Increased efficacy of intermediate-dose cytarabine + G-CSF compared to DHAP + G-CSF for stem cell mobilization in patients with lymphoma: an analysis by the polish lymphoma research group

• Published in: Annals of hematology Vol. 95; no. 2; pp. 263 - 269
• Main Authors: Giebel, Sebastian, Sadus-Wojciechowska, Maria, Halaburda, Kazimierz, Drozd-Sokolowska, Joanna, Wierzbowska, Agnieszka, Najda, Jacek, Mendrek, Wlodzimierz, Sobczyk-Kruszelnicka, Malgorzata, Nowicki, Mateusz, Holowiecki, Jerzy, Czerw, Tomasz
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2016; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Cisplatin - administration & dosage; Combined Modality Therapy - methods; Cytarabine - administration & dosage; Dexamethasone - administration & dosage; Female; Granulocyte Colony-Stimulating Factor - administration & dosage; Hematology; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - methods; Humans; Lymphoma - diagnosis; Lymphoma - epidemiology; Lymphoma - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Poland - epidemiology; Retrospective Studies; Salvage Therapy - methods; Treatment Outcome; Young Adult; Poland; Stem cell mobilization; Cytarabine; Lymphoma; Autologous hematopoietic cell transplantation
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-015-2557-y

Salvage regimens, like DHAP (dexamethasone, cytarabine, and cisplatin) are frequently used for stem cell mobilization in lymphoma. The aim of this study was to compare the efficacy of DHAP + G-CSF with intermediate-dose cytarabine (ID-AraC) + G-CSF, recently proposed as an alternative schedule. Consecutive patients with Hodgkin’s or non-Hodgkin lymphoma who had received at least 2 lines of chemotherapy, mobilized with either DHAP ( n  = 51) or ID-AraC ( n  = 50) + G-CSF were included in the analysis. AraC was administered at the dose of 400 mg/m [ 1 ] bid intravenously for 2 days followed by filgrastim starting from day 5. In the AraC group, 96 % of patients collected at least 2 × 10 [ 2 ] CD34 + cells/kg compared to 71 % in the DHAP group ( p  = 0.0006). The CD34 + cell yield was 9.3 (0–30.3) × 10 [ 2 ]/kg vs. 5.6 (0–24.8) × 10 [ 2 ]/kg, respectively ( p  = 0.006). A single apheresis was sufficient to achieve the threshold number of CD34 + cells in 82 % of the cases after AraC compared to 45 % after DHAP ( p  = 0.001). We conclude that stem cell mobilization using ID-AraC is associated with a significantly higher efficacy than DHAP, allowing for collection of the transplant material in almost all patients with lymphoma. Our observation suggests that ID-AraC + G-CSF may be a preferable mobilization regimen in this setting.