Stem cell mobilization in resistant or relapsed lymphoma: superior yield of progenitor cells following a salvage regimen comprising ifosphamide, etoposide and epirubicin compared to intermediate‐dose cyclophosphamide

McQuaker, I. Grant; Haynes, AP; Stainer, C; Anderson, Sally A.; Russell, Nigel H.

doi:10.1046/j.1365-2141.1997.1812998.x

Cited by 55 publications

(57 citation statements)

References 17 publications

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“…Prior radiation therapy appears to have less effect, a result that conflicts with some 3,4,9 but not other 11,12 studies. However, our ability to detect an influence was likely related to the use of radiation in only 24% of our patients, and only one course of radiation was received by 88% of these.…”

Section: Discussioncontrasting

confidence: 40%

“…These have disagreed over the influence of age, [1][2][3][4] gender, [4][5][6] interval from last chemotherapy, 1,3,4,7,8 bone marrow involvement, 1,3,4,8,9 tumor primary, 5,9,10 disease status, [3][4][5] and prior radiation, 3,4,9,11,12 suggesting that these are, at best, weak predictive factors. Overall, however, one of the most consistent negative influences on mobilization efficiency has been the amount of prior chemotherapy.…”

Section: Motherapy; Cd34mentioning

confidence: 99%

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Effect of prior chemotherapy on hematopoietic stem cell mobilization

Ford

Green

Warenski

et al. 2004

Bone Marrow Transplant

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Summary:A number of studies have suggested that prior chemotherapy correlates negatively with the efficiency of hematopoietic stem cell mobilization. However, little data exist with regard to the relative effects of the specific chemotherapeutic drug classes. We retrospectively reviewed the records of 201 consecutive patients with nonmyeloid malignancies undergoing CD34 þ cell mobilization with chemotherapy þ granulocyte colony-stimulating factor (G-CSF). The number of prior chemotherapy courses correlated negatively with the peripheral CD34 þ cell concentration (pCD34) on the first day of collection (Po0.001). No significant correlation was found for age, gender, tumor primary, mobilization chemotherapy regimen, disease status, marrow involvement, prior radiation therapy, or dose and timing of G-CSF administration. When the number of courses of individual classes of chemotherapeutic agents was correlated with pCD34, only exposures to platinum compounds (P ¼ 0.001) and alkylating agents (P ¼ 0.01) were found to be independent negative predictive factors for pCD34. Within classes, DNA crosslinking agents and etoposide appeared possibly more damaging than DNA methylating agents and doxorubicin, respectively. None of the drug classes showed evidence of recovery. We conclude that exposure to chemotherapy, especially platinum compounds and alkylating agents, should be minimized prior to mobilization.

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Section: Discussioncontrasting

confidence: 40%

Section: Motherapy; Cd34mentioning

confidence: 99%

Effect of prior chemotherapy on hematopoietic stem cell mobilization

Ford

Green

Warenski

et al. 2004

Bone Marrow Transplant

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“…Strategies employed to improxe the results of mobilization hax e included increasing the dose of cyclophosphamide administered or using combinations of cytotoxic drugs (Lie et al 1996: Dernirer et al 1997: McQuaker et al 1997. The majoritx of patients (87%7c) in the present study had receixed at least two prior schedules of chemotherapy.…”

Section: Discussionmentioning

confidence: 86%

High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels

Kanfer

McGuigan²,

Samson³

et al. 1998

Br J Cancer

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Summary High-dose etoposide (2.0-2.4 g m-2) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize perpheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 870,o) had received at least two prior regimens of chemotherapy. and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m-2 (n = 22). 1.8 g m-2 (n = 20) and 1.6 g m-2 (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34-cell content, with a target total collection of 2.0 x 106 CD34-cells kg-'. Toxicity was assessed by the development of significant mucositis. the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (169o) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m-2). 5.7 (1.8 g m-2) and 6.5 (1.6 g m-2) x 106 CD34-cells kg-'. Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield. Rehospitalization incidence was significantly lower in patients receiving 1.6 g m-2 etoposide than in those receiving 2.0 g m-2 (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m-2 appears to be as effective as higher doses but less toxic.

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“…The total number of progenitors collected, and median time to platelet and neutrophil engraftment, were similar for both groups. A number of chemotherapy-based mobilizing regimens has been reported in lymphoma patients, [32][33][34][35] however, only one is a randomized comparison to cyclophosphamide alone. 32 That trial compared ifosfamide 10 g/m 2 and GM-CSF to cyclophosphamide 4 g/m 2 and GM-CSF and reported similar CD34 + yields, but improved neutrophil engraftment and less toxicity with cyclophosphamide.…”

Section: C+e C (Matched Controls)mentioning

confidence: 99%

Cyclophosphamide, etoposide and G-CSF to mobilize peripheral blood stem cells for autologous stem cell transplantation in patients with lymphoma

Mollee

Pereira

Nagy

et al. 2002

Bone Marrow Transplant

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Summary:We aimed to assess the effectiveness of cyclophosphamide, etoposide and G-CSF (C+E) to mobilize peripheral blood stem cells for autologous stem cell transplantation in patients with lymphoma. A matched cohort study was performed comparing patients mobilized with C+E to patients mobilized with cyclophosphamide and G-CSF (C alone). Patients were matched for disease, prior radiotherapy and a chemotherapy score reflecting the amount and type of prior chemotherapy. Thirty-eight consecutive patients mobilized with C+E were compared with 38 matched controls. C+E was equivalent to C alone in terms of numbers of patients achieving a minimum threshold of у2 ؋ 10 6 /kg CD34 + cells (82% vs 79%, P = 0.74). C+E was superior, however, in terms of total CD34 + yield (6.35 vs 3.3 ؋ 10 6 /kg, P Ͻ 0.01), achieving a target graft of у5 ؋ 10 6 /kg (55% vs 34%, P = 0.04) and obtaining both a minimum (61% vs 32%, P Ͻ 0.01) and target (45% vs 13%, P Ͻ 0.01) graft in one apheresis. This superiority was largely confined to patients with lower chemotherapy scores. There was no difference in neutrophil and platelet recovery or transfusion requirements for those who subsequently received high-dose therapy and stem cell transplantation. Thus, C+E improves the efficiency of peripheral blood stem cell collection, but does not increase the number of patients who can proceed to transplantation. Most of the benefit of the regimen was confined to patients who had not received extensive prior therapy. Novel strategies are required to increase the collection efficiency of 'hard to mobilize' patients. in patients with lymphoma. Engraftment following transplantation of PBSCs is more rapid than with bone marrow 1 and has been demonstrated to correlate best with the number of CD34 + cells in the graft. With standardization of CD34 + enumeration, 2 у5 ϫ 10 6 /kg CD34 + cells has been suggested as a reasonable target for PBSC collection, as this allows optimal engraftment in nearly all patients. [3][4][5] Alternatively, transplantation of Ͻ1 to 2 ϫ 10 6 /kg CD34 + cells has been associated with delayed and failed engraftment, 6-10 leading to the concept of a minimum threshold CD34 + count in order to safely proceed with ASCT.Optimizing PBSC collection remains an important goal for several reasons: to increase the proportion of patients who can proceed to ASCT; to reduce the time to hematopoietic recovery post transplant; to maximize the efficiency of the PBSC collection process given the morbidity and costs of apheresis; and to reduce the need for second mobilizations and bone marrow harvests. Several studies 5,11-14 have described factors influencing the yield of PBSCs, including age, diagnosis, marrow involvement, prior radiation and time from prior chemotherapy therapy, but amount of previous chemotherapy seems to be the most consistent. The prior use of stem cell toxic regimens or agents such as nitrogen mustard, procarbazine, melphalan, carmustine, high-dose cytarabine, 15 Dexa-BEAM 16 and mini-BEAM 17,18 result in poor and unpredictable mob...

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Stem cell mobilization in resistant or relapsed lymphoma: superior yield of progenitor cells following a salvage regimen comprising ifosphamide, etoposide and epirubicin compared to intermediate‐dose cyclophosphamide

Cited by 55 publications

References 17 publications

Effect of prior chemotherapy on hematopoietic stem cell mobilization

Effect of prior chemotherapy on hematopoietic stem cell mobilization

High-dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels

Cyclophosphamide, etoposide and G-CSF to mobilize peripheral blood stem cells for autologous stem cell transplantation in patients with lymphoma

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