Outcome of peripheral blood stem cell mobilization in advanced phases of CML is dependent on the type of chemotherapy applied.
High-dose chemotherapy with autologous transplantation of in vivo purged PBSC is a novel investigational approach to treating chronic myelogenous leukemia (CML) patients not responsive to conventional therapy with interferon-alpha (IFN-alpha) and not eligible for allogeneic transplantation. PBSC mobilization using either '5+2/7+3'-type chemotherapy or 'mini-ICE/ ICE' chemotherapy was investigated in 43 patients with advanced phases of Philadelphia (Ph)-positive CML. Thirty patients were in late chronic phase (>12 months post diagnosis) and 13 patients in accelerated phase (AP) or blast crisis (BC). Contamination with Ph-positive cells was evaluated in harvests from 37/43 patients. The outcome of PBSC mobilization was dependent on the type of chemotherapy administered: a complete or major cytogenetic response (<35% Ph-positive metaphases) in leukapheresis collections was obtained in ten of 15 patients treated with 'mini-ICE/ICE' but in only three of 28 patients treated with '5 + 2/7 + 3' chemotherapy. One patient (1/43) in blast crisis died during mobilization therapy (2%). Twenty-five patients underwent PBSC transplantation and all of them engrafted successfully. Transplantation-related mortality was 0%. The data show that in advanced phases of CML the chance of harvesting Ph-negative peripheral blood stem cells depends on the type of chemotherapy used for mobilization.
III. Medizinische Klinik, Johannes-Gutenberg-Universität Mainz, Germany.
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Fischer
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Neubauer
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Mohm
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Huhn
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Busemann
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Link
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Arseniev
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Büssing
J
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Novotny
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Ganser
J
J
Duyster
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D
Bunjes
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Westermeier
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Flohr
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Desprès
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Gamm
J
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Decker
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Derigs
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Aulitzky
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Huber
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001752:Blast Crisis / Q000235:genetics / Q000401:mortality; D016190:Carboplatin / Q000008:administration & dosage; D015331:Cohort Studies; D005047:Etoposide / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D016896:Treatment Outcome
D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide