Cytarabine-based mobilisation yields higher CD34+ cell counts than cyclophosphamide regardless of prior daratumumab exposure in multiple myeloma
- 1Department of Haematology and Cellular Transplantation, Lower Silesian Oncology, Pulmonology and Hematology Center , ,
Abstract
Introduction: Anti-CD38-based quadruplets such as daratumumab-bortezomib-lenalidomide-dexamethasone (D-VRd) or daratumumab-bortezomib-thalidomide-dexamethasone (D-VTd), where lenalidomide is not reimbursed, are the internationally recommended first-line treatment for transplant-eligible myeloma. There is ongoing debate about whether anti-CD38 exposure impairs stem cell collection. Most studies compare daratumumab-containing with non-daratumumab induction whilst keeping the mobilisation strategy constant. None have compared two mobilisation agents against each other in both daratumumab-exposed and daratumumab-naïve patients.
Methods: We reviewed 66 patients (22 received Ara-C, 44 received CY) who were mobilised at a single centre in Poland between 2018 and 2024. No patients received plerixafor.
Results: Patients who were mobilised with Ara-C collected more CD34+ cells than those who received CY, with a median of 12.6 (IQR 9.1–15.9) versus 7.7 (4.9–12.1) ×10⁶/kg (p=0.005), with comparable apheresis sessions. Previous D-VTd treatment did not reduce the overall yield (p=0.43). The benefit of Ara-C persisted in the D-VTd subgroup, despite heavy confounding between induction and mobilisation choice.
Discussion: This is the first direct comparison of Ara-C and CY in the daratumumab era. Ara-C-based mobilisation was associated with higher CD34+ yields than CY in a plerixafor-free setting. The apparent advantage in D-VTd-treated patients is exploratory and requires prospective confirmation.
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BibTeX
@article{szlasa2026cytarabinebased,
title = {{Cytarabine-based mobilisation yields higher CD34+ cell counts than cyclophosphamide regardless of prior daratumumab exposure in multiple myeloma}},
author = {Wojciech Szlasa and Artur Borkowski and Monika Mordak-Domagała and Jacek Kwiatkowski and Katarzyna Malesa and Mateusz Sawicki and Jarosław Dybko},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1915658},
url = {https://europepmc.org/article/PMC/PMC13690519},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cytarabine-based mobilisation yields higher CD34+ cell counts than cyclophosphamide regardless of prior daratumumab exposure in multiple myeloma
AU - Wojciech Szlasa
AU - Artur Borkowski
AU - Monika Mordak-Domagała
AU - Jacek Kwiatkowski
AU - Katarzyna Malesa
AU - Mateusz Sawicki
AU - Jarosław Dybko
PY - 2026
DA - 2026/10/09
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1915658
UR - https://europepmc.org/article/PMC/PMC13690519
AB - Introduction: Anti-CD38-based quadruplets such as daratumumab-bortezomib-lenalidomide-dexamethasone (D-VRd) or daratumumab-bortezomib-thalidomide-dexamethasone (D-VTd), where lenalidomide is not reimbursed, are the internationally recommended first-line treatment for transplant-eligible myeloma. There is ongoing debate about whether anti-CD38 exposure impairs stem cell collection. Most studies compare daratumumab-containing with non-daratumumab induction whilst keeping the mobilisation strategy constant. None have compared two mobilisation agents against each other in both daratumumab-exposed and daratumumab-naïve patients. Methods: We reviewed 66 patients (22 received Ara-C, 44 received CY) who were mobilised at a single centre in Poland between 2018 and 2024. No patients received plerixafor. Results: Patients who were mobilised with Ara-C collected more CD34+ cells than those who received CY, with a median of 12.6 (IQR 9.1–15.9) versus 7.7 (4.9–12.1) ×10⁶/kg (p=0.005), with comparable apheresis sessions. Previous D-VTd treatment did not reduce the overall yield (p=0.43). The benefit of Ara-C persisted in the D-VTd subgroup, despite heavy confounding between induction and mobilisation choice. Discussion: This is the first direct comparison of Ara-C and CY in the daratumumab era. Ara-C-based mobilisation was associated with higher CD34+ yields than CY in a plerixafor-free setting. The apparent advantage in D-VTd-treated patients is exploratory and requires prospective confirmation.
SN - 2234-943X
ER -