Randomized trial of filgrastim versus chemotherapy and filgrastim mobilization of hematopoietic progenitor cells for rescue in autologous transplantation

Improving stem cell mobilization strategies: future directions

“…In particular, mobilization with CY and G-CSF rather than with G-CSF alone improves CD34 þ cell collection significantly in patients with either MM 27,29 or NHL. 28,63 Table 2 compares yields of CD34 þ cells achieved with chemomobilization to CD34 þ cell yields obtained using G-CSF alone in patients with either MM or NHL. Benefits of the relatively higher CD34 þ cell yields that result from chemomobilization include faster engraftment of plts and neutrophils and improved rates of survival.…”

“…The authors reported median CD34 þ cell yields of 6.2 Â 10 6 cells/kg, 3.4 Â 10 6 cells/kg and 1.2 Â 10 6 cells/kg in the respective treatment groups. 84 Narayanasami et al 28 mobilized stem cells in 22 patients with NHL or HD by using G-CSF 10 mg/kg s.c. daily for 4 days before the start of apheresis and reported a median CD34 þ cell collection of 2.5 Â 10 6 / kg; approximately 50% of these patients required only one apheresis session, whereas 4% of patients required three sessions.…”

“…60,61 For patients with MM or NHL, the number of CD34 þ cells collected is heavily influenced by the mobilization regimen employed. 25,28,29,63 Cytokine-induced mobilization…”

“…65,83 After transplantation, the median time to granulocyte engraftment has been reported to be 11 days, and plt engraftment has been reported to be B11-14 days. 27,28 Mobilization with G-CSF is generally well tolerated; common AEs are bone pain, headache, anemia and decreased plt counts. 65 Other AEs reported by healthy donors include fatigue, muscle aches, nausea, vomiting and stomach pain.…”

“…14,[22][23][24] Current regimens to mobilize PBSC for auto-HSCT have differing stem cell yields, safety considerations, resource utilization, and levels of contamination of the apheresis product with tumor cells. 20,[25][26][27][28][29][30] The two most common mobilization strategies today use cytokines alone or cytokines after chemotherapy (chemomobilization). Table 1 lists the agents that are approved by the United States (US) Food and Drug Administration (FDA) for stem cell mobilization and the agents that are in development or used off-label for this purpose.…”