title: Hematopoietic Progenitor Cell Mobilization with Ifosfamide, Carboplatin, and Etoposide Chemotherapy versus Plerixafor-Based Strategies in Patients with Hodgkin and Non-Hodgkin Lymphoma.
abstract: Studies comparing the efficacy and safety of chemo-mobilization with ifosfamide, carboplatin, and etoposide (ICE) ± rituximab with plerixafor-based approaches in lymphoma patients have not been performed. We analyzed hematopoietic progenitor cell mobilization outcomes in lymphoma patients undergoing chemo-mobilization with ICE (n = 35) compared with either routine plerixafor (n = 30) or "just in time" (JIT) plerixafor-based mobilization (n = 33). Chemo-mobilization provided a significantly higher total CD34(+) cell yield (median collection, 5.35 × 10(6) cells/kg for ICE versus 3.15 × 10(6) cells/kg for routine plerixafor and 3.6 × 10(6) cells/kg for JIT plerixafor, P < .001). The median day 1 yield of CD34(+) cells was not significantly different (median, 2.2 × 10(6) cells/kg in ICE versus 1.9 × 10(6) cells/kg in upfront plerixafor versus 1.7 × 10(6) cells/kg in JIT plerixafor, P = .20). There was no significant difference in the 3 groups in terms of total number of apheresis sessions performed (median, 2 in each group; P = .78). There were no mobilization failures (inability to collect at least 2 × 10(6) cells/kg) in the chemo-mobilization group, whereas 5 patients (16.7%) in the routine plerixafor and 3 patients (9.1%) in JIT group had mobilization failure (P = .04). Mean time to neutrophil engraftment was faster in the chemo-mobilization group, 10.3 days (±1.2) compared with 12.1 days (±3.6) in the routine plerixafor group and 11.6 days (±3.0) in the JIT group (P < .001) and mean time to platelet engraftment was 13.7 days (±.7) in ICE versus 20.3 days (±1.6) in routine plerixafor versus 17.1 days (± .9) in JIT group (P < .001). Red blood cell transfusions were significantly higher in the chemo-mobilization group (34.3% versus 0 versus 3.2% versus 1, P < .001) and so were the platelet transfusions (22.9% versus 0 versus 0, P < .001). Excluding the cost of chemotherapy administration, chemo-mobilization was associated with significantly less mobilization cost (average cost $17,601.76 in ICE versus $28,963.05 in routine and $25,679.81 in JIT, P < .001). Our data suggests that chemo-mobilization with ICE provides a higher total CD34(+) cell yield, lower rates of mobilization failure, faster engraftment, and lower cost compared to plerixafor-based approaches with comparable toxicity profile between the groups, except for higher transfusion requirements with chemo-mobilization.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Binod
authors.initials: B
authors.lastname: Dhakal
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Lauren Westfall
authors.initials: LW
authors.lastname: Veltri
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eastwood
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Craig
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Aaron
authors.initials: A
authors.lastname: Cumpston
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Shillingburg
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jean
authors.initials: J
authors.lastname: Esselman
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Kathy
authors.initials: K
authors.lastname: Watkins
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Anita
authors.initials: A
authors.lastname: D'Souza
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, West Virginia University, Morgantown, Wisconsin.
authors.forename: Abraham Sebastian
authors.initials: AS
authors.lastname: Kanate
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: mhamadani@mcw.edu.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use; D001596:Benzylamines; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016190:Carboplatin / Q000627:therapeutic use; D000080027:Cyclams; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics / Q000379:methods*; D006571:Heterocyclic Compounds / Q000627:therapeutic use; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D005047:Etoposide; D016190:Carboplatin; C088327:plerixafor; D007069:Ifosfamide
keywords: CD34; Chemo-mobilization; Granulocyte colony–stimulating factor (G-CSF); Ifosfamide, carboplatin, and etoposide (ICE); Lymphoma; Plerixafor