Erythropoietin Addition to Granulocyte Colony-Stimulating Factor Abrogates Life-Threatening Neutropenia and Increases Peripheral-Blood Progenitor-Cell Mobilization After Epirubicin, Paclitaxel, and Cisplatin Combination Chemotherapy: Results of a Randomized Comparison

Abstract

This randomized comparison revealed that EPO significantly increases most of the hematologic effect produced by G-CSF administration after chemotherapy. This biologic property of EPO translated in vivo into a global improvement of patients' hematologic status.

EPO in combination with G-CSF improves mobilization effectiveness after chemotherapy with ifosfamide, epirubicin and etoposide and reduces costs during mobilization and transplantation of autologous hematopoietic progenitor cells

“…17 To maximize the efficacy of stem cell collection-particularly in patients pretreated with chemotherapy in whom it may be difficult to attain the requested number of stem cells-and to reduce the necessary expenditures for treatment, a variety of cytokines (G-CSF þ SCF; G-CSF þ EPO) were used in clinical trials. 10,11,[18][19][20] Pierelli et al 10 showed in patients with ovarian cancer pretreated with epirubicin, paclitaxel and cisplatin that the collection of a higher number of CD34 þ cells with a lower number of necessary leukaphereses was achieved by the administration of G-CSF in combination with EPO compared with G-CSF alone. In the study of Oliveri et al 11 that comprised heavily pretreated patients suffering from mainly hematologic neoplasias, the number of CD34 þ cells could be enhanced by the additional use of EPO to G-CSF, but no effect on the number of leukaphereses was seen.…”

“…In the study of Oliveri et al 11 that comprised heavily pretreated patients suffering from mainly hematologic neoplasias, the number of CD34 þ cells could be enhanced by the additional use of EPO to G-CSF, but no effect on the number of leukaphereses was seen. In patients with breast cancer 19 and advanced gynecological malignancies, 10 the addition of EPO to G-CSF influenced neither the number of collected CD34 þ cells nor the number of leukaphereses. In our study, patients treated with the combination of G-CSF and EPO tended to mobilize CD34 þ cells more efficiently, resulting in a higher cell yield with fewer leukaphereses needed as compared with the patients mobilized with G-CSF alone, although the result was due to the low patient number not statistically significant.…”

“…8,9 Clinical trials with patients suffering from solid tumors have shown that the efficiency of stem cell mobilization is improved when EPO is added to G-CSF treatment after the mobilizing chemotherapy, confirming in vitro and in vivo observations that the mobilizing effect of G-CSF is augmented by EPO. [10][11][12] In this randomized, prospective study, we extended these observations to patients with multiple myeloma and compared the effect of adding EPO to G-CSF with regard to the number of PBSCs mobilized and the number of aphereses needed for successful PBSCT. Furthermore, the time interval needed for the recovery of peripheral blood cells after PBSCT as well as the incidence of infections during neutropenia and the need for supportive treatment in both groups was investigated.…”

Effective combination chemotherapy with paclitaxel and cisplatin with or without human granulocyte colony-stimulating factor and/or erythropoietin in patients with advanced gastric cancer

“…In addition, to maintain the planned dose intensity, granulocyte colony-stimulating factor (G-CSF) was given depending on absolute neutrophil counts on the days of scheduled chemotherapeutic drug administration. Since recent data suggest that erythropoietin, apart from its ability to potentiate the effect of G-CSF, significantly improves quality of life in cancer patients receiving cisplatin and non-platinum chemotherapy with a possible beneficial effect in terms on overall survival, we decided to co-administer this haematopoetic growth factor in patients with haemoglobin levels below 12 mg mL 71 (Pierelli et al, 1999;Littlewood, 2001). …”

Cytokines alone for PBPC collection in patients with advanced gynaecological malignancies: G-CSF vs G-CSF plus EPO

“…4 Recently, two EPO-based cytokine regimens have been proposed by our group for PBPC mobilization in patients with advanced ovarian cancer by using a disease-oriented chemotherapy supported by G-CSF or sequential GM-/G-CSF in combination with EPO, demonstrating that EPO significantly increases all the well-known myeloid growth factor properties in patients recovering from drug-induced myelosuppression. 5,6 However, whether mobilization with chemotherapy plus cytokines should be preferred over cytokines alone represents a clinically relevant aspect that remains to be established in the autologous setting. Data from clinical trials suggest that the greatest progenitor mobilization is obtained with chemotherapy followed by the administration of growth factors, but this approach is likely to cause additional toxicities and costs for patients' care.…”