Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia

Mahindra, Anuj; Bolwell, Brian J.; Rybicki, Lisa; Elder, Patrick; Kalaycio, Matt; Dean, Robert M.; Avalos, BR; Sobecks, Ronald; Tench, Shawnda; Andrèsen, Steven; Pohlman, Brad; Sweetenham, John W.; Devine, Steven M.; Copelan, Edward A.

doi:10.1038/bmt.2011.73

Cited by 25 publications

(29 citation statements)

References 16 publications

(16 reference statements)

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“…>2 ×10 6 CD34 + cells/kg). 31 Others have reported success with alternate CM strategies 13, 16 , including a study showing that 87% (N=39/45) of patients collected ≥2 ×10 6 CD34 + cells/kg using a vinorelbine/GCSF approach. 14 Our study, as well as Wood and colleagues, reported CM collection totals higher than the phase III study with GCSF alone (median 1.98; range 0–15) and G+P (median 5.69; range 0–29).…”

Section: Discussionmentioning

confidence: 99%

“…4, 5 Furthermore, lymphoma patients frequently receive an intensive chemotherapy regimen to treat the underlying disease prior to auto-HCT, which provides adequate HSC mobilization kinetics when combined with GCSF. 13–16 There are no prospective comparative analyses between chemomobilization, GCSF alone, GCSF + preemptive plerixafor, and GCSF + rescue plerixafor. Thus, we analyzed our institution’s prospectively collected mobilization outcomes.…”

Section: Introductionmentioning

confidence: 99%

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A single center’s experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation

Haverkos¹,

Huang

Elder

et al. 2017

Bone Marrow Transplant

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In an otherwise eligible patient with relapsed lymphoma, inadequate mobilization of peripheral blood stem cells is a limiting factor to proceeding with an autologous hematopoietic cell transplantation (auto-HCT). Multiple strategies have been used to mobilize an adequate number of hematopoietic stem cells (HSCs) with no obvious front-line strategy. We report a single institutional experience mobilizing HSCs using four different approaches in lymphoma patients. We prospectively collected mobilization outcomes on patients planning to undergo auto-HCT at Ohio State University. We report results of first mobilization attempt for all relapsed or refractory lymphoma patients between 2008–2014. We identified 255 lymphoma patients who underwent mobilization for planned auto-HCT. The 255 lymphoma patients underwent the following front line mobilization strategies: 95 (37%) GCSF alone, 38 (15%) chemomobilization (GCSF+chemotherapy), 97 (38%) preemptive day 4 plerixafor, and 25 (10%) rescue day 5 plerixafor. As expected, there were significant differences between cohorts including age, comorbid indices, histology, and amount of prior chemotherapy. After controlling for differences between groups, the odds of collecting 2×106/kg HSCs on the first day of collection and 5×106/kg HSCs in total was highest in the cohort undergoing chemomobilization. In conclusion, our experience highlights the effectiveness of chemomobilization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A single center’s experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation

Haverkos¹,

Huang

Elder

et al. 2017

Bone Marrow Transplant

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“…Various strategies for collection of peripheral blood stem cells (PBSC) have been employed, including chemomobilization and utilization of recombinant granulocyte colonyestimulating factor (G-CSF), which is widely used because of its efficacy, safety, and cost [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The American Society for Blood and Marrow Transplantation mobilization guidelines outline evidence supporting these approaches in detail [18].…”

Section: Introductionmentioning

confidence: 99%

Tbo-Filgrastim versus Filgrastim during Mobilization and Neutrophil Engraftment for Autologous Stem Cell Transplantation

Elayan

Horowitz

Magraner

et al. 2015

Biology of Blood and Marrow Transplantation

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There are limited data available supporting the use of the recombinant granulocyte colony-stimulating factor (G-CSF), tbo-filgrastim, rather than traditionally used filgrastim to mobilize peripheral blood stem cells (PBSC) or to accelerate engraftment after autologous stem cell transplantation (ASCT). We sought to compare the efficacy and cost of tbo-filgrastim to filgrastim in these settings. Patients diagnosed with lymphoma or plasma cell disorders undergoing G-CSF mobilization, with or without plerixafor, were included in this retrospective analysis. The primary outcome was total collected CD34(+) cells/kg. Secondary mobilization endpoints included peripheral CD34(+) cells/μL on days 4 and 5 of mobilization, adjunctive use of plerixafor, CD34(+) cells/kg collected on day 5, number of collection days and volumes processed, number of collections reaching 5 million CD34(+) cells/kg, and percent reaching target collection goal in 1 day. Secondary engraftment endpoints included time to neutrophil and platelet engraftment, number of blood product transfusions required before engraftment, events of febrile neutropenia, and length of stay. A total of 185 patients were included in the final analysis. Patients receiving filgrastim (n = 86) collected a median of 5.56 × 10(6) CD34(+) cells/kg, compared with a median of 5.85 × 10(6) CD34(+) cells/kg in the tbo-filgrastim group (n = 99; P = .58). There were no statistically significant differences in all secondary endpoints with the exception of apheresis volumes processed (tbo-filgrastim, 17.0 liters versus filgrastim, 19.7 liters; P < .01) and mean platelet transfusions (tbo-filgrastim, 1.7 units versus filgrastim, 1.4 units; P = .04). In conclusion, tbo-filgrastim demonstrated similar CD34(+) yield compared with filgrastim in mobilization and post-transplantation settings, with no clinically meaningful differences in secondary efficacy and safety endpoints. Furthermore, tbo-filgrastim utilization was associated with cost savings of approximately $1406 per patient utilizing average wholesale price.

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“…6 A larger, retrospective, multi-institutional analysis showed that in comparison to patients receiving G-CSF alone, patients who received etoposide 2g/m 2 in addition to G-CSF had a higher CD34 cell yield ( 9.34 × 10 6 vs. 3.83 × 10 6 ) and a higher rate of adequate collection after 2 days (42% vs 16%). 7 Concerns with chemomobilization include the potential for febrile neutropenia, tMDS/AML, and unpredictable timing of collection.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT

Wood

Whitley

et al. 2012

Bone Marrow Transplant

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The effectiveness of stem cell mobilization with granulocyte colony-stimulating factor (G-CSF) in lymphoma patients is suboptimal. We reviewed our institutional experience using chemomobilization with etoposide (VP-16; 375mg/m2 on days +1 and +2) and G-CSF (5ug/kg twice daily from day +3 through the final day of collection) in 159 patients with lymphoma. This approach resulted in successful mobilization (> 2 × 106 CD34 cells collected) in 94% of patients (83% within 4 apheresis sessions). 57% of patients collected at least 5 × 106 cells in ≤ 2 days and were defined as good mobilizers. The regimen was safe with a low rate of rehospitalization. Average costs were $14,923 for good mobilizers and $27,044 for poor mobilizers (p<0.05). Using our data, we performed a ‘break-even’ analysis that demonstrated that adding two doses of Plerixafor to predicted poor mobilizers at the time of first CD34 count would achieve cost neutrality if the frequency of good mobilizers were to increase by 21%, while the frequency of good mobilizers would need to increase by 25% if three doses of Plerixafor were used. We conclude that chemomobilization with etoposide and G-CSF in patients with lymphoma is effective, with future opportunities for cost-neutral improvement using novel agents.

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Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia

Cited by 25 publications

References 16 publications

A single center’s experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation

A single center’s experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation

Tbo-Filgrastim versus Filgrastim during Mobilization and Neutrophil Engraftment for Autologous Stem Cell Transplantation

Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT

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