Comparison of peripheral blood stem-cell and autologous bone marrow transplantation for lymphoma patients: A case-controlled analysis of the EBMT Registry data

Summary:The purpose of the study was to evaluate the effect of delayed granulocyte colony-stimulating factor (G-CSF) use on hematopoietic recovery post-autologous peripheral blood progenitor cell (PBPC) transplantation. Patients were randomized to begin G-CSF on day +1 or day +7 post transplantation. Thirty-seven patients with lymphoma or myeloma undergoing high-dose therapy and autologous PBPC rescue were randomized to daily subcutaneous G-CSF beginning on day +1 or day +7 post-transplant. Patients р70 kg received 300 g/day and Ͼ70 kg 480 g/day. All patients were reinfused with PBPCs with a CD34 + cell count Ͼ2.0 × 10 6 /kg. Baseline characteristics of age, sex and CD34 + cell count were similar between the two arms, the median CD34 + cell count being 5.87 × 10 6 /kg in the day +1 group and 7.70 × 10 6 /kg in the day +7 group (P = 0.7). The median time to reach a neutrophil count of Ͼ0.5 × 10 9 /l was 9 days in the day +1 arm and 10 days in the day +7 arm, a difference which was not statistically significant (P = 0.68). Similarly, there was no difference in median days to platelet recovery Ͼ20 000 × 10 9 /l, which was 10 days in the day +1 arm and 11 days in the day +7 arm (P = 0.83). There was also no significant difference in the median duration of febrile neutropenia (4 vs 6 days; P = 0.7), intravenous antibiotic use (7 vs 8 days; P = 0.54) or median number of red blood cell transfusions (4 vs 7 units; P = 0.82) between the two arms. Median length of hospital stay was 11 days post-PBPC reinfusion in both groups. The median number of G-CSF injections used was 8 in the day +1 group and 3 in the day +7 group (P Ͻ 0.0001). There is no significant difference in time to neutrophil or platelet recovery when G-CSF is initiated on day +7 compared to day +1 post-autologous PBPC transplantation. There is also no difference in number of febrile neutropenic or antibiotic days, number of red blood cell transfusions or length of hospital stay. The number of doses of G-CSF used per transplant is significantly reduced with delayed initiation, resulting in a significant reduction in drug

Section: Discussionmentioning

confidence: 99%

A randomized trial of granulocyte colony-stimulating factor (Neupogen) starting day 1 vs day 7 post-autologous stem cell transplantation

Bence‐Bruckler

Bredeson

Atkins

et al. 1998

“…24 The collection of bone marrow cells under general anesthesia may be successful in some of those patients who have failed mobilization of peripheral stem cells. Since ABMT has been shown to be inferior to PBSCT in terms of time to engraftment and infectious complications, 11,12 alternative mobilization strategies are needed.…”

Section: Cd34mentioning

confidence: 99%

“…Since the results of autologous bone marrow transplantation (ABMT) are proven inferior to PBSCT in terms of time to engraftment and infectious complications, the use of PBSC is preferred by most centers. 11,12 To investigate a different mobilization strategy, we used etoposide in patients with relapsed or resistant lymphoma. Here, we report on 16 patients with multiple risk factors for low stem cell yield who failed a first cycle of high-dose cyclophosphamide.…”

mentioning

confidence: 99%

Successful peripheral blood stem cell mobilization with etoposide (VP-16) in patients with relapsed or resistant lymphoma who failed cyclophosphamide mobilization

Reiser

Josting

Draube

et al. 1999

Summary:High-dose chemotherapy (HDCT) followed by autologous blood stem cell transplantation is considered the treatment of choice for patients with relapsed or resistant aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD). However, several authors report failure of standard mobilization regimens in 29% to 56% of these patients making the completion of HDCT impossible and as a result, negatively influencing long-term outcome. High-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT) is being increasingly used in patients with malignancies. However, there

“…TNC and MNC counts are clearly inadequate. Flow cytometric enumeration overall differences in long-term outcome, 40,41 several reports published suggest that the results of PBSC transof CD34 + cells is the most useful method currently available for pre-transplant graft evaluation, 36 although substanplantation in such cases may be suboptimal. 33,[42][43][44] In studies of PBSC mobilization in lymphoma patients, Dreyfus tial technical variability has been demonstrated.…”

Section: Cfu-gm/kgmentioning

confidence: 99%

Long-term engraftment failure after marrow ablation and autologous hematopoietic reconstitution: differences between peripheral blood stem cell and bone marrow recipients

Bentley

Brecher

Powell

et al. 1997

Summary:Since early studies demonstrated the feasibility of hematopoietic reconstitution by infusion of peripheral blood stem cells (PBSC), 1-4 autologous PBSC transplantation has We infused peripheral blood stem cells (PBSC) into 51 patients with various malignant disorders, after myebecome an established procedure in clinical oncology. In many centers, including our own, the majority of autololoablative conditioning. Twenty-four patients also received autologous bone marrow (PBSC + BM). In a gous transplantation procedures now employ stem cells harvested from peripheral blood rather than bone marrow. multivariate analysis, the only statistically significant predictors of neutrophil engraftment were log-dose PBSC transplantation offers several advantages over autologous bone marrow transplantation. PBSC collection by CFU-GM (P Ͻ 0.001) and the number of prior chemotherapy regimens (P = 0.004). The factors predicting apheresis involves less trauma to the patient than bone marrow aspiration and enables autologous hematopoietic RBC and platelet engraftment were log-dose CFU-GM (P = 0.002), PBSC + BM infusion (P = 0.007) and the reconstitution in cases in which metastasis, fibrosis or postradiation acellularity precludes marrow harvesting. Moreabsence of neoplastic bone marrow involvement (P = 0.009). Seven patients remained platelet and/or red cell over, there is evidence that PBSC engraft more rapidly than autologous marrow stem cells, 5-9 with the potential benefits transfusion-dependent for 100 days or more post-transplant after good neutrophil recovery. Six of these seven of reduced post-transplantation morbidity and a shorter hospital stay. long-term engraftment failures, as well as five additional patients, received Ͻ10 5 CFU-GM/kg. Of the 11 patients PBSC transplantation is not, however, without disadvantages. Under physiological conditions, peripheral blood who received Ͻ10 5 CFU-GM/kg (low-dose patients), seven were PBSC recipients, of whom six were longcontains far fewer stem cells than bone marrow. 10,11 Chemotherapeutic agents 12-16 and/or hematopoietic growth facterm engraftment failures. In contrast, there were no long-term engraftment failures among the four low-dose tors 5-9 may be used to mobilize stem cells from the marrow into the peripheral blood, but there is significant morbidity autologous marrow recipients. This difference in longterm engraftment failure rate was significant (P = associated with the use of these agents. Even with stem cell mobilization, multiple apheresis and cryopreservation 0.015). The low-dose PBSC patients all had a diagnosis of lymphoma with bone marrow involvement. The lowprocedures are required in the majority of cases to obtain adequate numbers of stem cells for hematopoietic reconstidose PBSC + BM group was more heterogeneous, but no patient had malignant involvement of the marrow.tution. There is also a concern that PBSC may be inferior to marrow stem cells in terms of their long-term repopulating The low-dose PBSC patients had also received significantly more pri...