title: Factors determining pbsc mobilization efficiency and nonmobilization following ICE with or without rituximab (R-ICE) salvage therapy for refractory or relapsed lymphoma prior to autologous transplantation.
abstract: ICE/R-ICE (ifosfamide, carboplatin, and etoposide without or with rituximab) chemotherapy followed by autologous stem cell transplantation is an established regimen in refractory/relapsed lymphoma. Few studies have addressed which factors are important in determining peripheral blood stem cell (PBSC) mobilization efficiency or nonmobilization following ICE/R-ICE. Between 2004 and 2013, 88 patients with refractory/relapsed lymphoma who received ICE/R-ICE salvage-chemotherapy prior to granulocyte colony stimulating factor (G-CSF) stimulated PBSC mobilization at a single center were identified. Mobilization efficiency was assessed by time from ICE/R-ICE to day of harvest, duration of G-CSF use, days to peripheral blood (PB) CD34(+) ≥15/µL, PB CD34(+) number on harvest day, CD34(+) yield and nonmobilization rate. Median PB CD34(+) at harvest were 54/μL (7-524); median days to first apheresis was 15 (11-30); median harvested total CD34(+) were 5.46 × 10(6) /kg (0.96-44.36); 71 patients (80.7%) successfully mobilized; 20 (22.7%) patients were poor mobilizers; 14 (15.9%) patients were considered nonmobilizers with maximal PB CD34(+) <7/µL and did not proceed to apheresis. Six of 20 poor mobilizers were apheresed with PB CD34(+) 7-12/µL, 50% were successfully harvested. No differences were found between ICE and R-ICE regimens. Impaired mobilization efficiency was associated with age, remission status, >1 line of induction chemotherapy, four cycles ICE/R-ICE and grade 4 neutropenia. Prior bone marrow (BM) involvement was associated with nonmobilization. The majority of patients can be successfully mobilized with ICE/R-ICE. Prior BM involvement is associated with high rates of nonmobilization following ICE/R-ICE. Such patients may benefit from novel mobilization agents and/or alternative salvage regimens to ICE/R-ICE.
authors.affiliation: Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia; Northern Blood Research Centre, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia; Haematology Laboratory, PaLMs, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Wei
authors.initials: W
authors.lastname: Xia
authors.forename: Chun Kei K
authors.initials: CK
authors.lastname: Ma
authors.forename: Cassandra
authors.initials: C
authors.lastname: Reid
authors.forename: Lijun
authors.initials: L
authors.lastname: Bai
authors.forename: Kelly
authors.initials: K
authors.lastname: Wong
authors.forename: Ian
authors.initials: I
authors.lastname: Kerridge
authors.forename: Christopher
authors.initials: C
authors.lastname: Ward
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenwood
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001772:Blood Cell Count; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008223:Lymphoma / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D015080:Mesna / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D005047:Etoposide; D016190:Carboplatin; D015080:Mesna; D007069:Ifosfamide
keywords: CD34+ cells; ICE/R-ICE; autologous stem cell transplantation; mobilization; refractory/relapsed lymphoma