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

• Published in: British journal of cancer 1998-10, Vol.78 (7), p.928-932
• Main Authors: Kanfer, EJ, McGuigan, D, Samson, D, Abboudi, Z, Abrahamson, G, Apperley, JF, Chilcott, S, Craddock, C, Davis, J, MacDonald, C, Macdonald, D, Olavarria, E, Philpott, N, Rustin, GJ, Seckl, MJ, Sekhar, M, Stern, S, Newlands, ES
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Aged; Antineoplastic agents; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Chemotherapy; Choriocarcinoma - therapy; clinical-oncology; Drug Resistance; Epidemiology; Etoposide - administration & dosage; Female; Germinoma - therapy; Granulocyte Colony-Stimulating Factor - administration & dosage; Hematopoietic Stem Cell Mobilization - methods; Hodgkin Disease - therapy; Humans; Leukemia - therapy; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; Molecular Medicine; Multiple Myeloma - therapy; Neoplasms - therapy; Oncology; Pharmacology. Drug treatments
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.1998.603

High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral 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, 87%) 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 10(6) CD34+ cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) 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 10(6) CD34+ cells kg(-1). 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.