Abstract
We explored the efficacy of the IGEV regimen (ifosfamide, gemcitabine, vinorelbine and prednisone) combined with a fixed dose of lenograstim (263 μg/day) to mobilize peripheral blood stem cells (PBSCs) in 90 Hodgkin's lymphoma patients. The median total CD34+ cells/μl peak, colony-forming units granulocyte–macrophage and white blood cells for all individual collection sets were 85/μl, 12 × 104/kg and 20 700/μl, respectively. An adequate number of CD34+ cells (more than 3 × 106 or 6 × 106 CD34+ cells/kg depending on whether single or tandem high-dose chemotherapy was used) were collected in 89 out of 90 (98.7%) mobilized patients, whereas the only failure reached 2.3 × 106 CD34+ cells/kg. The median CD34+ cell collections were 11 × 106/kg (range 2.3–39 × 106/kg) and 10 × 106/kg (range 6–22.0 × 106/kg) with a median of 1 and 2 leukaphereses for patients eligible for single high-dose treatment and for candidates for tandem transplant, respectively. Target yields were reached in 71.43 and 49.09% and additionally in 17.14 and 43.64% of cases after the first and second apheresis procedures, respectively. Hematological and non-hematological side effects were acceptable, and no toxic deaths occurred. Thirty-four patients received a single and 47 received tandem transplantation with rapid engraftment. These results confirm that the IGEV regimen with lenograstim support can be used successfully and safely to mobilize PBSCs.
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References
Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A et al. Dose intensification with autologous bone marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet 1993; 341: 1051–1054.
Magagnoli M, Castagna L, Balzarotti M, Demarco M, Santoro A . What is the best option to cure patients with resistant/relapse Hodgkin's disease? Curr Stem Cell Res Ther 2006; 1: 419–424.
Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M et al. German Hodgkin's lymphoma Study group; lymphoma working party of the European group for blood and marrow transplantation. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomized trial. Lancet 2002; 359: 2065–2071.
Seyfarth B, Josting A, Dreyling M, Schmitz N . Relapse in common lymphoma subtypes: salvage treatment options for follicular lymphoma, diffuse large cell lymphoma and Hodgkin disease. Br J Haematol 2006; 133: 3–18.
Alexandrescu DT, Karri S, Wiernick PH, Duthcher JP . Mitoxantrone, vinblastine and CCNU: long-term follow-up of patients treated for advanced and poor-prognosis Hodgkin's disease. Leuk Lymphoma 2006; 47: 641–656.
Baetz T, Belch A, Couban S, Imrie K, Yau J, Myers R et al. Gemcitabine, dexamethasone and cisplatin is an active and non-toxic chemotherapy regimen in relapsed or refractory Hodgkin's disease: a phase II study by the National Cancer Institute of Canada Clinical Trials Group. Ann Oncol 2003; 14: 1762–1767.
Bonfante V, Viviani S, Santoro A, Devizzi L, Di Russo A, Zanini M et al. Ifosfamide and vinorelbine: an active regimen for patients with relapsed or refractory Hodgkin's disease. Br J Haematol 1998; 103: 533–535.
Ferme C, Bastion Y, Lepage E, Berger F, Brice P, Morel P et al. MINE regimen as intensive salvage chemotherapy for relapsed and refractory Hodgkin's disease. Ann Oncol 1995; 6: 543–549.
Ibrahim D, Smith MR, Varterasian M, Karanes C, Millenson M, Yeslow G et al. Phase II study of PEND chemotherapy in patients with refractory/relapsed Hodgkin lymphoma. Leuk Lymphoma 2004; 45: 2079–2084.
Josting A, Rudolph C, Reiser M, Mapara M, Sieber M, Kirchner HH et al. Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease. Ann Oncol 2002; 13: 1628–1635.
Kuruvilla J, Nagy T, Pintilie M, Tsang R, Keating A, Crump M . Similar response rates and superior early progression-free survival with gemcitabine, dexamethasone, and cisplatin salvage therapy compared with carmustine, etoposide, cytarabine, and melphalan salvage therapy prior to autologous stem cell transplantation for recurrent or refractory Hodgkin lymphoma. Cancer 2006; 106: 353–360.
Martin A, Fernandez-Jimenez MC, Caballero MD, Canales MA, Perez-Simon JA, Garcia de Bustos J et al. Long-term follow-up in patients treated with mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease. Br J Haematol 2001; 113: 161–171.
McQuaker I, Haynes A, Stainer C, Byrne J, Russell N . 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. Bone Marrow Transplant 1999; 24: 715–722.
Moskowitz CH, Kewalramani T, Nimer SD, Gonzalez M, Zelenetz AD, Yahalom J . Effectiveness of high dose chemoradiotherapy and autologous stem cell transplantation for patients with biopsy-proven primary refractory Hodgkin's disease. Br J Haematol 2004; 124: 645–652.
Oyan B, Koc Y, Ozdemir E, Kars A, Turker A, Tekuzman G et al. Ifosfamide, idarubicin, and etoposide in relapsed/refractory Hodgkin disease or non-Hodgkin lymphoma: a salvage regimen with high response rates before autologous stem cell transplantation. Biol Blood Marrow Transplant 2005; 11: 688–697.
Ribrag V, Nasr F, Bouhris JH, Bosq J, Brault P, Girinsky T et al. VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refarctory Hodgkin's disease. Bone Marrow Transplant 1998; 21: 969–974.
Rodriguez J, Rodriguez MA, Fayad L, McLaughlin P, Swan F, Sarris A et al. ASHAP: a regimen for cytoreduction of refractory or recurrent Hodgkin's disease. Blood 1999; 11: 3632–3636.
Bartlett N, Niedzwiecki D, Johnson J, Friedberg J, Johnson K, van Besien K et al. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin's lymphoma: CALGB 59804. Ann Oncol 2007; 18: 1071–1079.
Smardova L, Engert A, Haverkamp H, Raemakers J, Baars J, Pfistner B et al. Successful mobilization of peripheral blood stem cells with the DHAP regimen (dexamethasone, cytarabine, cisplatinum) plus granulocyte colony-stimulating factor in patients with relapsed Hodgkin's disease. Leuk Lymphoma 2005; 46: 1017–1022.
Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M et al. Ifosfamide, gemcitabine, and vinorelbine (IGEV): a new induction regimen for refractory and relapsed Hodgkin's lymphoma. Haematologica 2007; 92: 35–41.
Castagna L, Magagnoli M, Balzarotti M, Sarina B, Siracusano L, Nozza A et al. Tandem high-dose chemotherapy and autologous stem cell transplantation in refractory/relapsed Hodgkin's lymphoma: a monocenter prospective study. Am J Haematol 2007; 82: 122–127.
Devizzi L, Santoro A, Bonfante V, Viviani S, Balzarini L, Valagussa P et al. Vinorelbine: an active drug in the management of patients with heavily pre-treated Hodgkin's disease. Ann Oncol 1994; 5: 817–820.
La Cesne A, Antoine E, Spielmann M, Le Chevalier T, Brain E, Toussaint C et al. High-dose ifosfamide: circumvention of resistance to standard dose ifosfamide in advanced soft tissue sarcomas. J Clin Oncol 1995; 13: 1600–1608.
Magagnoli M, Sarina B, Balzarotti M, Castagna L, Timofeeva I, Nozza A et al. Mobilising potential of ifosfamide/vinorelbine-based chemotherapy in pretreated malignant lymphoma. Bone Marrow Transplant 2001; 28: 923–927.
Lucas JB, Horwitz SM, Horning SJ, Sayegh A . Gemcitabine is active in relapsed Hodgkin's disease. J Clin Oncol 1999; 17: 2627–2628.
Zinzani PL, Bendandi M, Stefoni V, Albertini P, Gherlinzoni F, Tani M et al. Value of gemcitabine treatment in heavily pretreated Hodgkin's disease patients. Haematologica 2000; 85: 926–929.
Santoro A, Bredenfeld H, Devizzi L, Tesch H, Bonfante V, Viviani S et al. Gemcitabine in the treatment of refractory Hodgkin's disease: results of a multicenter phase II study. J Clin Oncol 2000; 18: 2615–2625.
Akhtar S, Tbakhi A, Humaidan H, El Weshi A, Rahal M, Maghfoor I . ESHAP + fixed dose G-CSF as autologous peripheral blood stem cell mobilization regimen in patients with relapsed or refractory diffuse large cell and Hodgkin's lymphoma: a single institution result of 127 patients. Bone Marrow Transplant 2006; 37: 277–282.
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Magagnoli, M., Spina, M., Balzarotti, M. et al. IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkin's lymphoma patients. Bone Marrow Transplant 40, 1019–1025 (2007). https://doi.org/10.1038/sj.bmt.1705862
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DOI: https://doi.org/10.1038/sj.bmt.1705862
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