Abstract
Autologous hematopoietic stem cell transplantation (auto-HSCT) provides hematopoietic support after high-dose chemotherapy and is the standard of care for patients with multiple myeloma (MM), chemo sensitive relapsed high or intermediate grade non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). However, yields of hematopoietic stem cells vary greatly between patients, and the optimal strategy to mobilize hematopoietic stem cells into peripheral blood for collection has not been defined yet. We investigated the efficacy and safety of chemo mobilization with an intermediate dose etoposide (VP-16; 200 mg/m2 on days 1-3) and granulocyte-colony stimulating factor (G-CSF)(5 µg/kg twice daily from day 4 through the final day of collection). We reviewed our institutional experience with 91 patients (71 MM, 12 HL, 8 NHL) mobilized with this regimen. VP-16 + G-CSF resulted in successful mobilization in 95.55% of the patients (on one patient stem cell collection with plerixafor was applied), including 76 patients (83.52%) whose stem cells were collected successfully in a single day. Collection was managed between min. D8 and max. D17. Patient age, gender, exposure to previous irradiation and chemotherapy, previous mobilization attempts, and disease characteristics were not considered during selection. Adverse effects of the regimen included supportive transfusions and fevers requiring hospitalization or intravenous antibiotics. VP-16 and G-CSF appears to be a safe and effective mobilization regimen for patients with multiple myeloma, non-Hodgkin’s lymphoma and Hodgkin’s lymphoma undergoing autologous stem cell transplantation, producing excellent stem cell yield with the majority of patients requiring 1 day of apheresis.
Highlights
Autologous hematopoietic SCT is the standard of care for patients with multiple myeloma (MM) or chemosensitive relapsed higher and intermediate grade non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL)
Collection with VP-16 and granulocyte-colony stimulating factor (G-CSF) were followed by ASCT in 91 patients
The efficacy of G-CSF alone for mobilization of PBSCs for auto-HSCT was established in a phase 3 study in which 58 patients with NHL or HL received either PBSCs mobilized with GCSF 10 μg/kg s.c. daily for 6 consecutive days (n=27) or bone marrow (BM) (n=31) for hematopoietic reconstitution after high-dose therapy (HDT)
Summary
Autologous hematopoietic SCT (auto-HSCT) is the standard of care for patients with multiple myeloma (MM) or chemosensitive relapsed higher and intermediate grade non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). It provides essential hematopoietic support after the administration of high-dose therapy (HDT).[1,2]. Auto-HSCT combined with HDT administration after relapse, has shown to prolong the duration of remission in patients with diffuse large B-cell lymphoma and provides these patients with approximately a 45% probability of long-term disease free survival.[2] Auto-HSCT is used in conjunction with high-dose myeloablative therapy as a salvage treatment for follicular lymphoma. Auto-HSCT may improve the prognosis in patients with mantle cell lymphoma, when it is used as part of first-line treatment
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