Mobilisation of peripheral blood stem cells with IVE and G-CSF improves CD34⁺ cell yields and engraftment in patients with non-Hodgkin’s lymphomas and Hodgkin’s disease

Abstract

The transplantation of mobilised peripheral blood stem cells is associated with more rapid engraftment than marrow transplantation. We have previously reported that G-IVE (G-CSF, ifosphamide, VP-16, epirubicin) improves the yield of CD34⁺ cells mobilised in patients with lymphoproliferative disorders compared with cyclophosphamide 3 g/m² and G-CSF (G/CYCLO). In this study we have extended these observations to a larger series of patients including different lymphoma subtypes. Ninety-seven patients undergoing stem cell mobilisation were studied. Forty-two patients with lymphoproliferative disorders received G-IVE for mobilisation and 55 patients G/CYCLO. The median number of mobilised CD34⁺cells per leucapheresis was significantly higher for those patients receiving G-IVE: 5.82 × 10⁶/kg (0.19–36) compared with 1.2 × 10⁶/kg (0.04–17), P < 0.001 which resulted in a significantly reduced number of leucapheresis procedures performed in the g-ive group. when patients were analysed dependent on underlying disease g-ive mobilised significantly more cd34⁺cells per leucapheresis for all lymphoma types reaching 8.41 × 10⁶/kg (0.2–32) compared to 1.32 × 10⁶/kg (0.06–17) for patients with high-grade NHL mobilised with G-IVE and C-GCSF respectively (P = 0.012). For patients with low-grade NHL 3.12 × 10⁶/kg (0.10–24.39) compared to 1.08 × 10⁶/kg (0.04–9.74) were collected (P = 0.04) and for patients with Hodgkin’s disease 3.02 × 10⁶/kg (1.48–36) and 1.04 × 10⁶/kg (0.1–12.3) (P = 0.001). Mobilisation with G-IVE resulted in the achievement of clinically significant CD34⁺ cell thresholds in a significantly higher proportion of patients compared to cyclophosphamide and G-CSF reaching >2.5 × 10⁶/kg CD34⁺ cells in 88% vs 62% (P = 0.004), >5 x 10⁶/kg in 67% vs18% (P = 0.001) and >10 × 10⁶/kg in 31% vs 14.5% (P = 0.05). Furthermore, an analysis of engraftment demonstrated that there was a significant reduction in the time to achieve platelet counts of >20 and >50 × 10⁹/l in patients receiving each incremental dose of CD34⁺ cells. We conclude that G-IVE mobilises significantly more CD34⁺cells than G/CYCLO in patients with lymphoproliferative disorders. This effect is consistent in patients with high-grade NHL, low-grade NHL and HD and results in fewer failed stem collections and increased CD34⁺ cells available for transplantation which results in significantly accelerated platelet engraftment post transplant.