A comparison of peripheral blood stem cell mobilisation after chemotherapy with cyclophosphamide as a single agent in doses of 4 g/m2 or 7 g/m2 in patients with advanced cancer.
We used cyclophosphamide at a dose of 7 g/m2 in patients with advanced cancer and compared the efficacy of this treatment to generate peripheral blood stem cells (PBSC) with the previously reported regimen of cyclophosphamide 4 g/m2 in a similar group of patients. None of these patients received haemopoietic growth factors. Twenty-two patients received 7 g/m2 and 37 received 4 g/m2. PBSC were collected by apheresis after the leukocyte count recovered to 1.0 x 10(9)/L. The yield of colony forming unit-granulocyte macrophage (CFU-GM) was higher for the 7 g/m2 group with a median of 35 x 10(4)/kg versus 15 x 10(4)/kg body weight (BW) (p < 0.05) and higher mononuclear cell yield with medians of 4.2 x 10(8)/kg compared with 3.1 x 10(8)/kg BW (p < 0.001). The percentage of patients achieving the minimum safe level of > 15 x 10(4) CFU-GM/kg BW was higher in the 7 g/m2 cyclophosphamide group (82%) than the 4 g/m2 cyclophosphamide group (51%). The duration of significant neutropaenia was a median of 11 compared with nine days (p < 0.004) and all patients receiving 7 g/m2 required admission to hospital and intravenous antibiotic therapy compared with 44% in the 4 g/m2 group. There was one death during the period of neutropaenia after cyclophosphamide in each group. Nineteen per cent of patients required platelet transfusions after cyclophosphamide 7 g/m2 compared with 18% after 4 g/m2. We conclude that the 7 g/m2 cyclophosphamide gives a higher yield of haemopoietic progenitor cells than the 4 g/m2 but at increased clinical toxicity.
Rowlings
P A
PA
Department of Haematology, Institute of Medical and Veterinary Science, Adelaide, SA.
Bayly
J L
JL
Rawling
C M
CM
Juttner
C A
CA
To
L B
LB
D000047:Academies and Institutes; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D015672:Erythroid Precursor Cells / Q000737:chemistry / Q000187:drug effects*; D005334:Fever / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000737:chemistry / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D010976:Platelet Count; D013021:South Australia / Q000453:epidemiology; D013921:Thrombocytopenia / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors
D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide