Factors determining pbsc mobilization efficiency and nonmobilization following ICE with or without rituximab (R‐ICE) salvage therapy for refractory or relapsed lymphoma prior to autologous transplantation

Abstract

ICE/R-ICE (ifosfamide, carboplatin, and etoposide without or with rituximab) chemotherapy followed by autologous stem cell transplantation is an established regimen in refractory/relapsed lymphoma. Few studies have addressed which factors are important in determining peripheral blood stem cell (PBSC) mobilization efficiency or nonmobilization following ICE/R-ICE. Between 2004 and 2013, 88 patients with refractory/relapsed lymphoma who received ICE/R-ICE salvage-chemotherapy prior to granulocyte colony stimulating factor (G-CSF) stimulated PBSC mobilization at a single center were identified. Mobilization efficiency was assessed by time from ICE/R-ICE to day of harvest, duration of G-CSF use, days to peripheral blood (PB) CD34(+) ≥15/µL, PB CD34(+) number on harvest day, CD34(+) yield and nonmobilization rate. Median PB CD34(+) at harvest were 54/μL (7-524); median days to first apheresis was 15 (11-30); median harvested total CD34(+) were 5.46 × 10(6) /kg (0.96-44.36); 71 patients (80.7%) successfully mobilized; 20 (22.7%) patients were poor mobilizers; 14 (15.9%) patients were considered nonmobilizers with maximal PB CD34(+) <7/µL and did not proceed to apheresis. Six of 20 poor mobilizers were apheresed with PB CD34(+) 7-12/µL, 50% were successfully harvested. No differences were found between ICE and R-ICE regimens. Impaired mobilization efficiency was associated with age, remission status, >1 line of induction chemotherapy, four cycles ICE/R-ICE and grade 4 neutropenia. Prior bone marrow (BM) involvement was associated with nonmobilization. The majority of patients can be successfully mobilized with ICE/R-ICE. Prior BM involvement is associated with high rates of nonmobilization following ICE/R-ICE. Such patients may benefit from novel mobilization agents and/or alternative salvage regimens to ICE/R-ICE.

Peripheral Stem Cell Apheresis is Feasible Post 131Iodine-Metaiodobenzylguanidine-Therapy in High-Risk Neuroblastoma, but Results in Delayed Platelet Reconstitution

“…Failure to harvest sufficient CD34 þ cells by apheresis occurred in only one 131 I-MIBG-and two chemotherapy-only-treated patients. Of interest, our findings indicate that BM tumor infiltration at diagnosis did impair the mobilization of CD34 þ cells, as described for other tumors (20), even though apheresis only started after clearing of initial BM disease. Concerning the timing of apheresis, there are different approaches: harvesting is performed after two induction chemotherapy courses in North America, as the Children's Oncology group previously showed that this was safe and feasible (21), whereas the consensus in Europe is still to harvest stem cells after the BM is cleared from tumor cells or post induction therapy.…”

Mobilization of hematopoietic progenitor cells for autologous transportation: consensus recommendations

“…Several studies carried out to investigate this question showed that the diagnosis of lymphoma, [14][15][16][17][18][19] thrombocytopenia, 14,[20][21][22][23] older age [18][19][20][21][23][24][25] and polytreatment 14,16,19,25,26 , among other factors, emerged as the main potential factors for the prediction of poor recruitment of hematopoietic stem cells.…”

A retrospective study of autologous stem cell mobilization by G‑CSF in combination with chemotherapy in patients with multiple myeloma and lymphoma

“…In the present study, the overall mobilization failure rate was 35.2% (45 of 128 patients), the failure rate of MM patients was 26.4% (14 of 53 patients) and that of lymphoma patients was 41% (31 of 75 patients). The mobilization failure rate appeared to be relatively higher than previously reported rates of 5-30% (8,18,19,(21)(22)(23)(24)(25)(26). The reasons for this discrepancy are unknown; however, some invariable or variable factors might have played a role, such as mobilization timing, mobilization schemes, and various parameters set by the separator.…”

“…The combined success rate of CTX, CHOP and MINE therapeutic schemes was 68.4%, while that of HyperCVAD scheme plans A or B was only 27.8%, suggesting that HyperCVAD might not be a suitable treatment option for patients with lymphoma. Other studies recommended various schemes with a success rate >70%, which included high-dose CTX, intermediate dose cytarabine, cytarabine combined with etoposide, ESHAP/DSHAP and ICE/RICE (8,(20)(21)(22)(23).…”