title: Impact of frontline fludarabine and cyclophosphamide combined treatment on peripheral blood stem cell mobilization in B-cell chronic lymphocytic leukemia.
abstract: Ongoing studies in B-cell chronic lymphocytic leukemia are evaluating autologous peripheral blood stem cell (PBSC) transplantation in first remission following fludarabine therapy. However, fludarabine could impair PBSC harvest. In 38 patients after frontline oral fludarabine and cyclophosphamide (FDR-CY) therapy, we prospectively evaluated steady state filgrastim- or lenograstim-primed PBSC mobilization to collect 2.0 x 106/kg or more CD34 cells. The first mobilization, performed a median of 178 days (range, 69-377 days) from the last FDR-CY course, was unsuccessful in 32 patients. This result was significantly associated with a low platelet count before mobilization but not with age, interval from last FDR-CY course, initial stage, remission status, or other blood parameters. Finally, after 1, 2, and 3 mobilizations in 27, 10, and 1 patients, 2.0 x 106/kg or more CD34 cells were collected in only 12. Explorations of the mechanism of poor mobilization and adaptation of PBSC harvest policies after fludarabine treatment are therefore warranted.
authors.affiliation: Service d'Hématologie Clinique, Hôtel Dieu, Centre Hospitalier Universitaire, Clermont-Ferrand, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Tournilhac
authors.forename: Bruno
authors.initials: B
authors.lastname: Cazin
authors.forename: Stéphane
authors.initials: S
authors.lastname: Leprètre
authors.forename: Marine
authors.initials: M
authors.lastname: Diviné
authors.forename: Karim
authors.initials: K
authors.lastname: Maloum
authors.forename: Alain
authors.initials: A
authors.lastname: Delmer
authors.forename: Bernard
authors.initials: B
authors.lastname: Grosbois
authors.forename: Pierre
authors.initials: P
authors.lastname: Feugier
authors.forename: Frederic
authors.initials: F
authors.lastname: Maloisel
authors.forename: Florence
authors.initials: F
authors.lastname: Villard
authors.forename: Bruno
authors.initials: B
authors.lastname: Villemagne
authors.forename: Dominique
authors.initials: D
authors.lastname: Bastit
authors.forename: Karim
authors.initials: K
authors.lastname: Belhadj
authors.forename: Nabi
authors.initials: N
authors.lastname: Azar
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Geraud
authors.initials: G
authors.lastname: Manhès
authors.forename: Philippe
authors.initials: P
authors.lastname: Travade
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000009:adverse effects*; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000188:drug therapy* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D014182:Transplantation, Autologous; D014740:Vidarabine / Q000009:adverse effects* / Q000031:analogs & derivatives*
chemical_list: D018952:Antigens, CD34; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine