BACKGROUND: It was previously reported that the combination of granulocyte‐macrophage‐colony‐stimulating factor (GM–CSF) and granulocyte‐CSF (G–CSF) for 4 days mobilized more primitive CD34+ subsets than did either G–CSF or GM–CSF alone.
STUDY DESIGN AND METHODS: The studies determine the optimal number of days of growth factor dosing for mobilization and collection of peripheral blood progenitor cells, by increasing the days of administration of GM–CSF and/or G–CSF or employing the sequential administration of GM–CSF followed by G–CSF. Sixty normal subjects were given injections of G–CSF or GM–CSF alone; GM–CSF and G–CSF concurrently for 4, 5, or 6 days; or a sequential regimen of GM–CSF for 3 or 4 days followed by G–CSF for 2 or 3 days. A 10‐L apheresis was performed 24 hours after the last dose.
RESULTS: The three most efficacious mobilization regimens consisted of sequential GM–CSF for 3 days followed by G–CSF for either 2 or 3 days and G–CSF alone for 5 days. Each of these regimens resulted in the collection of significantly greater numbers of CD34+ cells by apheresis than any of the 4‐day dosing regimens with G–CSF and/or GM–CSF (sequential GM–CSF/G–CSF: 3 days/2 days = 3.58 ± 0.53 × 106 CD34+ cells/kg; GM–CSF/G–CSF: 3 days/3 days = 4.45 ± 1.08 × 106 CD34+ cells/kg; G–CSF: 5 days = 3.58 ± 0.97 × 106 CD34+ cells/kg; all p < 0.05 vs. G–CSF and/or GM–CSF for 4 days). Clonogenic assays generally paralleled the level of CD34+ cells. Regimens containing GM–CSF resulted in a higher percentage of the cells from primitive CD34+/CD38–/HLA‐DR+ subset than G–CSF alone.
CONCLUSION: Compared with 4‐day dosing regimens with G–CSF and/or GM–CSF, mobilization of CD34+ cells in normal subjects using sequential GM–CSF for 3 days followed by G–CSF for 2 or 3 days or using G–CSF alone for 5 days increased the number CD34+ cells that can be collected by a single 10‐L apheresis 24 hours after the last dose of cytokine.