Mobilizing peripheral blood stem cells with high‐dose G‐CSF alone is as effective as with Dexa‐BEAM plus G‐CSF in lymphoma patients

• Published in: British journal of haematology 1998-09, Vol.102 (4), p.1101-1106
• Main Authors: Kroger, N, Zeller, W, Fehse, N, Hassan, H T
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34 - analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Carmustine - administration & dosage; Carmustine - pharmacology; CD34+ cells; Colony-Forming Units Assay; Cytarabine - administration & dosage; Cytarabine - pharmacology; Dexamethasone - administration & dosage; Dexamethasone - pharmacology; Etoposide; Female; Filgrastim; Graft Survival; Granulocyte Colony-Stimulating Factor - adverse effects; Granulocyte Colony-Stimulating Factor - therapeutic use; G‐CSF; Hematology; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation; Hospitalization; Humans; Lymphoma - drug therapy; Male; malignant lymphoma; Medical sciences; Melphalan - administration & dosage; Melphalan - pharmacology; Middle Aged; mobilization; peripheral stem cell support; Recombinant Proteins; Retrospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.1998.00865.x

We compared retrospectively the efficacy of granulocyte colony stimulating factor (G‐CSF) alone with chemotherapy plus G‐CSF in mobilizing CD34‐positive cells in patients with malignant lymphoma. 35 patients underwent peripheral blood stem cell (PBSC) collection following mobilization either with 24 μg/kg G‐CSF for 4 consecutive days (n = 18) or Dexa‐BEAM chemotherapy plus 5 μg/kg G‐CSF (n = 17). High‐dose G‐CSF was well tolerated with only slight bone pain and/or myalgia. The Dexa‐BEAM therapy required hospitalization with a median duration of 21 d. The median number of apheresis procedures in both groups was two (range two to four), resulting in a median of 5.3 and 5.1 × 106 CD34+ cells/kg. No patients in the G‐CSF group, but one in the Dexa‐BEAM group, failed to reach the target of collecting >2.0 × 106 CD34+ cells/kg. The number of CFU‐GM (10.4 v 6.0 × 105/kg) and of BFU‐E (10.6 v 4.5 × 105/kg; P = 0.04) was higher in the G‐CSF group than in the Dexa‐BEAM group. A subset analysis of CD34+ cells was performed in 16 patients showing a higher mean of Thy‐1 (CD90w) coexpression in the G‐CSF than in the Dexa‐BEAM group (4.8 v 1.8%, P = 0.12). Additionally the percentage of CD34+/CD38− cells was higher in the G‐CSF group (10.6% v 8.8%). However, these differences were not stastistically significant. The median time to leucocyte and platelet engraftment after high‐dose chemotherapy was slightly shorter in the G‐CSF than in the Dexa‐BEAM group (9 v 10 and 12 v 13.5 d, respectively). These results demonstrate that high‐dose G‐CSF is as effective as Dexa‐BEAM plus G‐CSF in mobilizing peripheral blood stem cells and produces prompt engraftment. The major advantages of G‐CSF mobilization were the safe outpatient self‐application and the fixed‐day apheresis.