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Stem Cell Procurement

ESHAP plus G-CSF as an effective peripheral blood progenitor cell mobilization regimen in pretreated non-Hodgkin's lymphoma: comparison with high-dose cyclophosphamide plus G-CSF

Summary:

The ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin) regimen has been shown to be effective as an active salvage therapy for lymphoma. Mobilizing stem cells following ESHAP should decrease time to transplantation by making separate mobilizing chemotherapy (MC) unnecessary, while controlling a patient's lymphoma. We therefore assessed the mobilization potential of ESHAP plus G-CSF in 26 patients (ESHAP group) with non-Hodgkin's lymphoma (NHL) and compared these results with those of 24 patients with NHL who received high-dose (4 g/m2l) cyclophosphamide (HDCY) as MC (HDCY group). The age, sex, and radiotherapy to the axial skeleton were well matched between groups, but the number of patients with poor mobilization predictors was higher in the ESHAP group. Significantly higher numbers of CD34+ cells (× 106/kg) (17.1±18.8 vs 5.8±5.0, P=0.03) and apheresis day 1 CD34+ cells (× 106/kg) (5.5±6.6 vs 1.7±2.0, P=0.014) were collected from the ESHAP group than from the HDCY group, and the number of patients who achieved an optimal CD34+ cell target of 5 × 106/kg was higher in the ESHAP group (81 vs 50%, P=0.022). Log-rank test revealed that time to target peripheral blood progenitor cell collection (5 × 106/kg) was shorter in the ESHAP group (P=0.007). These results indicate that ESHAP plus G-CSF is an excellent mobilization regimen in patients with relapsed and poor-risk aggressive NHL.

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References

  1. Vose JM, Zhang MJ, Rowlings PA et al. Autologous transplantation for diffuse aggressive non-Hodgkin's lymphoma in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 2001; 19: 406–413.

    Article  CAS  Google Scholar 

  2. Philip T, Guglielmi C, Hagenbeek A et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med 1995; 333: 1540–1545.

    Article  CAS  Google Scholar 

  3. Haioun C, Lepage E, Gisselbrecht C et al. Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma: final analysis of the prospective LNH87-2 protocol – a groupe d'Etude des lymphomes de l'Adulte study. J Clin Oncol 2000; 18: 3025–3030.

    Article  CAS  Google Scholar 

  4. Goldschmidt H, Hegenbart U, Haas R, Hunstein W . Mobilization of peripheral blood progenitor cells with high-dose cyclophosphamide (4 or 7 g/m2) and granulocyte colony-stimulating factor in patients with multiple myeloma. Bone Marrow Transplant 1996; 17: 691–697.

    CAS  Google Scholar 

  5. Velasquez WS, McLaughlin P, Tucker S et al. ESHAP – an effective chemotherapy regimen in refractory and relapsing lymphoma: a 4-year follow-up study. J Clin Oncol 1994; 12: 1169–1176.

    Article  CAS  Google Scholar 

  6. Rodriguez-Monge EJ, Cabanillas F . Long-term follow-up of platinum-based lymphoma salvage regimens. The MD Anderson Cancer Center experience. Hematol Oncol Clin N Am 1997; 11: 937–947.

    Article  CAS  Google Scholar 

  7. Petit J, Boque C, Cancelas JA et al. Feasibility of ESHAP+G-CSF as peripheral blood hematopoietic progenitor cell mobilisation regimen in resistant and relapsed lymphoma: a single-center study of 22 patients. Leukemia Lymphoma 1999; 34: 119–127.

    Article  CAS  Google Scholar 

  8. Berdeja JG, Ambinder RF, Jones RJ et al. Stem cell mobilization with G-CSF following standard ESHAP chemotherapy in patients with lymphoma. Blood 2001; 98: 456 (abstr. 754).

    Google Scholar 

  9. Watts MJ, Ings SJ, Leverett D et al. ESHAP and G-CSF is a superior blood stem cell mobilizing regimen compared to cyclophosphamide 1.5 g m(−2) and G-CSF for pre-treated lymphoma patients: a matched pairs analysis of 78 patients. Br J Cancer 2000; 82: 278–282.

    Article  CAS  Google Scholar 

  10. Lee JL, Kim SB, Lee GW et al. The efficacy of high-dose melphalan with autologous peripheral blood stem cell transplantation in patients with multiple myeloma. Yonsei Med J 2003; 44: 800–810.

    Article  CAS  Google Scholar 

  11. Lee JL, Kim SB, Lee GW et al. Clinical usefulness of the hematopoietic progenitor cell counts in predicting the optimal timing of peripheral blood stem cell harvest. J Korean Med Sci 2003; 18: 27–35.

    Article  Google Scholar 

  12. Park KU, Kim SH, Suh C et al. Correlation of hematopoietic progenitor cell count determined by the SE-automated hematology analyzer with CD34(+) cell count by flow cytometry in leukapheresis products. Am J Hematol 2001; 67: 42–47.

    Article  CAS  Google Scholar 

  13. Suh C, Kim S, Kim S-H et al. Initiation of peripheral blood stem cell harvest based on peripheral blood hematopoietic progenitor cell counts enumerated by the Sysmex SE-9000. Transfusion 2004; 44: 1762–1768.

    Article  Google Scholar 

  14. Lee JL, Kim SB, Lee GW et al. Collection of peripheral blood progenitor cells: analysis of factors predicting the yields. Transfus Apheresis Sci 2003; 29: 29–37.

    Article  Google Scholar 

  15. To LB, Haylock DN, Simmons PJ, Juttner CA . The biology and clinical uses of blood stem cells. Blood 1997; 89: 2233–2258.

    CAS  Google Scholar 

  16. Pavone V, Gaudio F, Guarini A et al. Mobilization of peripheral blood stem cells with high-dose cyclophosphamide or the DHAP regimen plus G-CSF in non-Hodgkin's lymphoma. Bone Marrow Transplant 2002; 29: 285–290.

    Article  CAS  Google Scholar 

  17. Olivieri A, Offidani M, Ciniero L et al. DHAP regimen plus G-CSF as salvage therapy and priming for blood progenitor cell collection in patients with poor prognosis lymphoma. Bone Marrow Transplant 1995; 16: 85–93.

    CAS  Google Scholar 

  18. Moskowitz CH, Bertino JR, Glassman JR et al. Ifosfamide, carboplatin, and etoposide: a highly effective cytoreduction and peripheral-blood progenitor-cell mobilization regimen for transplant-eligible patients with non-Hodgkin's lymphoma. J Clin Oncol 1999; 17: 3776–3785.

    Article  CAS  Google Scholar 

  19. Goldschmidt H, Hegenbart U, Wallmeier M et al. Factors influencing collection of peripheral blood progenitor cells following high-dose cyclophosphamide and granulocyte colony-stimulating factor in patients with multiple myeloma. Br J Haematol 1997; 98: 736–744.

    Article  CAS  Google Scholar 

  20. Watts MJ, Sullivan AM, Ings SJ et al. Evaluation of clinical scale CD34+ cell purification: experience of 71 immunoaffinity column procedures. Bone Marrow Transplant 1997; 20: 157–162.

    Article  CAS  Google Scholar 

  21. Le Gouill S, Moreau P, Morineau N et al. Tandem high-dose therapy followed by autologous stem-cell transplantation for refractory or relapsed high grade non-Hodgkin's lymphoma with poor prognosis factors: a prospective pilot study. Haematologica 2002; 87: 333–334.

    Google Scholar 

  22. Allan DS, Keeney M, Howson-Jan K et al. Number of viable CD34(+) cells reinfused predicts engraftment in autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29: 967–972.

    Article  CAS  Google Scholar 

  23. Dreger P, Marquardt P, Haferlach T et al. Effective mobilisation of peripheral blood progenitor cells with ‘Dexa-BEAM’ and G-CSF: timing of harvesting and composition of the leukapheresis product. Br J Cancer 1993; 68: 950–957.

    Article  CAS  Google Scholar 

  24. McQuaker IG, Haynes AP, Stainer C et al. Stem cell mobilization in resistant or relapsed lymphoma: superior yield of progenitor cells following a salvage regimen comprising ifosphamide, etoposide and epirubicin compared to intermediate-dose cyclophosphamide. Br J Haematol 1997; 98: 228–233.

    Article  CAS  Google Scholar 

  25. Aurlien E, Holte H, Pharo A et al. Combination chemotherapy with mitoguazon, ifosfamide, MTX, etoposide (MIME) and G-CSF can efficiently mobilize PBPC in patients with Hodgkin's and non-Hodgkin's lymphoma. Bone Marrow Transplant 1998; 21: 873–878.

    Article  CAS  Google Scholar 

  26. Weaver CH, Zhen B, Buckner CD . Treatment of patients with malignant lymphoma with mini-BEAM reduces the yield of CD34+ peripheral blood stem cells. Bone Marrow Transplant 1998; 21: 1169–1170.

    Article  CAS  Google Scholar 

  27. Zinzani PL, Barbieri E, Visani G et al. Ifosfamide, epirubicin and etoposide (IEV) therapy in relapsed and refractory high-grade non-Hodgkin's lymphoma and Hodgkin's disease. Haematologica 1994; 79: 508–512.

    CAS  PubMed  Google Scholar 

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Lee, JL., Kim, S., Kim, S. et al. ESHAP plus G-CSF as an effective peripheral blood progenitor cell mobilization regimen in pretreated non-Hodgkin's lymphoma: comparison with high-dose cyclophosphamide plus G-CSF. Bone Marrow Transplant 35, 449–454 (2005). https://doi.org/10.1038/sj.bmt.1704798

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