Peripheral blood progenitor cell collection after epirubicin, paclitaxel, and cisplatin combination chemotherapy using EPO‐based cytokine regimens: a randomized comparison of G–CSF and sequential GM–/G–CSF

Abstract

The sequential administration of GM-CSF and G-CSF in combination with EPO is feasible and improves the PBPC collection efficiency after platinum-based intensive polychemotherapy, associating high PBPC mobilization to high collection efficiency during apheresis.

Peripheral blood progenitor cell mobilization with intermediate‐dose cyclophosphamide, sequential granulocyte‐macrophage–colony‐stimulating factor and granulocyte–colony‐stimulating factor, and scheduled commencement of leukapheresis in 225 patients undergoing autologous transplantation

“…Furthermore, the sequential use of GM‐CSF followed by G‐CSF resulted in a higher proportion of cells from the primitive CD34+/CD38–/HLADR+ subset than mobilization with G‐CSF alone. In randomized comparisons, other investigators have also demonstrated that when used with chemotherapy, sequential GM‐CSF followed by G‐CSF mobilizes greater numbers of CD34+ cells than GM‐CSF alone 19 and approximately equivalent numbers of CD34+ cells to G‐CSF alone 19,22 . In the study by Perillo and coworkers, 22 sequential GM‐CSF followed by G‐CSF also resulted in a higher PBPC collection efficiency than G‐CSF alone.…”

Accurate prediction of autologous stem cell apheresis yields using a double variable‐dependent method assures systematic efficiency control of continuous flow collection procedures

“…has been collected. The degree of AHSC mobilization positively influences the success of leukapheresis and is currently defined by the magnitude of CD34+ cell recirculation in the PB [6]; in turn, CD34+ cell recirculation in PB depends on several clinical conditions such as chemotherapy type and dosage, cytokine administration schedule, patient's marrow reserve, age and disease status [7–10]. A threshold level of 15 000–20 000 CD34+ cells (or no less than 10 000 CD34+ cells in patients with leukaemia) per millilitre of PB is generally accepted as the minimum AHSC mobilization to admit patients to leukapheresis procedures.…”

Cytokines alone for PBPC collection in patients with advanced gynaecological malignancies: G-CSF vs G-CSF plus EPO

“…Our experience in patients with advanced gynaecological cancer confirms that G-CSF priming is feasible and achieves CD34 þ cell yields comparable to those reported in breast cancer. 9,10 Moreover, in our series EPO addition to G-CSF in different schedules does not seem to improve PBPC mobilization/ collection, suggesting that potentiation of PBPC mobilization induced by EPO in chemotherapy primed patients 5,6 cannot be reproduced in steady-state conditions. Therefore, G-CSF alone remains the most cost-effective cytokine regimen to promote PBPC recirculation in cancer patients in steady-state conditions.…”

“…4 Recently, two EPO-based cytokine regimens have been proposed by our group for PBPC mobilization in patients with advanced ovarian cancer by using a disease-oriented chemotherapy supported by G-CSF or sequential GM-/G-CSF in combination with EPO, demonstrating that EPO significantly increases all the well-known myeloid growth factor properties in patients recovering from drug-induced myelosuppression. 5,6 However, whether mobilization with chemotherapy plus cytokines should be preferred over cytokines alone represents a clinically relevant aspect that remains to be established in the autologous setting. Data from clinical trials suggest that the greatest progenitor mobilization is obtained with chemotherapy followed by the administration of growth factors, but this approach is likely to cause additional toxicities and costs for patients' care.…”