title: High-dose etoposide plus granulocyte colony-stimulating factor as an effective chemomobilization regimen for autologous stem cell transplantation in patients with non-Hodgkin Lymphoma previously treated with CHOP-based chemotherapy: a study from the Consortium for Improving Survival of Lymphoma.
abstract: We conducted a multicenter retrospective study to compare the efficacy and toxicity of various chemomobilization regimens: high-dose (HD) cyclophosphamide, HD etoposide (VP-16), and platinum-based chemotherapies. We reviewed the experiences of 10 institutions with 103 non-Hodgkin lymphoma patients who had previously only been treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy. The mobilization yields for each regimen were analyzed. HD VP-16 mobilized a significantly higher median number of CD34(+) cells (16.22 × 10(6) cells/kg) than HD cyclophosphamide (4.44 × 10(6) cells/kg) or platinum-based chemotherapies (6.08 × 10(6) cells/kg, P < .001). The rate of successful mobilization (CD34(+) cell count ≥ 5.0 × 10(6) cells/kg) was also significantly higher for HD VP-16 (86%) than for HD cyclophosphamide (45%) or platinum-based chemotherapies (61%, P = .004). The successful mobilization rate on day 1 of 72% for HD VP-16 was significantly higher than the rates for HD cyclophosphamide (13%) and platinum-based chemotherapies (26%, P < .001). In multivariate analysis, HD VP-16 was a significant predictor of successful mobilization (P = .014; odds ratio, 5.25; 95% confidence interval, 1.40 to 19.63). Neutropenic fever occurred in 67% of patients treated with HD VP-16. The incidence was similar for HD cyclophosphamide (58%, P = .454) but was significantly lower for platinum-based chemotherapies (12%, P < .001). However, fatal (grade ≥ 4) infection and treatment-related mortality were not observed in this study. In conclusion, the mobilization yield was significantly influenced by the chemomobilization regimen, and HD VP-16 was a highly effective mobilization regimen in patients with non-Hodgkin lymphoma.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Hyun
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: June-Won
authors.initials: JW
authors.lastname: Cheong
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: Soo-Jeong
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
authors.affiliation: Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea.
authors.forename: Deok-Hwan
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea.
authors.forename: Jae-Sook
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
authors.forename: Won-Sik
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Daegu Catholic University Medical Center, Daegu, Korea.
authors.forename: Hun-Mo
authors.initials: HM
authors.lastname: Ryoo
authors.affiliation: Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Young Rok
authors.initials: YR
authors.lastname: Do
authors.affiliation: Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Ho Sup
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Dong-A University College of Medicine, Busan, Korea.
authors.forename: Sung Yong
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh
authors.affiliation: Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Yhim
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea. Electronic address: hemakim@yuhs.ac.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D002945:Cisplatin / Q000494:pharmacology; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000494:pharmacology*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000187:drug effects*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D018952:Antigens, CD34; D015415:Biomarkers; D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D011241:Prednisone
keywords: Cyclophosphamide; Etoposide; Non-Hodgkin lymphoma; Platinum; Stem cell mobilization