title: Successful mobilization of peripheral blood stem cells after addition of ancestim (stem cell factor) in patients who had failed a prior mobilization with filgrastim (granulocyte colony-stimulating factor) alone or with chemotherapy plus filgrastim.
abstract: This study assessed the ability of recombinant human stem cell factor (rHuSCF) to mobilize stem cells in 44 patients who had failed a prior mobilization (CD34(+) yield 0.5-1.9 x 10(6)/kg BW) with filgrastim-alone or chemotherapy-plus-filgrastim. The same mobilization regimen was used with the addition of rHuSCF. In the filgrastim-alone group (n=13), rHuSCF 20 microg/kg was started 3 days before filgrastim and continued for the duration of filgrastim. In the chemotherapy-plus-filgrastim group (n=31), rHuSCF 20 microg/kg/day plus filgrastim 5-10 microg/kg/day were administered concurrently. Leukaphereses were continued to a maximum of four procedures or a target of >or=3 x 10(6) CD34(+) cells/kg. In both groups, CD34(+) yield (x 10(6)/kg BW) of the study mobilization was higher than that of the prior mobilization (median: 2.42 vs 0.84 P=0.002 and 1.64 vs 0.99 P=<0.001, respectively). In all 54 and 45% of patients in the filgrastim-alone group and chemotherapy-plus-filgrastim group, respectively, reached the threshold yield of 2 x 10(6)/kg. The probability of a successful mobilization was the same in those with a CD34+ yield of 0.5-0.75 x 10(6)/kg BW in the prior mobilization as in those with 0.76-1.99 x 10(6)/kg BW. Downmodulation of c-kit expression and a lower percentage of Thy-1 positivity in the mobilized CD34(+) cells were noted in the successful mobilizers compared with those in the poor mobilizers. This study shows that rhuSCF is effective in approximately half the patients who had failed a prior mobilization and allows them to proceed to transplant. It also points to the likely role of the SCF/c-kit ligand pair in mobilization.
authors.affiliation: Division of Haematology, Hanson Centre for Cancer Research, Adelaide, Australia.
authors.forename: L B
authors.initials: LB
authors.lastname: To
authors.forename: J
authors.initials: J
authors.lastname: Bashford
authors.forename: S
authors.initials: S
authors.lastname: Durrant
authors.forename: J
authors.initials: J
authors.lastname: MacMillan
authors.forename: A P
authors.initials: AP
authors.lastname: Schwarer
authors.forename: H M
authors.initials: HM
authors.lastname: Prince
authors.forename: J
authors.initials: J
authors.lastname: Gibson
authors.forename: I
authors.initials: I
authors.lastname: Lewis
authors.forename: B
authors.initials: B
authors.lastname: Swart
authors.forename: J
authors.initials: J
authors.lastname: Marty
authors.forename: T
authors.initials: T
authors.lastname: Rawling
authors.forename: L
authors.initials: L
authors.lastname: Ashman
authors.forename: S
authors.initials: S
authors.lastname: Charles
authors.forename: B
authors.initials: B
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D011994:Recombinant Proteins / Q000494:pharmacology; D019089:Stem Cell Factor / Q000494:pharmacology*
chemical_list: D018952:Antigens, CD34; D011994:Recombinant Proteins; D019089:Stem Cell Factor; D016179:Granulocyte Colony-Stimulating Factor; D019009:Proto-Oncogene Proteins c-kit; D000069585:Filgrastim