1082P - Very high efficacy of cytarabine + G-CSF compared to cyclophosphamide + G-CSF as hematopoietic stem cell mobilization in patients with lymphoid mali...

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Anti-Cancer Agents & Biologic Therapy
Haematologic Malignancies
Presenter Tomasz Kruzel
Authors T. Kruzel1, T. Czerw2, M. Sadus-Wojciechowska2, J. Najda1, M. Glowala-Kosinska1, A. Chwieduk1, J. Holowiecki1, S. Giebel1
  • 1Department Of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 41-101 - Gliwice/PL
  • 2Department Of Bone Marrow Transplantation, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice/PL

Abstract

High-dose therapy followed by autologous peripheral blood stem cell transplantation (autoPBSCT) is widely applied in the treatment of lymphoid malignancies. However, a significant proportion of patients fail to mobilize sufficient number of stem cells. So far, no standards for mobilization have been elaborated with G-CSF alone or G-CSF in combination with cyclophosphamide (CTX) being most commonly used regimens.

In this study we evaluated efficacy of mobilization based on cytosine arabinoside (AraC) 1600 mg/m2 + G-CSF (filgrastim) 5-10 ug/kg. Results of 67 subsequent patients were compared with 45 individuals mobilized with cyclophosphamide (CTX) (4 g/m2) + G-CSF, according to our preceding standard protocol. The median age of patients in the AraC group was 57 years; the indications were: multiple myeloma (MM, n = 37), Hodgkin's lymphoma (HL, n = 9) and non-Hodgkin lymphoma (n = 21). Patients had previously been treated with 8 (3-36) cycles of chemotherapy, 2 (1-6) lines of chemotherapy; 33% had received radiotherapy. The characteristics of the CTX group were comparable.

All but two patients (97%) treated with AraC reached > 15 CD34 + cells/uL in peripheral blood, which was required to start leukapheresis, compared to 67% in the CTX + G-CSF cohort (p < 0.0001). Median peak level was 127 (3-780) CD34 + cells/uL vs. 33 (1-240), respectively (p < 0.0001). After AraC treatment, 65 (97%) patients collected > = 2x10e6 CD34 + cells/kg, required for single autoPBSCT, while 54 (81%) collected > = 5x10e6 CD34 + cells/kg, needed for double transplantation. Respective proportions in the CTX cohort were 56% (p < 0.0001) and 42% (p < 0.0001). The total number of harvested CD34 + cells was 14.9 (2.2-57.2) x10e6/kg for AraC and 5.1 (2-14.3) for CTX (p < 0.0001). The toxicity related to both regimens was comparable.

We conclude that mobilization based on intermediate doses of AraC + G-CSF is highly effective allowing adequate CD34+ harvest in almost all patients with lymphoid malignancies, including heavily pre-treated and elderly individuals. The level of mobilized CD34+ cells is four times higher compared to commonly used protocol based on CTX. Hence, AraC + G-CSF may be a preferable option for predicted poor mobilizers, especially when high number of CD34+ cells is required for transplantation.

Disclosure

All authors have declared no conflicts of interest.