Impact of frontline fludarabine and cyclophosphamide combined treatment on peripheral blood stem cell mobilization in B-cell chronic lymphocytic leukemia

• Published in: Blood Vol. 103; no. 1; pp. 363 - 365
• Main Authors: Tournilhac, Olivier, Cazin, Bruno, Leprètre, Stéphane, Diviné, Marine, Maloum, Karim, Delmer, Alain, Grosbois, Bernard, Feugier, Pierre, Maloisel, Frederic, Villard, Florence, Villemagne, Bruno, Bastit, Dominique, Belhadj, Karim, Azar, Nabi, Michallet, Mauricette, Manhès, Geraud, Travade, Philippe
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.01.2004; The Americain Society of Hematology
• Subjects: Adult; Aged; Antigens, CD34 - metabolism; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Biological and medical sciences; Cyclophosphamide - adverse effects; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - blood; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Leukemia, Lymphocytic, Chronic, B-Cell - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Platelet Count; Transplantation, Autologous; Vidarabine - adverse effects; Vidarabine - analogs & derivatives; Antineoplastic agent; Human; Purine nucleotide; Drug combination; Stem cell; Hematopoietic cell; Malignant hemopathy; B-Lymphocyte; Alkylating agent; Autograft; Chronic; Cyclophosphamide; Chronic lymphocytic leukemia; Fludarabine; Treatment; Antimetabolic; Lymphoproliferative syndrome; Nitrogen mustard; Graft
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2003-05-1449

Ongoing studies in B-cell chronic lymphocytic leukemia are evaluating autologous peripheral blood stem cell (PBSC) transplantation in first remission following fludarabine therapy. However, fludarabine could impair PBSC harvest. In 38 patients after frontline oral fludarabine and cyclophosphamide (FDR-CY) therapy, we prospectively evaluated steady state filgrastim- or lenograstim-primed PBSC mobilization to collect 2.0 × 106/kg or more CD34 cells. The first mobilization, performed a median of 178 days (range, 69-377 days) from the last FDR-CY course, was unsuccessful in 32 patients. This result was significantly associated with a low platelet count before mobilization but not with age, interval from last FDR-CY course, initial stage, remission status, or other blood parameters. Finally, after 1, 2, and 3 mobilizations in 27, 10, and 1 patients, 2.0 × 106/kg or more CD34 cells were collected in only 12. Explorations of the mechanism of poor mobilization and adaptation of PBSC harvest policies after fludarabine treatment are therefore warranted.