title: Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma.
abstract: The objective of this study was to identify factors associated with poor mobilization of peripheral blood progenitor cells (PBPCs) or delayed platelet engraftment after high-dose therapy and autologous stem cell transplantation in patients with lymphoma. Fifty-eight patients with Hodgkin's disease or non-Hodgkin's lymphoma underwent PBPC transplantation as the "best available therapy" at Memorial Sloan-Kettering Cancer Center (New York, NY) between 1993 and 1995. PBPCs were mobilized with either granulocyte colony-stimulating factor (G-CSF) alone (n = 19) or G-CSF following combination chemotherapy (n = 39). Forty-eight of these patients underwent a PBPC transplant, receiving a conditioning regimen containing cyclophosphamide, etoposide, and either total body irradiation, total lymphoid irradiation, or carmustine. A median number of 4.6 x 10(6) CD34+ cells/kg were obtained with a median of three leukapheresis procedures. Mobilization of PBPCs using chemotherapy plus G-CSF was superior to G-CSF alone (6.7 x 10(6) versus 1.5 x 10(6) CD34+ cells/kg; P = 0.0002). Poorer mobilization of progenitor cells was observed in patients who had previously received stem cell-toxic chemotherapy, including (a) nitrogen mustard, procarbazine, melphalan, carmustine or > 7.5 g of cytarabine chemotherapy premobilization (2.0 x 10(6) versus 6.0 x 10(6) CD34+ cells/kg; P = 0.005), or (b) > or = 11 cycles of any previous chemotherapy (2.6 x 10(6) versus 6.7 x 10(6) CD34+ cells/kg; P = 0.02). Platelet recovery to > 20,000/microliter was delayed in patients who received < 2.0 x 10(6) CD34+ cells (median, 13 versus 22 days; P = 0.06). Patients who received > or = 11 cycles of chemotherapy prior to PBPC mobilization tended to have delayed platelet recovery to > 20,000/microliter and to require more platelet transfusions than less extensively pretreated patients (median, 13.5 versus 23.5 days; P = 0.15; median number of platelet transfusion episodes, 13 versus 9; P = 0.17). These data suggest that current strategies to mobilize PBPCs may be suboptimal in patients who have received either stem cell-toxic chemotherapy or > or = 11 cycles of chemotherapy prior to PBPC mobilization. Alternative approaches, such as ex vivo expansion or the use of other growth factors in addition to G-CSF, may improve mobilization of progenitor cells for PBPC transplantation.
authors.affiliation: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. moskowic@mskcc.org
authors.forename: C H
authors.initials: CH
authors.lastname: Moskowitz
authors.forename: J R
authors.initials: JR
authors.lastname: Glassman
authors.forename: D
authors.initials: D
authors.lastname: Wuest
authors.forename: P
authors.initials: P
authors.lastname: Maslak
authors.forename: L
authors.initials: L
authors.lastname: Reich
authors.forename: A
authors.initials: A
authors.lastname: Gucciardo
authors.forename: N
authors.initials: N
authors.lastname: Coady-Lyons
authors.forename: A D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: S D
authors.initials: SD
authors.lastname: Nimer
mesh_terms: D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D007937:Leukapheresis; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D017713:Platelet Transfusion; D016896:Treatment Outcome
chemical_list: D016179:Granulocyte Colony-Stimulating Factor