Second attempts at mobilization of peripheral blood stem cells in patients with initial low CD34+ cell yields.
The purpose of this study was to determine the effectiveness of second mobilization strategies in patients who yielded < 2.5 x 10(6) CD34+ PBSC/kg after initial mobilization. Repeat mobilization attempts were made with chemotherapy and G-CSF (n = 61) or G-CSF alone (n = 58) in patients who failed initial mobilization with chemotherapy and G-CSF (n = 92) or G-CSF alone (n = 27). A median of 0.27 x 10(6) CD34+ cells/kg per apheresis was collected after the second mobilization, compared with 0.16 with initial harvests (p = 0.0001). Forty-eight percent achieved a target CD34+ cell dose > or = 2.5 x 10(6)/kg when harvests from the first and second mobilizations were combined. Fifteen of 17 patients (88%) with > or = 1.5 x 10(6) CD34+ cells/kg harvested after first mobilization had > or = 2.5 x 10(6) CD34+ cells/kg collected when first and second harvests were combined, as compared with 42 of 102 (41%) achieving < 1.5 x 10(6) CD34+ cells/kg with first PBSC harvests (p = 0.0001). Second mobilizations with chemotherapy and G-CSF or G-CSF alone resulted in similar CD34+ cell yields. Toxicities of second mobilizations were comparable with those of first mobilizations. Seventy-nine patients (66%) received high-dose chemotherapy with PBSC support, with recovery of neutrophils and platelets in a median of 11 and 15 days, respectively. Transplant-related mortality was 4%, and event-free survival at 2 years was 0.34. It was concluded that second mobilization attempts in patients who fail to achieve > or = 2.5 x 10(6) CD34+ cells/kg on initial mobilization were successful in 48% of patients. G-CSF alone was as effective as chemotherapy plus G-CSF in mobilizing CD34+ cells and was associated with less morbidity.
Weaver
C H
CH
Clinical Research Division of Response Oncology, Inc., Memphis, TN 38117, USA.
Tauer
K
K
Zhen
B
B
Schwartzberg
L S
LS
Hazelton
B
B
Weaver
Z
Z
Lewkow
L
L
Allen
C
C
Longin
K
K
Buckner
C D
CD
D000328:Adult; D015703:Antigens, CD / Q000097:blood*; D018952:Antigens, CD34 / Q000097:blood*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D016238:Cytapheresis / Q000379:methods; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006412:Hematopoietic Stem Cells / Q000276:immunology / Q000473:pathology*; D006689:Hodgkin Disease / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000097:blood / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000628:therapy*; D009367:Neoplasm Staging
D015703:Antigens, CD; D018952:Antigens, CD34; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor; D008558:Melphalan