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  dr hab. n. med. Artur Jurczyszyn

  Specjalista chorób wewnętrznych, hematolog


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

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

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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