Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers

Abstract

The optimal protocol for mobilization of hematopoietic stem cells in patients with lymphoid malignancies has not been determined so far. We retrospectively analyzed the efficacy and safety of Ara-C at a dose of 1.6 g/m 2 compared with CY at a dose of 4.0 g/m 2 , both combined with filgrastim. Seventy and forty-five patients, respectively, were included, among whom 60% were defined as 'predicted poor mobilizers'. The use of Ara-C was associated with significantly higher peak number of circulating CD34þ cells compared with CY (Po0.0001). In the Ara-C group, 95% of patients with multiple myeloma (MM) collected at least 5 Â 10 6 CD34 þ cells/kg required for tandem transplantation, and 97% of lymphoma patients collected at least 2 Â 10 6 CD34 þ cells/kg, needed for a single autologous hematopoietic SCT (autoHSCT), which was achieved with a single leukapheresis in 91% of cases. Results for the CY group were significantly inferior (Po0.0001). No patient mobilized with Ara-C experienced febrile neutropenia, whereas 35% required platelet transfusions. Among patients who proceeded to autoHSCT, the time of both neutrophil and platelet recovery was significantly shorter for those mobilized with Ara-C than CY. We conclude that intermediate-dose Ara-C þ filgrastim is a very effective and relatively safe mobilization protocol for patients with lymphoid malignancies.Bone Marrow Transplantation (2013) 48, 915-921;

Intermediate doses of cytarabine plus granulocyte–colony‐stimulating factor as an effective and safe regimen for hematopoietic stem cell collection in lymphoma patients with prior mobilization failure

“…In this regard, the recent paper of Hyun and colleagues described 67% of febrile neutropenic episodes using high‐dose etoposide plus G‐CSF. Moreover, significant rates up to 35% of transfusion requirements related to mobilization regimens have been reported by other groups . Furthermore, neutrophil and PLT engraftment was not affected in our cohort in comparison to other recently published results …”

“…Moreover, significant rates up to 35% of transfusion requirements related to mobilization regimens have been reported by other groups. 25 Furthermore, neutrophil and PLT engraftment was not affected in our cohort in comparison to other recently published results. 19 Interestingly, one patient in our cohort had previously failed to plerixafor and the rest did not receive it for different reasons: failure to reach more than 5 × 10 6 CD34+ cells/L on the fourth or fifth day after G-CSF, so that these patients were not candidates to receive it at our institution, or because of drug unavailability.…”

Increased Efficacy of Stem Cell Chemomobilization with Intermediate-Dose Cytarabine Plus Granulocyte Colony-Stimulating Factor (G-CSF) Compared with G-CSF Alone in Patients with Multiple Myeloma: Results of a Randomized Trial

“…Intermediate-dose cytosine arabinoside (ID-AraC), at a total dose of 1.6 g/m 2 plus G-CSF, has shown very high efficacy as a firstor second-line mobilization regimen in patients with lymphoid malignancies, including MM [13][14][15][16]. In a retrospective comparison performed in our center, this strategy was significantly more effective than CY plus G-CSF [14]. This suggests that the type of chemotherapeutic agent added to G-CSF may play a role in mobilization efficacy.…”

Plerixafor for patients who fail cytokine-or chemotherapy-based stem cell mobilization: Results of a prospective study by the Polish Lymphoma Research Group (PLRG)

“…This is the first prospective multicenter observational study to In many studies, clinical benefits of engraftment rate and overall survival have been analyzed and point toward a correlation between higher CD34 + cell dose and faster engraftment and platelet recovery [4,6,7]. The search for an optimal mobilization regimen and efficient collection even in very poor mobilizers was a subject of series of AraC group, 96% of patients collected at least 2 × 10 6 CD34 + cells/kg compared with 71% in the DHAP group (p = 0.0006) [28]. At the time of that study plerixafor was not available in Poland [28].…”

“…The search for an optimal mobilization regimen and efficient collection even in very poor mobilizers was a subject of series of AraC group, 96% of patients collected at least 2 × 10 6 CD34 + cells/kg compared with 71% in the DHAP group (p = 0.0006) [28]. At the time of that study plerixafor was not available in Poland [28].…”