Chemomobilization with high-dose etoposide and G-CSF results in effective and safe stem cell collection in heavily pretreated lymphoma patients: Report from a single institution study and review

摘要

The optimal mobilization strategy prior to autologous stem cell transplantation (auto-SCT) for patients with lymphoma is yet to be determined. We reviewed our institutional experience using chemomobilization with high-dose (HD) etoposide (1.6 g/m2) and G-CSF (300 μg/day) in 79 patients with lymphoma. The majority (76%) had received at least two prior regimens of chemotherapy, and 12 (15.2%) patients had previously failed to mobilize following HD cyclophosphamide or DHAP or ICE with G-CSF. HD etoposide and G-CSF chemomobilization resulted in successful collection (2 × 106 CD34+ cells/kg) in 82.3% of patients within a median 2 (1-6) apheresis days. Patients had stem cells collected between days +8 and +15, with a median +12 day. Median total CD34+ cells/kg collected was 5.95 × 106 (0.1-36.8). Seventy-one percent of patients yielded 2 × 106 CD34+ cells/kg in ≤2 d of apheresis and were defined as good mobilizers. While median CD34+ cells/kg collected for good mobilizers was 7.6 × 106, it was 2.6 × 106 for poor mobilizers (P 0.001). This regimen was safe with a low rate of febrile neutropenia (7.6%) and acceptable rates of RBC (40.5%) and platelet transfusions (22.8%). Hematopoietic recovery after auto-SCT was achieved on expected time. Therapy-related myelodysplastic syndrome/acute myeloid leukemia occurred in only one patient (1.3%) with in a median follow-up of 16 months after chemomobilization. We conclude that HD etoposide and G-CSF chemomobilization appear to result in effective, tolerable, and safe stem cell collection in the majority of heavily pretreated lymphoma patients.