Chemotherapy for mobilisation of Ph-negative progenitor cells from patients with CML: impact of different mobilisation regimens.
Mobilised peripheral blood stem cells are widely used for autografting in patients with chronic myeloid leukaemia (CML) and it is generally thought that a high proportion of Ph-negative progenitor cells in the graft is desirable. We report here the results of 91 stem cell mobilisations performed with various chemotherapy regimens followed by G-CSF. We show that mobilisation of Ph-negative cells is possible after diagnosis as well as in advanced stages of the disease. The yield of Ph-negative cells is highly dependent on the chemotherapy regimen: while the combination of idarubicin and cytarabin for 3-5 days (IC3-5) mobilised Ph-negative cells in most patients, high-dose cyclophosphamide was ineffective. Mobilisation of Ph-negative progenitor cells after IC3 was at least as effective as after IC5; however, less apheresis sessions were required, and toxicity was much reduced after IC3. Compared to historical controls, IC was equally effective as the widely used ICE/miniICE (idarubicin, cytarabin, etoposide) protocol. No correlation was found between graft quality and the cytogenetic response to subsequent treatment with interferon-alpha. We conclude that IC3 is an effective and well-tolerated regimen for mobilising Ph-negative cells that compares well with more aggressive approaches such as IC5 and ICE/miniICE.
Deininger
M
M
Department of Hematology, University of Leipzig, Germany.
Pönisch
W
W
Krahl
R
R
Leiblein
S
S
Edel
E
E
Lange
T
T
Fiedler
F
F
Freund
M
M
Franke
A
A
Pasold
R
R
von Grünhagen
U
U
Herold
M
M
Dölken
G
G
Hoffmann
F A
FA
Uhle
R
R
Schultze
W
W
Steglich
J
J
Schwarzer
A
A
Richter
P
P
Winkelmann
C
C
Kettner
E
E
Dachselt
K
K
Subert
R
R
Schwalbe
E
E
Doepper
J
J
Helbig
W
W
Niederwieser
D
D
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000494:pharmacology; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D003561:Cytarabine / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods* / Q000592:standards; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage / Q000592:standards / Q000633:toxicity; D016898:Interferon-alpha / Q000008:administration & dosage; D007937:Leukapheresis / Q000592:standards; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome
D016898:Interferon-alpha; D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D015255:Idarubicin