Cyclophosphamide and paclitaxel as initial or salvage regimen for the mobilization of peripheral blood progenitor cells

Abstract

Summary:Peripheral blood progenitor cells are now commonly used for hematologic reconstitution after myelosuppressive chemotherapy for hematologic and solid malignancies. The purpose of this study was to evaluate the activity of paclitaxel 170 mg/m 2 and cyclophosphamide 2 g/m 2 (CP) with filgrastim (human G-CSF) for mobilization of PBPCs as the first or second maneuver after failure with filgrastim alone. Sixty-four patients with stage II-IV breast cancer received (CP) followed by filgrastim (10 g/kg/day). In 35 (55%) this was the first maneuver while it was for salvage in 29 (45%) patients. The median number of aphereses was two (range, 1-7). In 83% of the patients apheresis was initiated on days 10-11 following chemotherapy. The median numbers of CD34 + cells/kg, CD34 + cells/apheresis/kg and total nucleated cells/kg collected were 8.7 × 10 6 (2.11-73.5), 3.97 × 10 6 (0.3-36.75) and 164.15 × 10 8 (9-660), respectively. All the patients yielded at least 2 × 10 6 CD34 + cells/kg. CP mobilization salvaged the 29 patients who failed mobilization with filgrastim alone. When used as first-line mobilization the yield of CD34 + cells × 10 6 /kg was higher than in the salvage group (16.93 vs 3.94, P Ͻ 0.001). Patients receiving CP as salvage reached the target of 5 × 10 6 CD34 + cells/kg in only 45% (13/29) of cases vs 94.3% as first maneuver. CP followed by filgrastim is a safe and effective regimen for the mobilization of PBPCs in patients with breast cancer and shows significant activity in patients who failed to mobilize with filgrastim, suggesting a higher mobilization potential.

An EGFR-ERK-SOX9 Signaling Cascade Links Urothelial Development and Regeneration to Cancer

“…injection of 250 mg/kg body weight of cyclophosphamide (CPA) or Phosphate Buffered Saline (PBS, control). This dose is similar to that used in humans receiving high dose CPA (14). …”

Monitoring of Peripheral Blood CD34+ Cell Counts on the First Day of Apheresis Is Highly Predictive for Efficient CD34+ Cell Yield

“…The most reliable time for harvesting hematopoietic stem cells is still under investigation, but after a chemotherapy‐induced nadir, collections usually are begun when the white blood cells (WBC) count recovers to >1–3 × 10 9 /L (5,6,20,21). Recently, some reported that successful mobilization critically depends on accurate monitoring of the preleukapheresis circulating CD34+ cells/μL and their timely collection (12,22–26). Therefore, we investigated the correlation of the numbers of preleukapheresis circulating CD34+ cells/μL, WBC, and platelet counts with the numbers of collected CD34+ cells.…”

A phase II trial of docetaxel for peripheral blood stem cell mobilization for patients with breast cancer and ovarian cancer

“…[2][3][4][5][6][7] The other available taxane, paclitaxel, has been shown to be an effective PBPC mobilizer as a single agent and in combination with cyclophosphamide and etoposide, epirubicin, ifosfamide and high-dose cyclophosphamide. [8][9][10][11][12][13][14][15] As single agents, both docetaxel and paclitaxel induce WBC nadirs of brief duration without severe thrombocytopenia. Docetaxel can be safely administered on an outpatient basis as it causes minimal nausea and vomiting and does not require aggressive intravenous hydration as do the more traditional chemotherapeutic mobilizing regimens involving high-dose cyclophosphamide.…”