title: The impact of recent vincristine on human hematopoietic progenitor cell collection in pediatric patients with central nervous system tumors.
abstract: BACKGROUND
  Central nervous system (CNS) malignancies represent 20% of all childhood cancers. To improve outcomes in infants and children with high-risk disease, treatment can include adjuvant chemotherapy and early autologous peripheral blood human progenitor cell collection (AHPCC), followed by high-dose chemotherapy and stem cell rescue. In many protocols, postoperative chemotherapy includes the administration of weekly vincristine (VCR) between induction chemotherapy cycles, regardless of scheduled AHPCC. We observed anecdotal AHPCC failures in children receiving midcycle VCR (MC-VCR).
  
  
  METHODS
  The study was an 8-year retrospective chart review of all children with a CNS malignancy and who underwent AHPCC. Information included patient demographic and clinical data, mobilization regimen, VCR administration, product yields, infusion toxicity, and patient charges. Data were analyzed relative to MC-VCR administration. Graphics and statistical analysis (t-test, chi-square, linear regression) were performed with commercial software.
  
  
  RESULTS
  Twenty-four patients and 47 AHPCCs were available for analysis. Nine patients (37%) received MC-VCR within 7 days of scheduled AHPCC. MC-VCR was associated with delayed marrow recovery (17.9 days vs. 14.9 days, p=0.0012), decreased median peripheral CD34 counts (75 × 10(6) CD34/L vs. 352 × 10(6) CD34/L, p=0.03), decreased median CD34 yields (2.4 × 10(6) CD34/L vs. 17.8 × 10(6) CD34/kg, p=0.08), more AHPCCs per mobilization (2.9 vs. 1.1, p=0.01), and an increased rate of remobilization (33% vs. 6%). Mean patient charges were 2.5× higher in patients receiving MC-VCR than controls (p=0.01).
  
  
  CONCLUSIONS
  MC-VCR should be withheld before scheduled AHPCC to optimize CD34 collection.
authors: Department of Pathology, University of Michigan, Ann Arbor, Michigan.
authors: Laura
authors: L
authors: Cooling
authors: Melissa
authors: M
authors: Bombery
authors: Sandra
authors: S
authors: Hoffmann
authors: Robertson
authors: R
authors: Davenport
authors: Patricia
authors: P
authors: Robertson
authors: John E
authors: JE
authors: Levine
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D001853:Bone Marrow / Q000187:drug effects*; D016543:Central Nervous System Neoplasms / Q000097:blood* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D004334:Drug Administration Schedule; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007223:Infant; D007937:Leukapheresis; D008297:Male; D015337:Multicenter Studies as Topic; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D055815:Young Adult
chemical_list: D014750:Vincristine