title: Peripheral blood progenitor cell mobilization with intermediate-dose cyclophosphamide, sequential granulocyte-macrophage-colony-stimulating factor and granulocyte-colony-stimulating factor, and scheduled commencement of leukapheresis in 225 patients undergoing autologous transplantation.
abstract: BACKGROUND
  Interpatient variability in the kinetics of peripheral blood progenitor cell (PBPC) mobilization is commonly seen with conventional chemotherapy-based mobilization regimens. This necessitates the availability of leukapheresis (LP) facilities 7 days a week.
  
  
  METHODS
  The efficacy of an approach where LP was invariably commenced on Day 11 after intermediate-dose cyclophosphamide followed by sequential administration of granulocyte-macrophage-colony-stimulating factor (CSF) and granulocyte-CSF (Cy/GM/G) was retrospectively analyzed in 225 consecutive, unselected patients undergoing autologous hematopoietic stem cell transplantation for all diagnoses other than acute leukemia at our center. Cy/GM/G was scheduled to avoid weekend LP.
  
  
  RESULTS
  After Cy/GM/G, a CD34+ cell yield of at least 2.0x10(6) per kg was achieved in 90.7 percent of patients. Optimal yield (OY; >or=5x10(6) or 10x10(6) CD34+ cells/kg depending on diagnosis) was achieved in 67.6 percent of patients. Only three patients (1.3%) required LP on Saturday or Sunday. Febrile neutropenia (FN) was encountered in 5.3 percent. PBPC yield was highest on Day 1 of LP (p<0.001). In multivariate analyses, platelet (PLT) count on Day 1 of LP (PLT-D1LP) was positively associated with achievement of OY (p<0.001). PLT-D1LP and diagnosis of myeloma were associated with a shorter time to achieve a CD34+ cell yield of at least 5x10(6) per kg (p<0.001 and p=0.002, respectively).
  
  
  CONCLUSIONS
  Cy/GM/G with scheduled LP commencement on Day 11 enables optimal CD34+ cell yields in most patients undergoing autologous transplantation, despite a low risk of FN and avoidance of weekend LP.
authors.affiliation: Division of Blood and Marrow Transplantation, and Biostatistics Core, Rebecca and John Moores UCSD Cancer Center, La Jolla, California, USA. abashey@bmtga.com
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.forename: Michael
authors.initials: M
authors.lastname: Donohue
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Bridget
authors.initials: B
authors.lastname: Medina
authors.forename: Sue
authors.initials: S
authors.lastname: Corringham
authors.forename: Anita
authors.initials: A
authors.lastname: Ihasz
authors.forename: Ewa
authors.initials: E
authors.lastname: Carrier
authors.forename: Januario E
authors.initials: JE
authors.lastname: Castro
authors.forename: Peter R
authors.initials: PR
authors.lastname: Holman
authors.forename: Ronghui
authors.initials: R
authors.lastname: Xu
authors.forename: Ping
authors.initials: P
authors.lastname: Law
authors.forename: Edward D
authors.initials: ED
authors.lastname: Ball
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Lane
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006801:Humans; D007700:Kinetics; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D009503:Neutropenia; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D013997:Time Factors; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide