title: Hemopoietic progenitor cell mobilization and harvest following an intensive chemotherapy debulking in indolent lymphoma patients.
abstract: An in vivo purging with intensive debulking chemotherapy prior to peripheral blood progenitor cell (PBPC) collection may reduce the risk of tumor contamination of the harvest products; however, it is usually associated with a marked reduction in PBPC mobilization. These issues have been considered while designing an adapted version of the high-dose sequential regimen for patients with lymphoid malignancies and bone marrow involvement. To reduce tumor contamination risks, PBPC collection was postponed to the end of the high-dose phase; however, in order to enhance progenitor cell mobilization, a chemotherapy-free lag period was introduced prior to the final mobilizing course. Thirty-nine patients (median age 47 years, range 26-62) with previously untreated indolent lymphoma entered this pilot study; all had advanced-stage disease, and 29 had overt marrow involvement. Sufficient numbers of PBPC to perform autograft with safety were harvested in 34 patients, with a median of 3 (range 2-5) leukaphereses. A median of 14.8 x 10(6) (range 2-51) CD34+/kg and 32.6 x 10(4) (range 1.77-250) colony forming units-granulocyte/macrophage/kg were collected per patient. In univariate analysis, the duration of the chemotherapy-free interval prior to the final mobilizing course, i.e. > or <65 days, was the most significant variable influencing progenitor mobilization. These data suggest that extensive in vivo tumor debulking is feasible provided that a sufficient chemotherapy-free period preceding the mobilizing course is allowed in order to allow a full recovery of marrow functions.
authors.affiliation: Dipartimento di Medicina e Oncologia Sperimentale, Az. Ospedaliera S. Giovanni Battista, Torino, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Tarella
authors.forename: F
authors.initials: F
authors.lastname: Zallio
authors.forename: D
authors.initials: D
authors.lastname: Caracciolo
authors.forename: C
authors.initials: C
authors.lastname: Cherasco
authors.forename: P
authors.initials: P
authors.lastname: Bondesan
authors.forename: P
authors.initials: P
authors.lastname: Gavarotti
authors.forename: P
authors.initials: P
authors.lastname: Corradini
authors.forename: V
authors.initials: V
authors.lastname: Tassi
authors.forename: A
authors.initials: A
authors.lastname: Pileri
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology*; D016465:Bone Marrow Purging; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007937:Leukapheresis; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D014182:Transplantation, Autologous