Peripheral blood progenitor cell mobilization in patients with primary refractory lymphoma or at first relapse: comparison with patients at diagnosis and impact on clinical outcome

• Published in: British journal of haematology Vol. 99; no. 1; pp. 41 - 46
• Main Authors: Tarella, C., Castellino, C., Cherasco, C., Bondesan, P., Giaretta, F., Corradini, P., Caracciolo, D., Gavarotti, P, Pileri, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.10.1997; Blackwell
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents, Alkylating - therapeutic use; Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Cyclophosphamide - therapeutic use; Disease-Free Survival; Etoposide - therapeutic use; Female; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - methods; Hodgkin Disease - therapy; Humans; lymphoid malignancies; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; PBPC autograft; progenitor mobilization; Recurrence; salvage treatment; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Antineoplastic agent; Relapse; Transfusion; Prognosis; Stem cell; Hematopoietic cell; Blood; Autograft; Granulocyte colony stimulating factor; Isomerases; Lymphoproliferative syndrome; Graft; Antimitotic; High dose; Human; DNA topoisomerase (ATP-hydrolysing); Drug combination; Enzyme; Cytokine; Etoposide; Enzyme inhibitor; Hodgkin disease; Malignant hemopathy; Non Hodgkin lymphoma; Lymphoma; Podophyllotoxine derivatives; Mobilization; Alkylating agent; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Treatment; Polypeptide; Nitrogen mustard; Salvage treatment; Comparative study
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.1997.3433157.x

Peripheral blood progenitor cell (PBPC) mobilization was evaluated in 53 patients receiving the high‐dose sequential (HDS) regimen: 27 had non‐Hodgkin's lymphoma or Hodgkin's disease, primary refractory or at first relapse, 26 had non‐Hodgkin's lymphoma at diagnosis. Mobilization was assessed following either 7 g/m2 cyclophosphamide (48 patients) or 2 g/m2 etoposide, both followed by G‐CSF (filgrastim) at 5 μg/kg/d. PBPC mobilization was significantly higher in patients at diagnosis compared to refractory/relapsed patients (median peak values of circulating CFU‐GM: 25 209/ml v 4270/ml , P < 0.0001 and CD34+ cells: 286/μl v 47/μl, P < 0.0001). All patients receiving HDS as up‐front treatment mobilized enough PBPC for an autograft, often requiring a single leukapheresis; whereas only 15 patients under salvage treatment with HDS were able to complete PBPC autograft. Bone marrow (BM) cells, alone or with PBPC, were needed in six patients, and autograft could not be performed in six patients. Among refractory/relapsed patients, those having a high PBPC mobilization experienced a significantly longer EFS compared to those who had not; autograft completion also significantly enhanced EFS. Thus, the use of an effective mobilizing protocol does not ensure adequate PBPC mobilization in moderately pretreated patients; low mobilization must be considered as an early sign of poor outcome in patients receiving a high‐dose salvage programme.