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Stem Cell Procurement

Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT

Bone Marrow Transplantation volume 48, pages 771–776 (2013)Cite this article

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Abstract

The effectiveness of stem cell mobilization with G-CSF in lymphoma patients is suboptimal. We reviewed our institutional experience using chemomobilization with etoposide (VP-16; 375 mg/m2 on days +1 and +2) and G-CSF (5 μg/kg twice daily from day +3 through the final day of collection) in 159 patients with lymphoma. This approach resulted in successful mobilization (>2 × 106 CD34+ cells collected) in 94% of patients (83% within 4 apheresis sessions). Fifty-seven percent of patients yielded at least 5 × 106 cells in ⩽2 days and were defined as good mobilizers. The regimen was safe with a low rate of rehospitalization. Average costs were $14 923 for good mobilizers and $27 044 for poor mobilizers (P<0.05). Using our data, we performed a ‘break-even’ analysis that demonstrated that adding two doses of Plerixafor to predicted poor mobilizers at the time of first CD34+ cell count would achieve cost neutrality if the frequency of good mobilizers were to increase by 21%, while the frequency of good mobilizers would need to increase by 25% if three doses of Plerixafor were used. We conclude that chemomobilization with etoposide and G-CSF in patients with lymphoma is effective, with future opportunities for cost-neutral improvement using novel agents.

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Acknowledgements

Work on this study was supported by the Integrated Cancer Information and Surveillance System (ICISS), UNC Lineberger Comprehensive Cancer Center with funding provided by the University Cancer Research Fund. Work was also supported by NIH CTSA KL2RR025746.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Bone Marrow and Stem Cell Transplantation Program, Lineberger Comprehensive Center Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    W A Wood, J Whitley, R Goyal, A Sharf, R Irons, K V Rao, A Essenmacher, J S Serody, J M Coghill, P M Armistead, S Sarantopoulos, D A Gabriel & T C Shea

  2. School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, USA

    P M Brown

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  1. W A Wood
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  2. J Whitley
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  3. R Goyal
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  5. A Sharf
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  6. R Irons
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  13. D A Gabriel
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  14. T C Shea
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Correspondence to W A Wood.

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The authors declare no conflict of interest.

Additional information

This study was presented in abstract form at the American Society of Hematology Annual Meeting in 2011.

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Wood, W., Whitley, J., Goyal, R. et al. Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT. Bone Marrow Transplant 48, 771–776 (2013). https://doi.org/10.1038/bmt.2012.216

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