title: Treatment with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone combined with cytarabine and methotrexate results in poor mobilization of peripheral blood stem cells in patients with mantle cell lymphoma.
abstract: Hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone combined with cytarabine and methotrexate) is an intense chemotherapy regimen frequently used for hematologic malignancies including mantle cell lymphoma. To address whether treatment with hyper-CVAD impairs mobilization of peripheral blood stem cells, we retrospectively analyzed mobilization data from 77 consecutive adult patients with mantle cell lymphoma who underwent peripheral blood stem cell (PBSC) mobilization for planned autologous stem cell transplant (ASCT). Compared to patients treated with alternative regimens, patients treated with hyper-CVAD collected fewer CD34+ cells, required more total days of pheresis, and more frequently required a second mobilization attempt, despite being more likely to have undergone mobilization with a VP16-containing regimen. In multivariable linear regression analysis, treatment with hyper-CVAD was associated with a significant reduction in total CD34+ cells mobilized (p < 0.001). These findings suggest that alternative mobilizing strategies prior to ASCT are needed for patients with mantle cell lymphoma who have received hyper-CVAD.
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA. hillb2@ccf.org
authors.forename: Brian T
authors.initials: BT
authors.lastname: Hill
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Stephen
authors.initials: S
authors.lastname: Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: John
authors.initials: J
authors.lastname: Sweetenham
authors.forename: Shawnda
authors.initials: S
authors.lastname: Tench
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006412:Hematopoietic Stem Cells / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D020522:Lymphoma, Mantle-Cell / Q000097:blood / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D018952:Antigens, CD34; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate