Paclitaxel and filgrastim for hematopoietic progenitor cell mobilization in patients with hematologic malignancies after failure of a prior mobilization regimen

Abstract

Paclitaxel and G-CSF have been evaluated for HPC mobilization in breast cancer and found to have tolerable toxicity with a predictable time to initiate leukapheresis. However, this approach has not been reported in patients with hematologic malignancies failing prior mobilization. We report a case-series of 26 adults given paclitaxel and G-CSF for HPC mobilization after failure of an initial mobilization. Patients received paclitaxel 250 mg/m(2) followed by G-CSF 10-16 mcg/kg/day. Compared to the initial regimen, paclitaxel mobilization produced greater CD34+ cell yields (median 1.53 x 10(6) CD34+ cells/kg vs. 0.79 x 10(6) CD34+ cells/kg, p = 0.004). Seventy-six percent of patients initiated leukapheresis on day 8, the remainder on day 9 or 10. Three patients developed febrile neutropenia resulting in one death prior to leukapheresis. Overall, 73% of patients proceeded with autologous HPC transplant. This case-series suggests paclitaxel may be an option for HPC mobilization in patients failing prior regimens.

Successful mobilization of hematopoietic peripheral blood progenitor cells with paclitaxel-based chemotherapy as initial or salvage regimen in patients with hematologic malignancies

“…6 The present study has shown that the upward trend was confined to males diagnosed with lymphoid leukemia at ages 1-4 years. Current epidemiological evidence suggests a role for infections in etiology, 6 possibly in combination with other environmental agents.…”

“…Additionally, pre-clinical and clinical studies show that acute myeloid leukemia, and chronic lymphocytic leukemia cells may be mobilized by AMD3100 via CXCR4 inhibition, [8][9][10] thus limiting the use of this agent in patients with certain hematologic malignancies. Our findings show that paclitaxel is effective in mobilization of PBSC in patients with hematologic malignancies, not only as salvage therapy, 6 but also in patients with adverse prognostic factors for mobilization. The overall mobilization success rate was 75%, being lower in acute leukemia (44%) than in other hematologic malignancies (83%).…”

“…The use of paclitaxel resulted in 83% of patients achieving the minimum threshold number of CD34 >2×10 6 /Kg (73% in group A, 91% in group B, and 81% in group C, p=0.7550). Thus, the use of paclitaxel-based regimens allowed successful mobilization in 86% of patients that had failed previous mobilization with rhG-CSF ( Table 2).…”

“…[3][4][5] However, data on the use of paclitaxel and rhG-CSF for hematopoietic cell mobilization in patients with hematologic malignancies is scarce; only recently McKibbin et al have described this schedule in 26 patients after failure of a prior mobilization regimen. 6 To further determine the potential clinical utility of paclitaxel with rhG-CSF for hematopoietic progenitor mobilization in patients with non-solid tumors, we investigated: (i) the mobilizing ability and toxicity of this schedule as initial treatment, or as salvage therapy in patients who failed a mobilization attempt with rhG-CSF, and (ii) the efficacy and tolerability of cyclophosphamide (Cy), given in combination with paclitaxel and rhG-CSF after mobilization failure with filgrastim alone.…”

Paclitaxel, topotecan and rituximab: long term outcomes of an effective salvage programme for relapsed or refractory aggressive B‐cell non‐Hodgkin lymphoma

“…For this reason, patients responding to TTR were given a cycle of rituximab plus ifosphamide and etoposide to mobilize stem cells prior to collection. However, other investigators have subsequently utilized taxane‐based chemotherapy approaches for successful chemo‐mobilization in patients with relpased lymphomas (McKibbin et al , ; Sinha et al , ; Sinha et al , ).…”