Standard- versus high-dose lenograstim in adults with hematologic malignancies for peripheral blood progenitor cell mobilization

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2010-11, Vol.50 (11), p.2432-2446
• Main Authors: Romeo, Azzurra, Chierichini, Anna, Spagnoli, Alessandra, Vittori, Mariangela, Vacca, Michele, Gozzer, Maria, Spadea, Antonio, Anaclerico, Barbara, Dessanti, Maria Laura, D'Andrea, Mariella, Toglia, Giuseppe, Annino, Luciana, Petti, Maria Concetta, Mengarelli, Andrea, Arcese, William
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - administration & dosage; Adjuvants, Immunologic - adverse effects; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34 - metabolism; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Bone marrow, stem cells transplantation. Graft versus host reaction; Dose-Response Relationship, Drug; Female; Granulocyte Colony-Stimulating Factor - administration & dosage; Granulocyte Colony-Stimulating Factor - adverse effects; Hematologic Neoplasms - economics; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Mobilization - economics; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - economics; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cells - cytology; Hematopoietic Stem Cells - metabolism; Hospital Costs; Humans; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Retrospective Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; Treatment Outcome; Young Adult
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2010.02723.x

BACKGROUND: The aim of this retrospective, multicenter study was to compare high‐ versus standard‐dose lenograstim after chemotherapy in collecting target dose of CD34+ peripheral blood progenitor cells (PBPCs) in adult candidates for autologous transplant. STUDY DESIGN AND METHODS: A total of 166 consecutive patients (28 acute leukemias [ALs], 77 lymphomas, 61 multiple myeloma [MM]) underwent 182 mobilization procedures. Only the first were analyzed. The CD34+ cell target was at least 2 × 106, 4 × 106, and 8 × 106/kg and lenograstim started on days +19, +1, and +5 from the end of chemotherapy for AL, lymphomas, and MM, respectively. Eighty‐seven and 79 patients, respectively, received 5 and 10 µg/kg/day lenograstim subcutaneously (sc). An analysis to evaluate factors predicting satisfactory procedures and outcome of transplants performed with first‐mobilization‐procedure PBPCs was conducted. Most patients received 6 mg of pegfilgrastim or 5 µg/kg/day lenograstim sc after transplant. RESULTS: In multivariate analysis, high‐dose lenograstim (p = 0.053) in MM and male sex (p = 0.028) were positive predictive factors for reaching cell target. Fludarabine negatively influenced stimulation length (p = 0.002). Apheresis, CD34+ cells mobilized and collected, blood volume processed, side effects, transplants performed, and engraftment time were similar between lenograstim cohorts. Pegfilgrastim versus lenograstim delayed platelet (PLT) recovery times (13 days vs. 11 days, p = 0.036). CONCLUSIONS: High‐dose lenograstim more efficiently mobilized MM patients requiring the highest PBPC target but did not influence transplants performed and engraftment time. Male patients mobilized more efficiently. Fludarabine negatively influenced stimulation length. Finally, pegfilgrastim seems to delay PLT recovery.