Mobilization strategies for the collection of peripheral blood progenitor cells: Results from a pilot study of delayed addition G-CSF following chemotherapy and review of the literature

• Published in: Experimental hematology 2006-11, Vol.34 (11), p.1443-1450
• Main Authors: Jacoub, Jack F., Suryadevara, Uma, Pereyra, Vivian, Colón, Donna, Fontelonga, Antonio, MacKintosh, F. Roy, Hall, Stephen W., Ascensão, João L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antigens, CD34 - analysis; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Breast Neoplasms - diagnosis; Breast Neoplasms - economics; Breast Neoplasms - therapy; Cost-Benefit Analysis; Disease Progression; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Granulocyte-Macrophage Colony-Stimulating Factor - administration & dosage; Granulocyte-Macrophage Colony-Stimulating Factor - adverse effects; Hematopoietic Stem Cell Mobilization - adverse effects; Hematopoietic Stem Cell Mobilization - economics; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - methods; Hodgkin Disease - diagnosis; Hodgkin Disease - economics; Hodgkin Disease - therapy; Humans; Leukapheresis - methods; Male; Middle Aged; Multiple Myeloma - diagnosis; Multiple Myeloma - economics; Multiple Myeloma - therapy; Neoplasm Staging; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - economics; Ovarian Neoplasms - therapy; Pilot Projects; Transplantation, Autologous; Treatment Outcome
• ISSN: 0301-472X; 1873-2399
• DOI: 10.1016/j.exphem.2006.06.022

Given the potential to limit cost, we conducted a pilot study evaluating delayed, low-dose granulocyte colony-stimulating factor (G-CSF) following chemotherapy for the procurement of peripheral blood progenitor cells (PBPCs) for autologous transplantation and reviewed the relevant literature. Twenty-eight patients with various malignancies received cyclophosphamide 4 gm/m 2 and paclitaxel 170 mg/m 2 followed by G-CSF 300 μg/d or 480 μg/d starting day +5 until two to four daily large volume leukapheresis yielded ≥5.0 × 10 6 CD34 + cells. We searched MEDLINE, Pubmed, and EMBASE databases from 1990 to the present to identify papers on PBPC procurement using delayed G-CSF (starting day +4 or later) following chemotherapy. G-CSF was administered for a median of 9 days at an average cost of $1260 USD per 70-kg patient. Collection was initiated at a median of 12 days after chemotherapy. A median 2.5 (range 2–4) apheresis were performed yielding an average daily CD34 + collection of 6.9 × 10 6 /kg (range 0.35–56.7). After one apheresis, 82% and 57% of patients collected ≥2.5 × 10 6/kg and ≥5.0 × 10 6/kg, respectively. Ultimately, 89% collected ≥5.0 × 10 6/kg. Febrile neutropenia and catheter-related infection developed in five and two patients, respectively. All patients proceeded to transplantation and engrafted successfully with a median of 14.9 × 10 6/kg (range 1.05–113) cells infused. Eleven published reports were identified involving 590 patients of whom 498 received G-CSF at a dose range of 250 μg/d to 10 μg/kg/d starting day +4 to 15 for a period of 4 to 9 days for PBPC procurement. Among these reports, 62 to 100% and 33 to 96% of patients collected ≥2 to 2.5 × 10 6 and ≥5.0 × 10 6 CD34 + cells, respectively. The use of delayed, low-dose G-CSF plus chemotherapy for stem cell mobilization was feasible and provides further evidence supporting this potentially cost-effective strategy. A review of the literature supports our findings and emphasizes the need for larger studies to address this issue.