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 Anticancer Agents
Haematological Malignancies
Therapy
Biological Therapy
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.