Optimizing the timing of chemotherapy for mobilizing autologous blood hematopoietic progenitor cells.
BACKGROUND
Postchemotherapy mobilization results were reviewed in patients undergoing apheresis before planned autologous hematopoietic progenitor cell (HPC) transplantation to improve the timing of collection procedures.


METHODS
A total of 135 attempts to collect autologous HPC were studied in 132 unique patients with lymphoid malignancies (non-Hodgkin's lymphoma, multiple myeloma, and Hodgkin's disease). Chemotherapy mobilization regimens included cyclophosphamide (n = 59), ICE (n = 46), or other regimens (n = 30). Granulocyte-colony-stimulating factor (CSF) was administered once daily at a dose of 5 microg per kg starting 2 days after the last dose of chemotherapy; granulocyte-macrophage-CSF was added at a daily dose of 5 microg per kg 6 days later. Apheresis was initiated when the blood CD34+ content was more than 20 per microL.


RESULTS
In an initial cohort of 37 patients, 27 percent required apheresis during the weekend. An optimized timing for chemotherapy mobilization was developed based on retrospective data; prospective implementation of the new algorithm reduced the incidence of weekend apheresis to 13 percent in the subsequent 98 consecutive patients (p < 0.05). A median of 9 x 10(6) (range, 0.4 x 10(6)-96 x 10(6)) CD34+ cells per kg was collected from the entire cohort of 135 patients after a mean of 1.8 days of apheresis. Apheresis was initiated following a median (+/-SD) of 10 +/- 2.7 days of cytokines.


CONCLUSIONS
In the majority of patients, the first day of apheresis occurred 11 to 13 days after the last dose of chemotherapy with a variety of different chemotherapy regimens. Administering the last dose of chemotherapy on Thursday or Friday versus Monday, Tuesday, or Wednesday was associated with a 77 percent lower incidence in the frequency of weekend apheresis collections (p < 0.001).
Hicks
Michelle L
ML
Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Lonial
Sagar
S
Langston
Amelia
A
Flowers
Christopher
C
Roback
John D
JD
Smith
Kenneth J
KJ
Mossavi Sai
Sarah
S
Teagarden
Diane
D
Hamilton
Ellie S
ES
Waller
Edmund K
EK
Kaufman
Jonathan
J
D000328:Adult; D000368:Aged; D000465:Algorithms; D018952:Antigens, CD34 / Q000097:blood; D001781:Blood Component Removal / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006412:Hematopoietic Stem Cells / Q000166:cytology* / Q000187:drug effects / Q000276:immunology; D006689:Hodgkin Disease / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D013997:Time Factors
D018952:Antigens, CD34; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide