Peripheral blood stem cell collection in children with acute leukemia: effectiveness of the ‘DIAVE’ mobilizing regimen

Abstract

Summary:Few experiences of peripheral blood (PB) hematopoietic stem cell mobilization for autologous transplantation have been reported to date in children with acute leukemia (AL). The five-drug-chemotherapy 'DIAVE' (dexamethazone, idarubicine, cytosine-arabinoside, vincristine, etoposide), followed by G-CSF, previously reported as consolidation, was adopted as a mobilization regimen in 29 children (median age: 8 years, range: 3-21; median weight: 34 kg, range: 15-73) with ALL in second remission (CR2: 21), in CR3 (2) or ANLL in CR1 (6). A median peak of 94 ؋ 10 6 CD34 + cells/l (range: 10-604) was reached at a median time of 12 days (range: 10-18) after the beginning of the mobilizing regimen, which was well tolerated. A median of 10.9 ؋ 10 6 CD34 + cells/kg (range: 2.4-56.6) were collected in 25 patients (86%), approaching 40 ؋ 10 6 /l CD34 + cells in the PB (ALL in CR2: 20/21, in CR3: 0/2; ANLL: 5/6) by means of one (20) or two (5) leukaphereses; a median of 2.5 blood volumes was processed. Patients with ANLL mobilized more cells than patients with ALL; moreover, the shorter the interval between remission and mobilizing therapy, the higher was the yield. The products collected underwent purification, aiming at achieving complete removal of possibly contaminating leukemic cells, in 21 cases; also, unmanipulated aliquots were stored as rescues for all but one patient. All the 23 patients undergoing transplantation engrafted (ANC Ͼ0.5 ؋ 10 9 /l) at a median of 12 days. In conclusion, the DIAVE regimen compares favorably with conventional mobilizing regimens, usually containing cyclophosphamide, in terms of low toxicity, collection time predictability, and efficacy, as shown by the high proportion of patients mobilizing, the large amounts of stem cell collected by means of one or two leukaphereses only, and the prompt engraftment after infusion.

Autologous purified peripheral blood SCT in childhood low-risk relapsed ALL

“…CR2 was attained at a median time of 42 days (range 9-76) after relapse. PBSC were mobilized at a median time of 80 days (range 24-151) after CR2, by means of the five-drugchemotherapy 'DIAVE' in 27 patients, 38 in block 3 of the AIEOP Rec'98 Protocol in three patients and in high-dose MTX associated with high-dose cytarabine in one patient who had failed to mobilize after DIAVE. One patient did not achieve 0.03 Â 10 9 CD34 þ /L in the peripheral blood and failed stem cell mobilization; in this child, stem cells were collected from the BM and were unfused unmanipulated.…”

“…38 Circulating stem cell collection was scheduled when the number of CD34 þ cells approached a minimum of 0.03 Â 10 9 /L, with an optimal amount of 0.05 Â 10 9 /L in the peripheral blood. The collection target was 5.0 Â 10 6 CD34 þ cells/kg by means of one or two leukaphereses, expected at a median time of 12 days after starting the mobilizing regimen.…”

“…(24) or 2000 (5) frontline protocols; one patient was treated abroad. [35][36][37][38] Mobilization, collection, purification Thirty-one patients were actually enrolled in the mobilization protocol and underwent autologous transplant.…”

More efficient mobilisation of peripheral blood stem cells with HiDAC+AMSA+G-CSF than with mini-ICE+G-CSF in patients with AML

“…11 On the other hand and arguing against a negative role of idarubicine, several previous investigators have reported a high percentage of successful PBSC collections in AML patients following consolidation with combination CT including idarubicine or other anthracyclines ( þ G-CSF). 8,14,27,28 The optimal scheduling of G-CSF, as combined with CT for mobilisation of PBSC, is not known and may depend on the CT regimen used. 12 In most protocols, G-CSF is started 1-2 days after CT and administered once daily until completion of leukapheresis.…”

“…Peak B-CD34 ((19 (2-262)m/l)) was observed on day 23 (17-31) ( Table 2). Notably, 18/20 patients reached B-CD34 45/ml and therefore underwent 1 (1-4) leukaphereses, starting on day 23 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). All except one of these patients reached the target harvest yield after 1-3 leukaphereses (Table 3).…”