Chemotherapy Regimen Improves Stem Cell Mobilization in Myeloma, Lymphoma

A prospective, multicenter phase 2 study found that an optimized regimen of etoposide, cytarabine, and pegfilgrastim (EAP) achieved adequate stem cell collection in all evaluable patients with multiple myeloma or lymphoma undergoing first-line mobilization. Investigators reported that 90.8% of patients reached optimal mobilization, with only 3.1% requiring additional plerixafor.

Why Stem Cell Mobilization Strategy Matters in Myeloma and Lymphoma

Stem cell mobilization strategy remains an active area of investigation for patients with multiple myeloma or lymphoma who are candidates for autologous hematopoietic stem cell transplantation. Chemomobilization regimens are used in some centers as an alternative to growth factor-alone approaches, though data directly comparing yield, safety, and apheresis burden across strategies remain limited.

Previous single-center and retrospective studies have suggested that chemomobilization with etoposide, cytarabine, and pegfilgrastim can outperform growth factor-alone approaches on CD34+ yield and apheresis burden, though these regimens have also been associated with greater rates of infection and platelet transfusion need. To address this gap in research with prospective, multicenter data, investigators led by Ying Lu, MD, chief physician in the Department of Hematology at The Affiliated People's Hospital of Ningbo University, evaluated an optimized EAP regimen as a first-line mobilization option.

The findings were published online July 9, 2026, in the Chinese Medical Journal.

Phase 2 Trial Design for First-Line EAP Mobilization

The trial (NCT05536154) enrolled 68 patients across 12 medical institutions in China; 65 completed the study, including 34 with multiple myeloma and 31 with lymphoma. All participants were mobilization-naive and eligible for autologous transplantation. The team applied dose reductions for elderly patients and those with impaired renal function. Peripheral blood CD34+ cell counts were monitored daily, and leukapheresis was initiated according to uniform criteria across sites.

CD34+ Stem Cell Yield and Mobilization Outcomes

All 65 patients met the standard for adequate stem cell collection, and 90.8% achieved optimal mobilization. Most patients completed collection with a single apheresis session, and the median total CD34+ cell yield was 14.7 x10^6 cells/kg. The analysis found no significant differences in mobilization efficacy between the multiple myeloma and lymphoma groups.

Safety Profile of the EAP Mobilization Regimen

Hematologic toxicities were the primary adverse events observed, with grade 4 neutropenia and thrombocytopenia occurring commonly. These were managed with supportive care, including blood transfusion and thrombopoietin. Investigators reported only mild to moderate infections, and no fatal complications occurred during the study.

Autologous Stem Cell Transplant Outcomes

Fifty-two patients went on to receive autologous hematopoietic stem cell transplantation. Neutrophil and platelet engraftment proceeded without complication, and patients with lymphoma showed slightly faster hematopoietic recovery than those with multiple myeloma.

Study Limitations and Next Steps for EAP Mobilization Research

The authors noted limitations including a relatively small sample size and heterogeneous baseline characteristics among participants. Two phase 3 randomized trials are currently underway to further evaluate the regimen in larger populations, including a randomized comparison against disease-specific chemotherapy mobilization in lymphoma.

The study team concluded that the optimized EAP regimen is an effective and well-tolerated first-line mobilization option for patients with multiple myeloma or lymphoma, offering a practical alternative to conventional mobilization strategies.

References:

1. Lu Y, et al. A prospective, multicenter study on stem cell mobilization using the EAP regimen as first-line mobilization in patients with multiple myeloma and lymphoma. Chin Med J. Published online July 9, 2026. doi:10.1097/CM9.0000000000004157

2. Efficacy and safety of etoposide + cytarabine + pegfilgrastim mobilization regimen versus G-CSF mobilization regimen alone for hematopoietic stem cell mobilization in patients with multiple myeloma and lymphoma. PubMed. https://pubmed.ncbi.nlm.nih.gov/40679461/

3. Etoposide combined with cytarabine and pegfilgrastim for poorly mobilizing patients with multiple myeloma and lymphoma: A prospective multicentre study. Br J Haematol. https://onlinelibrary.wiley.com/doi/10.1111/bjh.19367

4. Ye P, et al. Etoposide-cytarabine-pegfilgrastim (EAP) and disease-specific chemotherapy regimens for hematopoietic stem cell mobilization in lymphoma: A randomized phase III trial. Blood. 2025;146(Suppl 1):4182. doi:10.1182/blood-2025-4182

5. ClinicalTrials.gov. Etoposide+Cytarabine+PEG-rhG-CSF as First Line Mobilization Regimen of Hematopoietic Stem Cells in Patients With Hematological Malignancies. NCT05536154. https://clinicaltrials.gov/study/NCT05536154