High-dose ARA-C with autologous peripheral blood progenitor cell (PBPC) support induces a marked mobilization fostering the optimal harvest of circulating hemopoietic progenitors

D. Caracciolo, M. Di Nicola, C. Tarella, P. Bondesan, C. Castellino, A. Gallamini, M. Magni, P. Matteucci, P. Omede, I. Ricca, F. Zallio, A. M. Gianni

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Abstract

An aggressive chemotherapy program, including sequential administration of highdose (hd) cyclophosphamide (CY) (7 g/sm) and hd-Ara-c (2 g/sm twice a day for 6 consecutive days), followed by final intensive consolidation with PBPC autograft, was employed in 111 patients with hématologie malignancies. Patients were aged between 18 and 60 yrs., 78 were at disease onset, whereas the remaining had refractory/relapsed disease; 106 pts. had non-Hodgkin's lymphoma (69 high-grade, 37 low-intermediate grade malignancy), 4 had Hodgkin's lymphoma and 1 had amiloidosis. PBPC were harvested following both hd-CY and hd-Ara-c. To minimize hématologie toxicity, PBPC (1-2x106 CD34+ cells/kg) were given following hd-Ara-c. According to the amount of PCPC collected, 96 pts. (86%) were considered "good mobilizers", since they were able to collect more than 2xl06/kg CD34+ elements following hd-CY. In this group, mobilization following CY and Ara-c was almost overimposable (median values of total collected CD34+ ×106/kg: 17.6 and 21.6, respectively). The remaining 15 pts. (14%) were unable to mobilize adequate amounts of progenitor cells following CY and were considered "poor mobilizers". Minimal amounts of progenitors could be collected and then employed for reinfusion following the subsequent hd-Ara-c course. Interestingly, all 14 évaluable poor mobilizer pts. could restore very good harvests following Ara-C. The median quantity of collected CD34+ x 106/kg was 10 (2-36.9) following hd-Ara-c, versus 2 (1-2) following hd-CY; analogously, the median quantity of collected CFU-GM x 104/kg was 61.9 (23.6167) following hd-Ara-c, versus 1.21 (0-2.5) following hd-CY. PBPC collected in this subset of patients allowed satisfactory engraftment following autograft. The data suggest that hd-Ara-C with reinfusion of even minimal amounts of progenitors may be successfully employed in those patients with non-optimal PBPC mobilization at the first hd-treatment. This approach may widen the number of patients able to collect sufficient amounts of PBPC for autograft consolidation. In addition, PBPC collection following repeated intensive chemotherapy courses contributes to a more extensive in vivo purging effect, making this program particularly suitable in patients at high-risk for tumor cell harvest contamination.

Original languageEnglish
JournalBlood
Volume96
Issue number11 PART I
Publication statusPublished - 2000

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ASJC Scopus subject areas

  • Hematology

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