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Cell Procurement

A randomized study comparing filgrastim versus lenograstim versus molgramostim plus chemotherapy for peripheral blood progenitor cell mobilization

Bone Marrow Transplantation volume 38, pages 407–412 (2006)Cite this article

Abstract

We conducted a prospective randomized clinical trial to assess the mobilizing efficacy of filgrastim, lenograstim and molgramostim following a disease-specific chemotherapy regimen. Mobilization consisted of high-dose cyclophosphamide in 45 cases (44%), and cisplatin/ifosfamide/etoposide or vinblastine in 22 (21%), followed by randomization to either filgrastim or lenograstim or molgramostim at 5 μg/kg/day. One hundred and three patients were randomized, and 82 (79%) performed apheresis. Forty-four (43%) patients were chemonaive, whereas 59 (57%) were pretreated. A median number of one apheresis per patient (range, 1–3) was performed. The median number of CD34+ cells obtained after mobilization was 8.4 × 106/kg in the filgrastim arm versus 5.8 × 106/kg in the lenograstim arm versus 4.0 × 106/kg in the molgramostim arm (P=0.1). A statistically significant difference was observed for the median number of days of growth factor administration in favor of lenograstim (12 days) versus filgrastim (13 days) and molgramostim (14 days) (P<0.0001) and for the subgroup of chemonaive patients (12 days) versus pretreated patients (14 days) (P<0.001). In conclusion, all three growth factors were efficacious in mobilizing peripheral blood progenitor cells with no statistically significant difference between CD34+ cell yield and the different regimens, and the time to apheresis is likely confounded by the different mobilization regimens.

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References

  1. Gratwohl A, Baldomero H, Demirer T, Rosti G, Dini G, Ladenstein R et al. Hematopoietic stem cell transplantation for solid tumors in Europe. Ann Oncol 2004; 15: 653–660.

    Article  CAS  Google Scholar 

  2. Demirer T, Buckner CD, Bensinger WI . Optimization of peripheral blood stem cell mobilization. Stem Cells 1996; 14: 106–116.

    Article  CAS  Google Scholar 

  3. De Giorgi U, Rosti G, Zaniboni A, Ballardini M, Minzi MR, Baioni M et al. High-dose epirubicin, preceded by dexrazoxane, given in combination with paclitaxel plus filgrastim provides an effective mobilizing regimen to support three courses of high-dose dense chemotherapy in patients with high-risk stage II–IIIA breast cancer. Bone Marrow Transplant 2003; 32: 251–255.

    Article  CAS  Google Scholar 

  4. De Giorgi U, Rosti G, Papiani G, Marangolo M . The status of high-dose chemotherapy with hematopoietic stem cell transplantation in germ cell tumor patients. Haematologica 2002; 87: 95–104.

    CAS  PubMed  Google Scholar 

  5. Siena S, Schiavo R, Pedrazzoli P, Carlo-Stella C . Therapeutic relevance of CD 34+ cell dose in blood cell transplantation for cancer therapy. J Clin Oncol 2000; 18: 1360–1377.

    Article  CAS  Google Scholar 

  6. Hoeglund M, Smedmyr B, Bengtsson M, Toetterman TH, Yver A, Cour-Chabernaud V et al. Mobilization of CD34+ cells by glycosylated and nonglycosylated G-CSF in healthy volunteers – a comparative study. Eur J Haematol 1997; 59: 177–183.

    Article  Google Scholar 

  7. Gianni AM, Siena S, Bregni M, Di Nicola M, Orefice S, Cusumano F et al. Granulocyte–macrophage colony stimulating factor to harvest circulating hemopoietic stem cells for autotransplantation. Lancet 1989; 2: 580–585.

    Article  CAS  Google Scholar 

  8. Bregni M, Siena S, Di Nicola M, Dodero A, Peccatori F, Ravagnani F et al. Comparative effects of granulocyte–macrophage colony stimulating factor and of granulocyte colony stimulating factor after high-dose cyclofosfamide cancer therapy. J Clin Oncol 1996; 14: 628–635.

    Article  CAS  Google Scholar 

  9. Dazzi C, Cariello A, Giovanis P, Monti M, Vertogen B, Leoni M et al. Prophylaxis with GM-CSF mouthwashes does not reduce frequency and duration of severe oral mucositis in patients with solid tumors undergoing high-dose chemotherapy with autologous peripheral stem cell transplantation rescue: a double blind, randomized, placebo-controlled study. Ann Oncol 2003; 14: 559–563.

    Article  CAS  Google Scholar 

  10. Correale P, Campoccia G, Tsang KY, Micheli L, Cusi MG, Sabatino M et al. Recruitment of dendritic cells and enhanced antigen-specific immune reactivity in cancer patients treated with hr-GM-CSF (molgramostim) and hr-IL-2. Results from a phase Ib clinical trial. Eur J Cancer 2001; 37: 892–902.

    Article  CAS  Google Scholar 

  11. Bengala C, Pazzaglia F, Tibaldi C, Favre C, Vanacore R, Greco F et al. Mobilization, collection, and characterization of peripheral blood hemopoietic progenitors after chemotherapy with epirubicin, paclitaxel and granulocyte-colony stimulating factor administered to patients with metastatic breast carcinoma. Cancer 1998; 82: 867–873.

    Article  CAS  Google Scholar 

  12. Pedrazzoli P, Ferrante P, Kulekci A, Schiavo R, De Giorgi U, Carminati O et al. Autologous hematopoietic stem cell transplantation for breast cancer in Europe: critical evaluation of data from the European Group for Blood and Marrow Transplantation (EBMT) Registry 1990–1999. Bone Marrow Transplant 2003; 32: 489–494.

    Article  CAS  Google Scholar 

  13. Siegel S, Castellan Jr NJ . Statistica Non Parametrica, 2nd edn. McGraw-Hill: New York, 1992.

    Google Scholar 

  14. Armitage P, Berry G . Statistical Methods in Medical Research, 2nd edn. Blackwell Scientific Publications: Cambridge, MA, 1987.

    Google Scholar 

  15. SAS Institute Inc. SAS/STAT User's Guide, version 8.02, vol. 1. SAS Institute: Cary, NC, 1989.

  16. Seggewiss R, Buss EC, Herrmann D, Goldschmidt H, Ho AD, Fruehauf S . Kinetics of peripheral blood stem cell mobilization following G-CSF-supported chemotherapy. Stem Cells 2003; 21: 568–574.

    Article  CAS  Google Scholar 

  17. Milone G, Leotta S, Indelicato F, Mercurio S, Moschetti G, Di Raimondo F et al. G-CSF alone vs cyclophosphamide plus G-CSF in PBPC mobilization of patients with lymphoma: results depend on degree of previous pretreatment. Bone Marrow Transplant 2003; 31: 747–754.

    Article  CAS  Google Scholar 

  18. Goterris R, Hernandez-Boluda JC, Teruel A, Gomez C, Lis MJ, Terol MJ et al. Impact of different strategies of second-line stem cell harvest on the outcome of autologous transplantation in poor peripheral blood stem cell mobilizers. Bone Marrow Transplant 2005; 36: 847–853.

    Article  CAS  Google Scholar 

  19. Andre M, Baudoux E, Bron D, Canon JL, D’Hondt V, Fassotte MF et al. Phase III randomized study comparing 5 or 10 microg per kg per day of filgrastim for mobilization of peripheral blood progenitor cells with chemotherapy, followed by intensification and autologous transplantation in patients with nonmyeloid malignancies. Transfusion 2003; 43: 50–57.

    Article  CAS  Google Scholar 

  20. Kim S, Kim HJ, Park JS, Lee J, Chi HS, Park CJ et al. Prospective randomized comparative observation of single- vs split-dose lenograstim to mobilize peripheral blood progenitor cells following chemotherapy in patients with multiple myeloma or non-Hodgkin's lymphoma. Ann Hematol 2005; 84: 742–747.

    Article  CAS  Google Scholar 

  21. Dazzi C, Cariello A, Rosti G, Monti G, Sebastiani L, Argnani M et al. Peripheral blood progenitor cell (PBPC) mobilization in heavily pretreated patients with germ cell tumours: e report of 34 cases. Bone Marrow Transplant 1999; 23: 529–532.

    Article  CAS  Google Scholar 

  22. Olivieri A, Brunori M, Capelli D, Montanari M, Massidda D, Gini G et al. Salvage therapy with an outpatient DHAP schedule followed by PBSC transplantation in 79 lymphoma patients: an intention to mobilize and transplant analysis. Eur J Haematol 2004; 72: 10–17.

    Article  Google Scholar 

  23. Arora M, Burns LJ, Barker JN, Miller JS, Defor TE, Olujohungbe AB et al. Randomized comparison of granulocyte colony-stimulating factor versus granulocyte–macrophage colony-stimulating factor plus intensive chemotherapy for peripheral blood stem cell mobilization and autologous transplantation in multiple myeloma. Biol Blood Marrow Transplant 2004; 10: 395–404.

    Article  CAS  Google Scholar 

  24. Lonial S, Hicks M, Rosenthal H, Langston A, Redei I, Torre C et al. A randomized trial comparing the combination of granulocyte–macrophage colony-stimulating factor plus granulocyte colony-stimulating factor versus granulocyte colony-stimulating factor for mobilization of dendritic cell subsets in hematopoietic progenitor cell products. Biol Blood Marrow Transplant 2004; 10: 848–857.

    Article  CAS  Google Scholar 

  25. Spitzer G, Adkins D, Mathews M, Velasquez W, Bowers C, Dunphy F et al. Randomized comparison of G-CSF + GM-CSF vs G-CSF alone for mobilization of peripheral blood stem cells: effects on hematopoietic recovery after high-dose chemotherapy. Bone Marrow Transplant 1997; 20: 921–930.

    Article  CAS  Google Scholar 

  26. Yu J, Leisenring W, Bensinger WI, Holmberg LA, Rowley SD . The predictive value of white cell or CD34+ cell count in the peripheral blood for timing apheresis and maximizing yield. Transfusion 1999; 39: 442–450.

    Article  CAS  Google Scholar 

  27. Demirer T, Ilhan O, Ayli M, Arat M, Dagli M, Ozcan M et al. Monitoring of peripheral blood CD34+ cell counts on the first day of apheresis is highly predictive for efficient CD34+ cell yield. Ther Apher 2002; 6: 384–389.

    Article  Google Scholar 

  28. Marques JFC, Vigorito AC, Aranha FJP, Lorand-Metz I, Miranda ECM, Lima Filho EC et al. Early total white blood cell recovery is a predictor of low number of apheresis and good CD34+ cell yield. Transfus Sci 2000; 23: 91–100.

    Article  CAS  Google Scholar 

  29. Steidl U, Fenk R, Bruns I, Neuman F, Kondakci M, Hoyer B et al. Successful transplantation of peripheral blood stem cells mobilized by chemotherapy and a single dose of pegylated G-CSF in patients with multiple myeloma. Bone Marrow Transplant 2005; 35: 33–36.

    Article  CAS  Google Scholar 

  30. Bruns I, Steidl U, Kronenwett R, Fenk R, Graef T, Rohr UP et al. A single dose of 6 or 12 mg of pegfilgrastim for peripheral blood progenitor cell mobilization results in similar yields of CD34+ progenitors in patients with multiple myeloma. Transfusion 2006; 46: 180–185.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported by a special grant from Istituto Oncologico Romagnolo.

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Authors and Affiliations

  1. Department of Oncology and Hematology, Istituto Oncologico Romagnolo, Santa Maria delle Croci Hospital, Ravenna, Italy

    B Kopf, U De Giorgi, B Vertogen, A Molinari, D Turci, C Dazzi, M Leoni, A Tienghi, A Cariello, G Rosti & M Marangolo

  2. Department of Clinical Pathology, Santa Maria delle Croci Hospital, Ravenna, Italy

    G Monti

  3. Blood Bank, Santa Maria delle Croci Hospital, Ravenna, Italy

    M Argnani

  4. Department of Oncology, Pierantoni Hospital, Forlì, Italy

    L Frassineti

  5. Unit of Biostatistics and Clinical Trials, Pierantoni Hospital, Forlì, Italy

    E Scarpi

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  1. B Kopf
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Correspondence to B Kopf.

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Kopf, B., De Giorgi, U., Vertogen, B. et al. A randomized study comparing filgrastim versus lenograstim versus molgramostim plus chemotherapy for peripheral blood progenitor cell mobilization. Bone Marrow Transplant 38, 407–412 (2006). https://doi.org/10.1038/sj.bmt.1705465

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