title: Topotecan-filgrastim combination is an effective regimen for mobilizing peripheral blood stem cells.
abstract: We compared the efficacy, toxicity, and cost of topotecan-filgrastim and filgrastim alone for mobilizing peripheral blood stem cells (PBSCs) in 24 consecutive pediatric patients with newly diagnosed medulloblastoma. PBSCs were mobilized with an upfront window of topotecan-filgrastim for 11 high-risk patients (residual tumor > or =1.5 cm2 after resection; metastases limited to neuraxis) and with filgrastim alone for 13 average-risk patients. All patients subsequently underwent craniospinal irradiation and four courses of high-dose chemotherapy with stem cell rescue. Target yields of CD34+ cells (> or =8 x 10(6)/kg) were obtained with only one apheresis procedure for each of the 11 patients treated with topotecan-filgrastim, but with a mean of 2.3 apheresis procedures for only six (46%) of the 13 patients treated with filgrastim alone (P = 0.0059). The median peak and median total yield of CD34+ cells were six-fold higher for the topotecan-filgrastim group (328/microl and 21.5 x 10(6)/kg, respectively) than for the filgrastim group (54/microl and 3.7 x 10(6)/kg, respectively). Mean times to neutrophil and platelet engraftment were similar. Myelosuppression was the only grade 4 toxicity associated with topotecan-filgrastim mobilization and lasted a median of 5 days. Compared with filgrastim mobilization, topotecan-filgrastim mobilization resulted in a mean cost saving of $3966 per patient. Topotecan-filgrastim is an efficacious, minimally toxic, and cost-saving combination for PBSC mobilization.
authors.affiliation: Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Yeoh
authors.forename: J M
authors.initials: JM
authors.lastname: Cunningham
authors.forename: G C
authors.initials: GC
authors.lastname: Yee
authors.forename: D
authors.initials: D
authors.lastname: Hunt
authors.forename: J A
authors.initials: JA
authors.lastname: Houston
authors.forename: S L
authors.initials: SL
authors.lastname: Richardson
authors.forename: C F
authors.initials: CF
authors.lastname: Stewart
authors.forename: P J
authors.initials: PJ
authors.lastname: Houghton
authors.forename: L C
authors.initials: LC
authors.lastname: Bowman
authors.forename: A J
authors.initials: AJ
authors.lastname: Gajjar
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use / Q000633:toxicity; D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000150:complications / Q000628:therapy; D018242:Neuroectodermal Tumors, Primitive / Q000150:complications / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D011994:Recombinant Proteins; D012189:Retrospective Studies; D013810:Therapeutic Equivalency; D019772:Topotecan / Q000008:administration & dosage*
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D019772:Topotecan; D000069585:Filgrastim