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Mobilization

Topotecan–filgrastim combination is an effective regimen for mobilizing peripheral blood stem cells

Bone Marrow Transplantation volume 28, pages 563–571 (2001)Cite this article

Abstract

We compared the efficacy, toxicity, and cost of topotecan–filgrastim and filgrastim alone for mobilizing peripheral blood stem cells (PBSCs) in 24 consecutive pediatric patients with newly diagnosed medulloblastoma. PBSCs were mobilized with an upfront window of topotecan–filgrastim for 11 high-risk patients (residual tumor ⩾1.5 cm2 after resection; metastases limited to neuraxis) and with filgrastim alone for 13 average-risk patients. All patients subsequently underwent craniospinal irradiation and four courses of high-dose chemotherapy with stem cell rescue. Target yields of CD34+ cells (⩾8 × 106/kg) were obtained with only one apheresis procedure for each of the 11 patients treated with topotecan–filgrastim, but with a mean of 2.3 apheresis procedures for only six (46%) of the 13 patients treated with filgrastim alone (P = 0.0059). The median peak and median total yield of CD34+ cells were six-fold higher for the topotecan–filgrastim group (328/μl and 21.5 × 106/kg, respectively) than for the filgrastim group (54/μl and 3.7 × 106/kg, respectively). Mean times to neutrophil and platelet engraftment were similar. Myelosuppression was the only grade 4 toxicity associated with topotecan–filgrastim mobilization and lasted a median of 5 days. Compared with filgrastim mobilization, topotecan–filgrastim mobilization resulted in a mean cost saving of $3966 per patient. Topotecan–filgrastim is an efficacious, minimally toxic, and cost-saving combination for PBSC mobilization. Bone Marrow Transplantation (2001) 28, 563–571.

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Acknowledgements

This work was supported by Cancer Center Support (CORE) grant P30 CA 21765 and grant P01 CA 23099 from the National Cancer Institute; by grant NMRC 0082/95 from the National Medical Research Council (Singapore); and by the American Lebanese Syrian Associated Charities (ALSAC). We thank Dr Julia Cay Jones for editorial consultation and Patsy Burnside for typing the manuscript. We also acknowledge the National Medical Research Council of Singapore for the funding of Dr Yeoh at St Jude Children's Research Hospital.

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Authors and Affiliations

  1. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    E-J A Yeoh, JM Cunningham, JA Houston, SL Richardson, LC Bowman & AJ Gajjar

  2. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA

    D Hunt

  3. Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    CF Stewart

  4. Department of Molecular Pharmacology, St Jude Children's Research Hospital, Memphis, TN, USA

    PJ Houghton

  5. Department of Pediatrics, College of Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA

    JM Cunningham, LC Bowman & AJ Gajjar

  6. Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA

    GC Yee

  7. Department of Pediatrics, National University of Singapore, Singapore

    E-J A Yeoh

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Yeoh, EJ., Cunningham, J., Yee, G. et al. Topotecan–filgrastim combination is an effective regimen for mobilizing peripheral blood stem cells. Bone Marrow Transplant 28, 563–571 (2001). https://doi.org/10.1038/sj.bmt.1703202

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