were considered independent predictors of successful collection. A premobilization white blood cell count of ≥4.5×10(9)/L (OR=2.35, 95% CI: 1.01-5.45, P=0.046), a premobilization platelet count of ≥150×10(9)/L (OR=5.85, 95% CI: 1.72-19.94, P<0.005), and a CD34(+) cell count of ≥10/μl on the day before collection (OR=10.45, 95% CI: 4.26-25.63, P<0.001) were considered independent predictors for collection quality. Timely administration of plerixafor based on the CD34(+) cell count on the day before collection improved the success rate by 27.8% and the quality rate by 5.0% . Conclusion: In the new drug era, different induction chemotherapy regimens significantly impact hematopoietic stem cell mobilization and collection, with lenalidomide and daratumumab exhibiting notable effects. Timely administration of plerixafor for salvage mobilization based on CD34(+) cell counts on the day before collection improves both the success rate and quality rate of hematopoietic stem cell collection.