The Hyper‐CVAD chemotherapy regimen has an adverse long‐term impact on the ability to mobilize peripheral blood stem cells, which can be readily circumvented by using the early cycles for mobilization

Abstract

The Hyper-CVAD chemotherapy regimen is being increasingly applied to a number of haematological malignancies. We assessed the impact of Hyper-CVAD on peripheral blood stem cell (PBSC) yields and examined the optimal timing of PBSC collection when using this regimen. Seventy-four consecutive patients were identified in whom an attempt was made to collect PBSC, usually on recovery from cycle A or B. Where PBSC collection was attempted after cycle 3B, only 18% (3/17) of patients successfully mobilized. Fifty-seven patients were mobilized on recovery from cycle 1B (n = 13), 2A (n = 22), 2B (n = 14) or 3A (n = 8). Compared with cycle 2A, 1B was not superior in achieving the minimum of > or =2 x 10(6)/kg CD34+ cells (100% vs. 77%, p = 0.13), but was superior in terms of total CD34+ yield (21.4 vs. 3.2 x 10(6)/kg, p < 0.001), achieving the target CD34+ cell count of > or =5 x 10(6)/kg (92% vs 36%, p = 0.002), and obtaining both a minimum (92% vs. 18%, p < 0.001) and target (77% vs. 0%, p < 0.001) graft with a single apheresis. There were no significant differences in PBSC yields following cycles 2A, 2B and 3A. Hyper-CVAD has substantial stem cell toxicity which can be readily circumvented by using the early chemotherapy cycles for mobilization.

A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant‐eligible patients with previously untreated mantle cell lymphoma

“…In the R‐hyper‐CVAD/MA regimen as originally published, ASCT is reserved for the small minority of patients with less CR after 6 cycles . Indeed, the R‐hyper‐CVAD/MA regimen may compromise successful stem cell mobilization, but this can be mitigated by early harvesting . A smaller study investigating R‐hyper‐CVAD induction followed by a BuMel‐conditioned ASCT for 12 (out of 13) patients showed this strategy to be feasible with an encouraging 3‐year overall and event‐free survival of 92% .…”

Comparación del hyper-CVAD con un régimen institucional en el tratamiento de la leucemia linfoblástica aguda del adulto en un hospital de México

“…En dicho estudio 4 de los 125 pacientes desarrollaron una leucemia aguda o síndrome mielodisplásico secundario lo que orienta a un daño directo del régimen sobre las células progenitoras hematopoyéticas. Keane et al describieron también este efecto, ya la toxicidad combinada de los dos brazos limitó la capacidad para poder movilizar progenitores hematopoyéticos (17) .…”

Advances in stem cell mobilization

“…Studies have identified multiple chemotherapeutic agents which increase the risk of poor stem cell mobilization, including melphalan, 11 Lenalidomide, 12,13 Fludarabine, 14,15 Chlorambucil, 16 Carmustine, 17 Hyper-CVAD 18 and DHAP. 19 …”