Impact of autologous bone marrow infusion on hematopoietic recovery after high-dose cyclophosphamide, etoposide, and cisplatin.

Abstract

Because of potential tumor contamination and inadequacy of current purging technique of bone marrow in patients with solid tumors, we investigated an alternative approach to high-dose therapy without autologous bone marrow (ABM) infusion. Three levels of nonmyeloablative doses of cyclophosphamide 4.5 to 5.25 g/m2, etoposide 750 to 1,200 mg/m2, and cisplatin 120 to 165 mg/m2 (CVP) were administered to patients with metastatic solid tumors. Patients were randomized to ABM (n = 46) or no-ABM (NABM) (n = 46) infusion after CVP to study the impact of ABM on hematopoietic recovery, morbidity, and mortality. All patients had ABM harvested, underwent conventional chemotherapy, and then received CVP. Seventy-three patients received two courses of similar doses. The following were the median days to absolute neutrophil count (ANC) of 0.1 x 10(9)/L: for the ABM arm, 19, 21, and 19 and for the NABM arm, 23, 20, and 21 at levels 1, 2, and 3, respectively, during course 1 (P = .01, .80, and .01, respectively). During course 2, ANCs to 0.1 x 10(9)/L and 0.5 x 10(9)/L were attained significantly faster at levels 1 and 3 in the ABM arm. ANC to 1.0 x 10(9)/L was comparable in both arms. Incidence of infection and duration of fever were similar in both arms. Although mortality and the incidence of delayed hematopoietic recovery were more frequent in the NABM arm, this was not statistically significant. Platelet recovery was consistently prolonged in course 2 in both arms, with demonstrable benefit of ABM in course 2 when dose levels were collectively considered. We conclude that (1) ABM enhanced recovery of ANC to 0.1 x 10(9)/L; (2) ABM did not decrease the incidence of infections and the duration of fever; and (3) CVP can be safely given without ABM to carefully selected patients.

Intensive Dose Ifosfamide and Etoposide with G-CSF for Stem Cell Mobilization in Patients with Non-Hodgkin's Lymphoma

“…Patients who achieved a complete response after ifosfamide and mitoxantrone went on to consolidation BEAM and stem cell rescue. Patients who achieved a Downloaded by [University of Otago] at 08:17 07 October 2015 partial response to the ifosfamide and mitoxantrone received a first intensification with cyclophosphamide, etoposide, cisplatin (CVP) [19][20][21] with infusion of half of the collected stem cells, followed by a second consolidation cycle with BEAM and infusion of the remaining stem cells. At any time, patients with progressive disease were taken off study.…”

Superior autologous blood stem cell mobilization from dose-intensive cyclophosphamide, etoposide, cisplatin plus G-CSF than from less intensive chemotherapy regimens

“…9 Jennis and colleagues reported on 80 patients who underwent C 5 g/m 2 , E 1500 mg/m 2 , and P 120 mg/m 2 plus G-CSF. 10 In a median of two apheresis procedures this regimen yielded excellent quantities of CD34 + cells (median of 15.8 ϫ 10 6 /kg) with efficient hematopoietic engraftment.The doses we chose were higher than those studied by Schwartzberg et al 8 and Demirer et al 9 in an attempt to improve anti-cancer effect, but slightly lower than those reported by other investigators [4][5][6]10 in order to avoid thrombocytopenia at the time of apheresis. We observed that DICEP and G-CSF seemed to mobilize ABSC more effectively than our previous mobilization regimens.…”

“…The doses we chose were higher than those studied by Schwartzberg et al 8 and Demirer et al 9 in an attempt to improve anti-cancer effect, but slightly lower than those reported by other investigators [4][5][6]10 in order to avoid thrombocytopenia at the time of apheresis. We observed that DICEP and G-CSF seemed to mobilize ABSC more effectively than our previous mobilization regimens.…”

“…DICEP is a well studied, intensive, but non-myeloablative regimen with acceptable treatment-related morbidity and mortality rates. [4][5][6] It is very closely related to a common 'high-dose' regimen used with ASCT for Hodgkin's and non-Hodgkin's lymphoma called CBV (cyclophosphamide 6 g/m 2 , BCNU 300 mg/m 2 and etoposide 750 mg/m 2 ). 3,7 DICEP plus G-CSF has previously been reported to mobilize blood stem cells.…”

Optimal use of G-CSF administration after hematopoietic SCT

“…The rationale for delaying the initiation of G-CSF is that late-committed neutrophilic progenitors responsive to G-CSF are not yet formed immediately after PBSCT, 44,45 making the early G-CSF treatment futile. With this in mind, several studies have analyzed the optimal time to start G-CSF after autologous PBSCT.…”