title: The Hyper-CVAD chemotherapy regimen has an adverse long-term impact on the ability to mobilize peripheral blood stem cells, which can be readily circumvented by using the early cycles for mobilization.
abstract: The Hyper-CVAD chemotherapy regimen is being increasingly applied to a number of haematological malignancies. We assessed the impact of Hyper-CVAD on peripheral blood stem cell (PBSC) yields and examined the optimal timing of PBSC collection when using this regimen. Seventy-four consecutive patients were identified in whom an attempt was made to collect PBSC, usually on recovery from cycle A or B. Where PBSC collection was attempted after cycle 3B, only 18% (3/17) of patients successfully mobilized. Fifty-seven patients were mobilized on recovery from cycle 1B (n = 13), 2A (n = 22), 2B (n = 14) or 3A (n = 8). Compared with cycle 2A, 1B was not superior in achieving the minimum of > or =2 x 10(6)/kg CD34+ cells (100% vs. 77%, p = 0.13), but was superior in terms of total CD34+ yield (21.4 vs. 3.2 x 10(6)/kg, p < 0.001), achieving the target CD34+ cell count of > or =5 x 10(6)/kg (92% vs 36%, p = 0.002), and obtaining both a minimum (92% vs. 18%, p < 0.001) and target (77% vs. 0%, p < 0.001) graft with a single apheresis. There were no significant differences in PBSC yields following cycles 2A, 2B and 3A. Hyper-CVAD has substantial stem cell toxicity which can be readily circumvented by using the early chemotherapy cycles for mobilization.
authors.affiliation: Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Colm
authors.initials: C
authors.lastname: Keane
authors.forename: Simon
authors.initials: S
authors.lastname: Gibbs
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Mills
authors.forename: Karen
authors.initials: K
authors.lastname: Grimmett
authors.forename: Rosita
authors.initials: R
authors.lastname: Van Kuilenberg
authors.forename: Russell
authors.initials: R
authors.lastname: Saal
authors.forename: Devinder
authors.initials: D
authors.lastname: Gill
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
authors.forename: Paula
authors.initials: P
authors.lastname: Marlton
authors.forename: Peter
authors.initials: P
authors.lastname: Mollee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D001781:Blood Component Removal / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide