Successful mobilization of peripheral blood HPCs with G-CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU-GM with chemotherapy and G-CSF.
[en] BACKGROUND: Mobilization with chemotherapy and G-CSF may result in poor peripheral blood HPC collection, yielding <2 x 10(6) CD34+ cells per kg or <10 x 10(4) CFU-GM per kg in leukapheresis procedures. The best mobilization strategy for oncology patients remains unclear. STUDY DESIGN AND METHODS: In 27 patients who met either the CD34 (n = 3) or CFU-GM (n = 2) criteria or both (n = 22), the results obtained with two successive strategies-that is, chemotherapy and G-CSF at 10 microg per kg (Group 1, n = 7) and G-CSF at 10 microg per kg alone (Group 2, n = 20) used for a second mobilization course-were retrospectively analyzed. The patients had non-Hodgkin's lymphoma (5), Hodgkin's disease (3), multiple myeloma (5), chronic myeloid leukemia (1), acute myeloid leukemia (1), breast cancer (6), or other solid tumors (6). Previous therapy consisted of 10 (1-31) cycles of chemotherapy with additional chlorambucil (n = 3), interferon (n = 3), and radiotherapy (n = 7). RESULTS: The second collection was undertaken a median of 35 days after the first one. In Group 1, the results of the two mobilizations were identical. In Group 2, the number of CD34+ cells per kg per apheresis (0.17 [0.02-0.45] vs. 0.44 [0.11-0.45], p = 0. 00002), as well as the number of CFU-GM (0.88 [0.00-13.37] vs. 4.19 [0.96-21.61], p = 0.00003), BFU-E (0.83 [0.00-12.72] vs. 8.81 [1. 38-32.51], p = 0.00001), and CFU-MIX (0.10 [0.00-1.70] vs. 0.56 [0. 00-2.64], p = 0.001134) were significantly higher in the second peripheral blood HPC collection. However, yields per apheresis during the second collection did not significantly differ in the two groups. Six patients in Group 1 and 18 in Group 2 underwent transplantation, and all but one achieved engraftment, with a median of 15 versus 12 days to 1,000 neutrophils (NS), 22 versus 16 days to 1 percent reticulocytes (NS), and 26 versus 26 days to 20,000 platelets (NS), respectively. However, platelet engraftment was particularly delayed in many patients. CONCLUSION: G-CSF at 10 microg per kg alone may constitute a valid alternative to chemotherapy and G-CSF to obtain adequate numbers of peripheral blood HPCs in patients who previously failed to achieve mobilization with chemotherapy and G-CSF. This strategy should be tested in prospective randomized trials.
Disciplines :
Hematology
Author, co-author :
Fraipont, V.
Sautois, Brieuc ; Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Baudoux, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > Thérapie cellulaire
Pereira-Martins, Maguy ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Fassotte, Marie-France ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Hermanne, J. P.
Jerusalem, Guy ; Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Longree, L.
Schaaf-Lafontaine, Nicole ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie biologique et immuno hématologie
Fillet, Georges ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Beguin, Yves ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Language :
English
Title :
Successful mobilization of peripheral blood HPCs with G-CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU-GM with chemotherapy and G-CSF.
Publication date :
2000
Journal title :
Transfusion
ISSN :
0041-1132
eISSN :
1537-2995
Publisher :
American Association of Blood Banks, Bethesda, United States - Maryland
Demirer T, Buckner CD, Gooley T, et al. Factors influencing collection of peripheral blood stem cells in patients with multiple myeloma. Bone Marrow Transplant 1996;17:937-41.
Lie AK, Rawling TP, Bayly JL, To LB. Progenitor cell yield in sequential blood stem cell mobilization in the same patients: insights into chemotherapy dose escalation and combination of haemopoietic growth factor and chemotherapy. Br J Haematol 1996;95:39-44.
Bensinger W, Appelbaum F, Rowley S, et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J Clin Oncol 1995;13:2547-55.
Beguin Y, Baudoux E, Sautois B, et al. Hematopoietic recovery in cancer patients after transplantation of autologous peripheral blood CD34+ cells or unmanipulated peripheral blood stem and progenitor cells. Transfusion 1998;38:199-208.
Van Bockstaele DR, Peetermans ME. 1,3′-diethyl-4,2′-quinolylthiacyanine iodide as a "thiazole orange" analogue for nucleic acid staining. Cytometry 1989;10:214-6.
Bensinger WI, Longin K, Appelbaum F, et al. Peripheral blood stem cells (PBSCs) collected after recombinant granulocyte colony stimulating factor (rhG-CSF): an analysis of factors correlating with the tempo of engraftment after transplantation. Br J Haematol 1994;87:825-31.
Tricot G, Jagannath S, Vesole D, et al. Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients. Blood 1995;85:588-96.
Prince HM, Imrie K, Sutherland DR, et al. Peripheral blood progenitor cell collections in multiple myeloma: predictors and management of inadequate collections. Br J Haematol 1996;93:142-5.
Sautois B, Fraipont V, Baudoux E, et al. Peripheral blood progenitor cell collections in cancer patients: analysis of factors affecting the yields. Haematologica 1999;84:342-9.
Schwartzberg LS, Weaver CH, Birch R, et al. A randomized trial of two doses of cyclophosphamide with etoposide and G-CSF for mobilization of peripheral blood stem cells in 318 patients with stage II-III breast cancer. J Hematother 1998;7:141-50.
Makki J, Miclea JM, Lefrere F, et al. Successful PBPC harvesting with G-CSF alone after previous mobilization failure by both chemotherapy and hematopoietic growth factor: preliminary data about hematologic recovery after intensive therapy (abstract). Br J Haematol 1996;93(Suppl 2):84.
Jennis A, Pecora A, Preti R, et al. High-dose G-CSF stem cell mobilization after initial stem cell mobilization failure (abstract). Blood 1998;92(Suppl 1):271A.
Gazitt Y, Freytes C, Callander N, et al. Successful stem cell mobilization with high-dose of G-CSF alone for patients failing first round of mobilization (abstract). Blood 1998;92(Suppl 1):271A.
Dansey R, Klein J, Karanes C, et al. Successful peripheral blood mobilization of CD34 progenitor cells by cyclophosphamide, paclitaxel and G-CSF after failure with G-CSF alone (abstract). Blood 1997;90(Suppl 1):98A.
Heyll A, Kobbe G, Söhngen D, et al. Dependence of peripheral blood stem cell (PBSC) yield collected in patients with malignant lymphoma and multiple myeloma on the extent of previous radiochemotherapy and the dose of G-CSF (abstract). Exp Hematol 1995;23:758.
Lagarias DM, Richman CM. CD34+CD38- primitive progenitor cells constitute a lower proportion of CD34+ cells in patients receiving chemotherapy with G-CSF mobilization than patients and normal donors receiving G-CSF alone (abstract). Blood 1998;92(Suppl 1):723A.
Cesana C, Carlo-Stella C, Regazzi E, et al. CD34+ cells mobilized by cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) are functionally different from CD34+ cells mobilized by G-CSF. Bone Marrow Transplant 1998;21:561-8.
Cremer FW, Kiel K, Wallmeier M, et al. Leukapheresis products in multiple myeloma: lower tumor load after mobilization with cyclophosphamide plus granulocyte colony-stimulating factor (G-CSF) compared with G-CSF alone. Exp Hematol 1998;26:969-75.
Klumpp TR. Complications of peripheral blood stem cell transplantation. Semin Oncol 1995;22:263-70.
Desikan KR, Barlogie B, Jagannath S, et al. Comparable engraftment kinetics following peripheral-blood stem-cell infusion mobilized with granulocyte colony-stimulating factor with or without cyclophosphamide in multiple myeloma. J Clin Oncol 1998;16:1547-53.