title: Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia.
abstract: The use of etoposide (VP-16) for stem cell mobilization has been reported as a significant risk factor for the development of therapy-related myelodysplasia/therapy-related AML (tMDS/tAML) after transplantation. We compared the safety and effectiveness of VP-16+G-CSF (VP+G) to G-CSF alone for PBPC mobilization in patients with non-Hodgkin's lymphoma and Hodgkin's lymphoma who underwent autologous transplantation at the Cleveland Clinic and Ohio State University. In the VP+G group, median total CD34+ cells collected were 9.34 × 10(6) per kg (range 0.97-180.89), with 42% of all patients having adequate (2 × 10(6) cells per kg) CD 34+ collection after 2 days of apheresis compared with a median in the G-CSF group of 3.83 × 10(6) per kg (range, 0.72-50.38), with only 16% patients having adequate collection after 2 days (P<0.001). tMDS/tAML occurred in 15 patients (2.3%) in the VP+G and in 12 patients (3.8%) receiving G-CSF alone. (P=0.62). Increased number of days of apheresis was associated with the risk of tMDS/tAML (hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.08-1.30, P<0.001). Priming regimen was not a significant variable for relapse-free survival or OS. The addition of etoposide significantly improves the effectiveness of mobilization at the cost of an increased incidence of neutropenic fever though with no mortalities. There is no evidence of increased incidence of tMDS/tAML in patients receiving VP+G compared with those mobilized with G-CSF alone.
authors: Division of Hematology and Medical Oncology, Massachusetts General Hospital, Boston, MA 02114, USA. amahindra@partners.org
authors: A
authors: A
authors: Mahindra
authors: B J
authors: BJ
authors: Bolwell
authors: L
authors: L
authors: Rybicki
authors: P
authors: P
authors: Elder
authors: M
authors: M
authors: Kalaycio
authors: R
authors: R
authors: Dean
authors: B
authors: B
authors: Avalos
authors: R
authors: R
authors: Sobecks
authors: S
authors: S
authors: Tench
authors: S
authors: S
authors: Andresen
authors: B
authors: B
authors: Pohlman
authors: J
authors: J
authors: Sweetenham
authors: S
authors: S
authors: Devine
authors: E
authors: E
authors: Copelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use*; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007938:Leukemia / Q000209:etiology; D008223:Lymphoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide