Reply to the letter by V Pitini

Bone Marrow Transplantation (2003) 31, 1067 & 2003 Nature Publishing Group All rights reserved 0268-3369/03 $25.00 www.nature.com/bmt Reply Reply to the letter by V Pitini Bone Marrow Transplantation doi:10.1038/sj.bmt.1704080 (2003) 31, 1067. Dr Pitini has raised a very important issue of the effect of immunomodulatory drugs (thalidomide) on the mobilization and collection of stem cells. Data on this issue remain controversial. Ghobrial et al1 presented their data on the role of thalidomide (Thal) and stem cell mobilization in patients with multiple myeloma (MM) as a poster at the Annual ASCO meeting of 2002. Their conclusion was that limited exposure of thalidomide had no effect on stem cell mobilization. Our practice has been to utilize thalidomide as salvage with either dexamethasone (D) or along with VAD for two cycles. Responding patients then go on to stem cell mobilization with high-dose cytoxan (4.5 g/m2) followed by G-CSF 10 mg/kg. Our experience has been mixed, with either decreased stem cell yield or an increased number of collections required for some patients who were mobilized while on Thal. Based on our previous experience, Thal is stopped at least 2 weeks prior to mobilization and restarted after collection. Currently, Thal is being evaluated as part of induction therapy with either dexamethasone (D-Thal) or with VAD. At Roswell Park Cancer Institute, the induction protocol is VAD for four cycles+Thal (100 mg for 16 weeks). Responding patients go on to autologous PBSCT. This and similar studies will help to clarify this controversy. AR Alam Blood and Bone Marrow Transplant Program Roswell Park Cancer Program Elm and Carlton Sts Buffalo, NY 14263, USA References 1 Ghobrial I, Dispenzieri A, Bundy K et al. Pretransplant induction with thalidomide-dexamethasone does not adversely affect stem cell collection or engraftment in patients with multiple myeloma. J Clin Oncol 2002; 21: 1670a.  (...truncated)