Factors determining the actual received dose intensity in a program of multicyclic dose-intensive alternating chemotherapy with sequential stem cell support.
Dose intensity has been related to clinical outcome in several solid tumors. We studied the influence of clinical and cellular parameters on dose intensity received in a series of 53 patients with metastatic breast cancer or advanced ovarian cancer. They received courses of cisplatin 120 mg/m(2) plus etoposide 600 mg/m(2) alternating every 14 days with ifosfamide 8 g/m(2) plus paclitaxel 200--350 mg/m(2). Blood stem cell support was administered after every course except for the first one. Patients with excellent mobilization underwent immunomagnetic selection of CD34+ cells. We found a significant inverse correlation between the CD34+ cell dose infused and the delay for the administration of the next cycle. A CD34+ cell dose between 1.5 and 5 x 10(6)/kg per cycle was found to be feasible and was followed by a median delay of 1 day (not different from doses above 5 x 10(6)/kg). Three factors independently predicted the actually received dose intensity in a multiple regression model (R(2) = 0.4): previous autologous transplantation, eligibility for immunomagnetic selection (excellent response to mobilization) and median CD34+ cell dose received along the treatment.
Pérez-Calvo
J
J
Department of Oncology and Cell Therapy Area, Clínica Universitaria de Navarra, Pamplona, Spain. jpcalvo@unav.es
Martínez-Aguillo
M
M
García-Rayo
S
S
Ramón y Cajal
T
T
Santisteban
M
M
Ordóñez
J M
JM
Inogés
S
S
Subirá
M L
ML
Martín-Algarra
S
S
Brugarolas
A
A
D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000628:therapy*; D002452:Cell Count; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000592:standards*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D018189:Immunomagnetic Separation; D008875:Middle Aged; D008954:Models, Biological; D010051:Ovarian Neoplasms / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D013234:Stem Cells / Q000276:immunology*; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018952:Antigens, CD34; D005047:Etoposide; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide