Abstract
The efficacy of high-dose chemotherapy (HDC) and circulating progenitor cell (CPC) transplantation in metastatic breast cancer (MBC) relies mainly on giving this treatment after a response to conventional induction chemotherapy has been achieved. For this reason an optimal mobilization regimen should be therapeutically effective while minimizing the number of leucaphereses required to support the myeloablative therapy. The combination of an anthracycline and paclitaxel in chemotherapy-untreated MBC has produced impressive response rates. We evaluated the CPC-mobilizing capacity of the combination epirubicin (90 mg m(-2)) and paclitaxel (135 mg m(-2)) followed by filgrastim (5 microg kg(-1) day(-1)) starting 48 h after chemotherapy administration in ten patients with MBC who were eligible for an HDC and CPC transplantation programme. Leucaphereses were performed by processing at least two blood volumes per procedure at recovery from neutrophil nadir when CD34+ cells in the peripheral blood exceeded 20 microl(-1). In most patients (six out of 10) more than 2.5 x 10(6) CD34+ cells kg(-1), a threshold considered to be sufficient for haematopoietic reconstitution, were collected with a single apheresis. In the remaining four patients an additional procedure, performed the following day, was enough to reach the required number of progenitors. These data suggest that the epirubicin-paclitaxel combination, besides being a very active regimen in MBC, is effective in releasing large amounts of progenitor cells into circulation.
Highlights
The autologous transfusion of circulating progenitor cells (CPCs) collected from the peripheral blood by leucapheresis is rapidly replacing autologous bone marrow transplantation to support haematopoiesis after high-dose chemotherapy (HDC) for lymphoma and solid tumours (Gianni AM, 1994; Holoyake, 1994)
The main reason for the success of this procedure is the capability of CPCs to produce a much faster haematopoietic recovery than bone marrow cells (Siena et al, 1989; Sheridan et al, 1992; Chao et al, 1993; Schmitz et al, 1996)
Median neutrophil count at nadir was 0.49 x 109 1-1
Summary
The autologous transfusion of circulating progenitor cells (CPCs) collected from the peripheral blood by leucapheresis is rapidly replacing autologous bone marrow transplantation to support haematopoiesis after high-dose chemotherapy (HDC) for lymphoma and solid tumours (Gianni AM, 1994; Holoyake, 1994). The main reason for the success of this procedure is the capability of CPCs to produce a much faster haematopoietic recovery than bone marrow cells (Siena et al, 1989; Sheridan et al, 1992; Chao et al, 1993; Schmitz et al, 1996)
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