Mobilizing peripheral blood stem cells with high-dose G-CSF alone is as effective as with Dexa-BEAM plus G-CSF in lymphoma patients

Br J Haematol. 1998 Sep;102(4):1101-6. doi: 10.1046/j.1365-2141.1998.00865.x.

Abstract

We compared retrospectively the efficacy of granulocyte colony stimulating factor (G-CSF) alone with chemotherapy plus G-CSF in mobilizing CD34-positive cells in patients with malignant lymphoma. 35 patients underwent peripheral blood stem cell (PBSC) collection following mobilization either with 24 microg/kg G-CSF for 4 consecutive days (n = 18) or Dexa-BEAM chemotherapy plus 5 microg/kg G-CSF (n = 17). High-dose G-CSF was well tolerated with only slight bone pain and/or myalgia. The Dexa-BEAM therapy required hospitalization with a median duration of 21 d. The median number of apheresis procedures in both groups was two (range two to four), resulting in a median of 5.3 and 5.1 x 10(6) CD34+ cells/kg. No patients in the G-CSF group, but one in the Dexa-BEAM group, failed to reach the target of collecting >2.0 x 10(6) CD34+ cells/kg. The number of CFU-GM (10.4 v 6.0 x 10(5)/kg) and of BFU-E (10.6 v 4.5 x 10(5)/kg; P = 0.04) was higher in the G-CSF group than in the Dexa-BEAM group. A subset analysis of CD34+ cells was performed in 16 patients showing a higher mean of Thy-1 (CD90w) coexpression in the G-CSF than in the Dexa-BEAM group (4.8 v 1.8%, P = 0.12). Additionally the percentage of CD34+/CD38- cells was higher in the G-CSF group (10.66% v 8.8%). However, these differences were not statistically significant. The median time to leucocyte and platelet engraftment after high-dose chemotherapy was slightly shorter in the G-CSF than in the Dexa-BEAM group (9 v 10 and 12 v 13.5 d, respectively). These results demonstrate that high-dose G-CSF is as effective as Dexa-BEAM plus G-CSF in mobilizing peripheral blood stem cells and produces prompt engraftment. The major advantages of G-CSF mobilization were the safe outpatient self-application and the fixed-day apheresis.

MeSH terms

  • Adolescent
  • Adult
  • Antigens, CD34 / analysis
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carmustine / administration & dosage
  • Carmustine / pharmacology
  • Colony-Forming Units Assay
  • Cytarabine / administration & dosage
  • Cytarabine / pharmacology
  • Dexamethasone / administration & dosage
  • Dexamethasone / pharmacology
  • Etoposide
  • Female
  • Filgrastim
  • Graft Survival
  • Granulocyte Colony-Stimulating Factor / adverse effects
  • Granulocyte Colony-Stimulating Factor / therapeutic use*
  • Hematopoietic Stem Cell Mobilization / methods*
  • Hematopoietic Stem Cell Transplantation
  • Hospitalization
  • Humans
  • Lymphoma / drug therapy*
  • Male
  • Melphalan / administration & dosage
  • Melphalan / pharmacology
  • Middle Aged
  • Recombinant Proteins
  • Retrospective Studies

Substances

  • Antigens, CD34
  • Recombinant Proteins
  • Cytarabine
  • Granulocyte Colony-Stimulating Factor
  • Etoposide
  • Dexamethasone
  • Filgrastim
  • Melphalan
  • Carmustine

Supplementary concepts

  • Dexa-BEAM protocol