Patients with AL amyloidosis experience higher rates of complications and mortality during peripheral blood stem cell mobilization and collection, with the overall complication rate around 15%. Peripheral and pulmonary oedema, symptomatic hypocalcaemia, hypoxia, orthostatic hypotension, arrhythmia and sudden death have all been reported in patients with AL amyloid undergoing stem cell mobilization and collection.
The use of cyclophosphamide mobilization is also associated with greater toxicity and higher rates of neutropenic sepsis, mucositis, bleeding and cardiac complications than mobilization with G-CSF alone in patients with AL amyloidosis and as such stem cell mobilization with G-CSF 10mcg/kg alone (given in twice daily divided doses with collection beginning on day 5) is recommended.
Given the cardiac risks associated with mobilization and apheresis (including atrial tachycardias and non-sustained ventricular tachycardia) – in patients with any degree of cardiac disease consideration should be given to cardiac monitoring/telemetry during mobilization, apheresis and stem cell infusion.