title: Mobilization strategies for the collection of peripheral blood progenitor cells: Results from a pilot study of delayed addition G-CSF following chemotherapy and review of the literature.
abstract: OBJECTIVE
  Given the potential to limit cost, we conducted a pilot study evaluating delayed, low-dose granulocyte colony-stimulating factor (G-CSF) following chemotherapy for the procurement of peripheral blood progenitor cells (PBPCs) for autologous transplantation and reviewed the relevant literature.
  
  
  METHODS
  Twenty-eight patients with various malignancies received cyclophosphamide 4 gm/m(2) and paclitaxel 170 mg/m2 followed by G-CSF 300 microg/d or 480 microg/d starting day +5 until two to four daily large volume leukapheresis yielded > or =5.0 x 10(6) CD34+ cells. We searched MEDLINE, Pubmed, and EMBASE databases from 1990 to the present to identify papers on PBPC procurement using delayed G-CSF (starting day +4 or later) following chemotherapy.
  
  
  RESULTS
  G-CSF was administered for a median of 9 days at an average cost of 1260 USD per 70-kg patient. Collection was initiated at a median of 12 days after chemotherapy. A median 2.5 (range 2-4) apheresis were performed yielding an average daily CD34+ collection of 6.9 x 10(6)/kg (range 0.35-56.7). After one apheresis, 82% and 57% of patients collected > or =2.5 x 10(6)/kg and > or =5.0 x 10(6)/kg, respectively. Ultimately, 89% collected > or =5.0 x 10(6)/kg. Febrile neutropenia and catheter-related infection developed in five and two patients, respectively. All patients proceeded to transplantation and engrafted successfully with a median of 14.9 x 10(6)/kg (range 1.05-113) cells infused. Eleven published reports were identified involving 590 patients of whom 498 received G-CSF at a dose range of 250 microg/d to 10 microg/kg/d starting day +4 to 15 for a period of 4 to 9 days for PBPC procurement. Among these reports, 62 to 100% and 33 to 96% of patients collected > or =2 to 2.5 x 10(6) and > or =5.0 x 10(6) CD34+ cells, respectively.
  
  
  CONCLUSIONS
  The use of delayed, low-dose G-CSF plus chemotherapy for stem cell mobilization was feasible and provides further evidence supporting this potentially cost-effective strategy. A review of the literature supports our findings and emphasizes the need for larger studies to address this issue.
authors.affiliation: Division of Hematology/Oncology, University of Nevada, School of Medicine, Veterans Affairs Medical Center, Washoe Medical Center, Reno, Nevada, USA.
authors.forename: Jack F
authors.initials: JF
authors.lastname: Jacoub
authors.forename: Uma
authors.initials: U
authors.lastname: Suryadevara
authors.forename: Vivian
authors.initials: V
authors.lastname: Pereyra
authors.forename: Donna
authors.initials: D
authors.lastname: Colón
authors.forename: Antonio
authors.initials: A
authors.lastname: Fontelonga
authors.forename: F Roy
authors.initials: FR
authors.lastname: Mackintosh
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hall
authors.forename: João L
authors.initials: JL
authors.lastname: Ascensão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006689:Hodgkin Disease / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D010865:Pilot Projects; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34; D016178:Granulocyte-Macrophage Colony-Stimulating Factor