ESHAP plus G-CSF as an effective peripheral blood progenitor cell mobilization regimen in pretreated non-Hodgkin's lymphoma: comparison with high-dose cyclophosphamide plus G-CSF

Abstract

Summary:The ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) regimen has been shown to be effective as an active salvage therapy for lymphoma.Mobilizing stem cells following ESHAP should decrease time to transplantation by making separate mobilizing chemotherapy (MC) unnecessary, while controlling a patient's lymphoma. We therefore assessed the mobilization potential of ESHAP plus G-CSF in 26 patients (ESHAP group) with non-Hodgkin's lymphoma (NHL) and compared these results with those of 24 patients with NHL who received high-dose (4 g/m 2 l) cyclophosphamide (HDCY) as MC (HDCY group). The age, sex, and radiotherapy to the axial skeleton were well matched between groups, but the number of patients with poor mobilization predictors was higher in the ESHAP group. Significantly higher numbers of CD34 þ cells ( Â 10 6 /kg) (17.1718.8 vs 5.875.0, P ¼ 0.03) and apheresis day 1 CD34 þ cells ( Â 10 6 /kg) (5.576.6 vs 1.772.0, P ¼ 0.014) were collected from the ESHAP group than from the HDCY group, and the number of patients who achieved an optimal CD34 þ cell target of 5 Â 10 6 /kg was higher in the ESHAP group (81 vs 50%, P ¼ 0.022). Log-rank test revealed that time to target peripheral blood progenitor cell collection (X5 Â 10 6 /kg) was shorter in the ESHAP group (P ¼ 0.007). These results indicate that ESHAP plus G-CSF is an excellent mobilization regimen in patients with relapsed and poor-risk aggressive NHL. Bone Marrow Transplantation (2005) 35, 449-454.

ESHAP+fixed dose G-CSF as autologous peripheral blood stem cell mobilization regimen in patients with relapsed or refractory diffuse large cell and Hodgkin's lymphoma: a single institution result of 127 patients

“…Three other studies 19,20,35 have also reported the use of ESHAP as a mobilization regimen in NHL and HD. It is difficult to compare our results with other reports due to the difference in patient population, type and dosing of growth factors, stem cell collection technique and the machine used.…”

“…Both ours and Watts 20 study showed that 470% patients required only one apheresis. Lee et al 35 described 26 patients with different types of NHL. All the Data in median days.…”

An analysis of the optimal timing of peripheral blood stem cell harvesting following priming with cyclophosphamide and G-CSF

“…Another strategy to improve the yield may be to select ESHAP/G-CSF priming for lymphoma patients, for whom this appears to be superior. 27,28 The optimal dose of G-CSF in combination with cyclophosphamide is unknown. In our study, no difference in outcome was found between the different priming regimens, but since only 11% did not receive 5 mg/kg G-CSF and only 17% did not receive 2 g/m 2 cyclophosphamide, this study has limited value in excluding a significant difference.…”

Optimal timing of G-CSF administration for effective autologous stem cell collection

“…[11][12][13] Among patients treated and mobilized with non-HDC regimens, 67 received ESHAP (etoposide, methylprednisolone, high-dose cytarabine and cisplatin) with (n ¼ 14) or without Rituximab (n ¼ 53); 13 were treated with a modified CALGB protocol 14 (CY, VCR, high-dose MTX, ifosfamide, VP-16, Ara-C, dexamethasone and doxorubicin); 10 received high dose Ara-C; 5 were treated with DHAP (dexamethasone, high-dose cytarabine and cisplatin); 5 received CODOX-M/IVAC (CY, doxorubicin, high-dose MTX/ifosfamide, etoposide and high-dose cytarabine); 5 were treated with CYVE (high-dose cytarabine with VP-16); and 3 received ESHAOx (etoposide, methylprednisolone, high-dose cytarabine and oxaliplatin). Other non-HDC regimens included HDC plus VP-16, CHOP and ifosfamide with VP-16.…”