Peripheral blood progenitor cell (PBPC) mobilization in heavily pretreated patients with germ cell tumors: a report of 34 cases

Abstract

Summary:The aim of the study was to evaluate peripheral blood progenitor cell mobilization by disease-specific chemotherapy in heavily pretreated patients with germ cell tumor (GCT), scheduled for high-dose chemotherapy. Thirty-four consecutive patients, 29 males and five females, with advanced GCT referred to our department for high-dose chemotherapy were evaluated retrospectively. Sixteen patients were mobilized by vinblastine 0.11 mg/kg on days 1 and 2, ifosfamide 1200 mg/m 2 days 1-5 and cisplatin 20 mg/m 2 days 1-5 (VeIP). In 10 patients, etoposide 75 mg/m 2 days 1-5 was used instead of vinblastine (VIP), while in eight patients the mobilization was attempted by administering 7 g/m 2 of cyclophosphamide. The choice of either etoposide or vinblastine was predicated upon which of these two drugs was associated with best results during premobilization chemotherapy. Cyclophosphamide was selected in patients refractory to previous cisplatin-based salvage chemotherapy. Twenty-five out of 34 patients underwent a successful PBPC collection. In 17 of them one leukapheresis procedure was sufficient to collect the target number of CD34 ؉ cells, while in eight patients a double procedure was necessary. Altogether 33 aphereses were performed in 25 patients. In nine patients leukapheresis was not attempted. This was due to the fact that the chemotherapy failed to mobilize the target number of CD34 ؉ cells in eight of them, treated with the VeIP mobilizing regimen, while one patient treated with high-dose cyclophosphamide rapidly progressed during therapy and for this reason leukapheresis was not undertaken. In conclusion, in heavily pretreated patients with GCT, PBPC mobilization is feasible by a further course of salvage chemotherapy. The choice of either etoposide (VIP) or vinblastine (VeIP) can be predicated upon which of these two drugs was associated with best results during premobilization chemotherapy. In our hands, VeIP seems to be less satisfactory as mobilizing treatment than VIP, possibly due to a superior number of premobilization courses of chemotherapy in some patients. Moreover, high-dose cycloCorrespondence: Dr C Dazzi, Dipartimento di Oncologia, Ospedale Santa Maria delle Croci, Viale Randi 5, 48100 Ravenna, Italy Received 9 September 1998; accepted 5 November 1998 phosphamide remains a good alternative for mobilizing patients refractory to salvage chemotherapy.

A randomized study comparing filgrastim versus lenograstim versus molgramostim plus chemotherapy for peripheral blood progenitor cell mobilization

“…These results confirmed those of previous studies that showed that prior treatment influences negatively the ability to mobilize PBPC. 21 With respect to recovery of hematological toxicity, we did not observe a reduction of thrombocytopenia in the patient group treated with GM-CSF, as described in other studies. 6,7 Moreover, no statistically significant difference among treatment arms was observed for incidence and duration of grade 4 thrombocytopenia, whereas higher incidence and duration of grade 4 neutropenia in the molgramostim arm occurred.…”

“…The nearly 20% mobilization failure rate is quite high, and could be partially justified with the high percentage of pretreated patients (57%), and the significant percentage of GCT (26%) and NHL (13%) patients, who could have a mobilization failure rate of about 20-30%. 21,22 Of patients who underwent apheresis, 70% obtained at least 2 Â 10 6 /kg CD34 þ cells, which was considered the minimum threshold value to guarantee the clinical safety of a high-dose chemotherapy treatment. 5 A not statistically significant trend in favor of filgrastim was observed when considering the median number of CD34 þ cells collected ( Table 2).…”

Modification of polyindole by the incorporation of pyrrole unit

“…In total, 75 courses were supported by BM reinfusion, 29 courses were supported by PBSC reinfusion, and 1 course was supported by both BM and PBSC reinfusion. Mobilizing regimens for PBSC collection were the following: cyclophosphamide 7 g/m 2 ; vinblastine 0.11 mg/Kg on Days 1 and 2, ifosfamide 1200 mg/m 2 on Days 1–5, and cisplatin 20 mg/m 2 on Days 1–5 (VeIP); etoposide 75 mg/m 2 , ifosfamide 1200 mg/m 2 , and cisplatin 20 mg/m 2 on Days 1–5 (VIP); or GM‐CSF or G‐CSF 5 μg/Kg per day was started 24 hours after the end of chemotherapy until leukapheresis 16…”

Peripheral blood hematopoietic stem cell mobilization and collection efficacy is not an independent prognostic factor for autologous stem cell transplantation

“…Advantages of the use of hematopoietic stem cells include shorter engraftment time, shorter hospital stay, convenience of stem cell collection, and potentially lower chance of tumor contamination 2 . The application of chemotherapy, either after consolidation regimen with multiple drugs or single agent, in addition to granulocyte–colony‐stimulating factor (G‐CSF) and granulocyte‐macrophage–colony‐stimulating factor (GM‐CSF) havebeen increasingly considered as the benchmark mobilization protocol simply because they are more effective than the use of G‐CSF or GM‐CSF alone 3‐18 …”