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"Pamiętaj o tym, że twoje swobodne i wolne od zajęć chwile obciążone są największymi zadaniami i odpowiedzialnością." - św. Augustyn
  dr hab. n. med. Artur Jurczyszyn

  Specjalista chorób wewnętrznych, hematolog
CZYTELNIA

Publikacje

Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers



Bone Marrow Transplantation (2012), 1–7
www.nature.com/bmt

The optimal protocol for mobilization of hematopoietic stem cells in patients with lymphoid malignancies has not been determined so far. We retrospectively analyzed the efficacy and safety of Ara-C at a dose of 1.6 g/m2 compared with CY at a dose of 4.0 g/m2, both combined with filgrastim. Seventy and fourty-five patients, respectively, were included, among whom 60% were defined as "predicted poor mobilizers". The use of Ara-C was associated with significantly higher peak number of circulating CD34? cells compared with CY (Po<0.0001). In the Ara-C group, 95% of patients with multiple myeloma (MM) collected at least 5,106 CD34p cells/kg required for tandem transplantation, and 97% of lymphoma patients collected at least 2,106 CD34p cells/kg, needed for a single autologous hematopoietic SCT (autoHSCT), which was achieved with a single leukapheresis in 91% of cases. Results for the CY group were significantly inferior (Po<0.0001). No patient mobilized with Ara-C experienced febrile neutropenia, whereas 35% required platelet transfusions. Among patients who proceeded to autoHSCT, the time of both neutrophil and platelet recovery was significantly shorter for those mobilized with Ara-C than CY. We conclude that intermediate-dose Ara-C + filgrastim is a very effective and relatively safe mobilization protocol for patients with lymphoid malignancies.

Bone Marrow Transplantation (2012) 0, 000–000. doi:10.1038/bmt.2012.269

Keywords: SCT; mobilization; Ara-C; CY

INTRODUCTION
Autologous hematopoietic SCT (autoHSCT) is a standard treatment of patients with multiple myeloma (MM) and selected patients with Hodgkin's (HL) or non-Hodgkin's lymphoma (NHL). Currently, 99% of the procedures are performed using peripheral blood as a source of stem cells.[1] The minimal number of CD34p cells required for neutrophil and platelet recovery after autoHSCT is 2,106/kg. However, some data indicate that higher levels are associated with less need for blood product transfusions and administration of antibiotics, as well as prolonged survival in both MM and lymphoma settings.[2–7] Q1 Furthermore, patients planned for double autoHSCT, as used in MM, require relatively higher CD34p cell yield. Therefore, 5,106/kg is considered the optimal level.[8–10] Mobilization protocols may either be based on the use of cytokines alone, most frequently G-CSF, or cytokines in combination with chemotherapy. Chemomobilization was demonstrated to increase CD34p cell yield.[11] On the other hand, it may produce severe toxicity and the need for transfusions.[11] In patients with MM, CY at wide dose range 1.5–7 g/m2 is most commonly used for mobilization.[12] For patients with lymphomas, mobilization is often a part of salvage multiagent chemotherapy. Unfortunately, 5–40% of patients fail to mobilize sufficient number of CD34p cells.[6,13–15]

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