Mobilization of Peripheral Blood Stem Cells in High-Risk Breast Cancer Patients Using G-CSF After Standard Dose Docetaxel

Abstract

Chemotherapy, in addition to recombinant growth factors, has been effective in mobilizing stem cells. Unfortunately, the use of chemotherapy for this purpose has resulted in profound myelosuppression and increased morbidity. Docetaxel, the single most active agent in the treatment of advanced breast cancer, was evaluated for its potential to mobilize stem cells when given at conventional doses followed by granulocyte colony-stimulating factor (G-CSF). Sixteen high-risk breast cancer patients were mobilized with a regimen consisting of docetaxel (100 mg/m2) followed by daily G-CSF (10 microg/kg), beginning 72 h after the docetaxel, and continuing until completion of the apheresis. The median white blood cell count (WBC) nadir was 1,000/microl (range 500 to 4000/microl ) occurring a median of 6 days (range 4 to 9 days) after the docetaxel. No patient experienced a neutropenic febrile episode due to the mobilization regimen. The median time interval for initiating the apheresis was 8 days (range 6 to 11 days) following the docetaxel. The median number of apheresis was 2 (range 1 to 3) in each patient. Stem cell recovery as measured by the CD34 cell count x 10(6)/kg was a median of 5.2 (range 1.4 to 15.1). A significant correlation was found between CFU-GM, BFU-E, and CFU-GEMM/kg and CD34 cells/kg (r = 0.891, 0.945, and 0.749, respectively, p < 0.001). When our results were compared to a matched cohort receiving G-CSF alone, the docetaxel group demonstrated a superior CD34 cells/kg yield (p = <0.001). Following myeloablative chemotherapy consisting of thiotepa and cyclophosphamide with or without carboplatinum, the hematopoetic recovery determined by an absolute neutrophil count (ANC) of greater than 500/microl and an unsupported platelet count of > or =20,000/microl for 48 h, was a median of 10 days (range 9 to 14 days) and 10 days (range 8 to 30 days), respectively. The results demonstrate that conventional dose docetaxel, combined with G-CSF, is an effective mobilization regimen with minimal toxicity in high-risk breast cancer patients.

Mobilization of peripheral blood stem cells using regimen combining docetaxel with granulocyte colony-stimulating factor in breast cancer patients

“…The CD34 + cell counts were more than 2.00×10 6 /kg at single collection in 27 collections (23.68%). These results are similar to previous reports [20][21][22] . The total number of collected MNC and CD34 + cells had correlated with the WBC count at the bottom after docetaxel treatment (P=0.005, 0.000).…”

“…Docetaxel either single or in combination with cyclophosphamide or anthracycline has been reported to successfully mobilize CD34 + cells from peripheral blood [20][21][22] . Prince et al [20] prospectively evaluated docetaxel (100 mg/m 2 ) with G-CSF (10 μg/kg S.C., daily) for mobilization efficiency in 26 patients with breast cancer.…”

Bioequivalence of two recombinant granulocyte colony-stimulating factor formulations in healthy male volunteers

“…Increments in circulating leukocytes were exclusively due to ANC since other lineages did not have variations. The circulating CD34+ cell count increment has been suggested to be an adequate variable that measures stem cell mobilization [30][31][32][33]. The compared formulations did not differ significantly with respect to this variable either.…”