Circulating progenitors following high-dose sequential (HDS) chemotherapy with G-CSF: Short intervals between drug courses severely impair progenitor mobilization

C. Tarella, D. Caracciolo, P. Gavarotti, P. Bondesan, C. Cherasco, P. Omede, M. Bregni, S. Siena, A. M. Gianni, A. Pileri

Research output: Contribution to journalArticle

Abstract

Sequential administration of high-dose chemotherapy courses possibly allows extensive in vivo purging before circulating progenitor collection for autograft. To evaluate whether progenitor cell mobilization was negatively affected by repeated high-dose chemotherapy courses, we studied 23 lymphoma patients undergoing the HDS regimen. The scheme includes the sequential administration of cyclophosphamide (CY) given at 7 g/m2 and etoposide (VP16) given at 2 g/m2, each followed by G-CSF (filgrastim) at 5 μg/kg/day. Eleven patients received the standard HDS sequence, with a short interval between first and second myelotoxic courses of less than 45 days (median: 30 days); the remaining 12 patients received a modified HDS where the interval between first and second high-dose course was protracted over 2 months (median: 70 days); in this latter group, 2 to 4 conventional debulking courses were delivered prior to HDS. In patients receiving the standard HDS, progenitor mobilization following the first course was consistently high (median circulating CFU-GM/ml peak value: 29 022); however, significantly lower values were observed at the second course (median CFU-GM/ml peak value 3757, P = 0.002). Circulating BFU-E and CD34+ cell values paralleled those of CFU-GM. No significant difference was observed in progenitor mobilization following either course in patients receiving HDS with extended interval (median circulating CFU-GM/ml peak value: 14 363 vs 9208, at first and second course respectively, P = 0.27). Eleven patients had their progenitor cells harvested following the second delayed course and 2-4 leucaphereses allowed very satisfactory harvests in all of them (CFU-GM/kg ranging from 39-340 x 104). The results indicate that mobilization is severely inhibited when the mobilizing treatment is delivered at a short interval after a previous one; however, adequate mobilization is maintained even after repeated myelotoxic courses provided that a sufficient treatment-free interval is allowed before the final mobilizing high-dose course.

Original languageEnglish
Pages (from-to)223-228
Number of pages6
JournalBone Marrow Transplantation
Volume16
Issue number2
Publication statusPublished - 1995

Keywords

  • Autograft
  • Circulating progenitors
  • G-CSF
  • High-dose chemotherapy

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Tarella, C., Caracciolo, D., Gavarotti, P., Bondesan, P., Cherasco, C., Omede, P., Bregni, M., Siena, S., Gianni, A. M., & Pileri, A. (1995). Circulating progenitors following high-dose sequential (HDS) chemotherapy with G-CSF: Short intervals between drug courses severely impair progenitor mobilization. Bone Marrow Transplantation, 16(2), 223-228.