the impact of daratumumab-containing induction on stem cell mobilization, collection and engraftment in newly diagnosed multiple myeloma: results of the prospective DILEMMA study

Autologous stem cell transplantation (ASCT) is still considered the gold standard of intensification therapy for younger fit patients with newly diagnosed multiple myeloma (NDMM).1 For this purpose, apheresis procedures should secure a minimum cell dose of 2x106 CD34+ cells/kg for a single transplant, with the goal of collecting at least 4x106 CD34+ cells/kg for patients presenting cytogenetic high-risk status to support a second ASCT.2 The incorporation of anti-CD38 monoclonal antibodies (mAb) into induction regimens has led to deeper clinical responses, but concerns have emerged regarding the potential negative effects on stem cell mobilization and collection, even if causative mechanisms have not so far been identified.3,4 In clinical trials, decreased yield of mobilized CD34+ cells in apheresis products, prolonged days of collection, and increased use of plerixafor are, in fact, reported in patients receiving daratumumab-induction regimens.5-7