THE BENEFITS AND PITFALLS OF PERIPHERAL BLOOD STEM CELLS MOBILIZED BY ETOPOSIDE: THE EFFECT OF CUMULATIVE DOSAGES OF ETOPOSIDE
(Abstract release date: 05/19/16)
EHA Library. Kim D. 06/09/16; 135061; PB2161
Dr. Daesik Kim
Contributions
Contributions
Abstract
Abstract: PB2161
Type: Publication Only
Background
Successful collection of adequate hematopoietic stem cells is necessary for autologous stem cell transplantation (AutoSCT). However, the optimal mobilization strategy for transplantation has still not been established. High dose cyclophosphamide with granulocyte-colony stimulating factor (G-CSF) is one of the most widely used mobilization strategies; however, in a proportion of patients, it fails to secure the collection of sufficient cells. Therefore, effective and safe alternative mobilization strategies are required.
Aims
We conducted a retrospective study to determine the impact of etoposide mobilization strategy for AutoSCT in patients with lymphoid malignacies.
Methods
We compared the effectiveness and safety profiles of chemomobilization using three regimens: intermediate-dose etoposide (750 mg/m2) followed by the late addition of G-CSF, high dose cyclophosphamide and G-CSF, and G-CSF alone. A total of 116 patients (60 multiple myeloma, 56 lymphoma) who underwent autologous stem cell transplantation (autoSCT) were included in this study.
Results
Median CD34+ cell yield was significantly higher in the etoposide group (12.3×106 cells/kg) compared to the cyclophosphamide group (4.99×106 cells/kg) and the G-CSF group (3.8×106 cells/kg) (p < .001). The rate of successful mobilization (≥5×106 cells/kg) was also significantly higher in the etoposide group (86.1%) compared to the cyclophosphamide (49.1%) and the G-CSF group (22.2%) (p < .001). There were no significant differences in neutrophil and platelet counts at the nadir between the etoposide and the cyclophosphamide group. Severe febrile neutropenia and mobilization-related mortality were not observed in any group. However, platelet engraftment was slower in the etoposide group compared to the other groups (p = 0.029). Furthermore, the proportion of delayed platelet engraftment (≥30 days) was also greater in the etoposide group than in the cyclophosphamide and the G-CSF group (20.6% vs 6.7% vs 3.8%, p = 0.032). In multivariate analysis, the etoposide mobilization strategy (p = 0.025) and the high cumulative etoposide dose (≥ 2500 mg, p = 0.003) were significantly associated with delayed platelet recovery.
Conclusion
Intermediate dose etoposide with the late addition of G-CSF may be an effective mobilization strategy. However, high cumulative doses of etoposide, including systemic chemotherapy, mobilization, and conditioning of autoSCT may delay platelet engraftment.
Session topic: E-poster
Keyword(s): Autologous stem cell collection, Etoposide, G-CSF, Stem cell mobilization
Type: Publication Only
Background
Successful collection of adequate hematopoietic stem cells is necessary for autologous stem cell transplantation (AutoSCT). However, the optimal mobilization strategy for transplantation has still not been established. High dose cyclophosphamide with granulocyte-colony stimulating factor (G-CSF) is one of the most widely used mobilization strategies; however, in a proportion of patients, it fails to secure the collection of sufficient cells. Therefore, effective and safe alternative mobilization strategies are required.
Aims
We conducted a retrospective study to determine the impact of etoposide mobilization strategy for AutoSCT in patients with lymphoid malignacies.
Methods
We compared the effectiveness and safety profiles of chemomobilization using three regimens: intermediate-dose etoposide (750 mg/m2) followed by the late addition of G-CSF, high dose cyclophosphamide and G-CSF, and G-CSF alone. A total of 116 patients (60 multiple myeloma, 56 lymphoma) who underwent autologous stem cell transplantation (autoSCT) were included in this study.
Results
Median CD34+ cell yield was significantly higher in the etoposide group (12.3×106 cells/kg) compared to the cyclophosphamide group (4.99×106 cells/kg) and the G-CSF group (3.8×106 cells/kg) (p < .001). The rate of successful mobilization (≥5×106 cells/kg) was also significantly higher in the etoposide group (86.1%) compared to the cyclophosphamide (49.1%) and the G-CSF group (22.2%) (p < .001). There were no significant differences in neutrophil and platelet counts at the nadir between the etoposide and the cyclophosphamide group. Severe febrile neutropenia and mobilization-related mortality were not observed in any group. However, platelet engraftment was slower in the etoposide group compared to the other groups (p = 0.029). Furthermore, the proportion of delayed platelet engraftment (≥30 days) was also greater in the etoposide group than in the cyclophosphamide and the G-CSF group (20.6% vs 6.7% vs 3.8%, p = 0.032). In multivariate analysis, the etoposide mobilization strategy (p = 0.025) and the high cumulative etoposide dose (≥ 2500 mg, p = 0.003) were significantly associated with delayed platelet recovery.
Conclusion
Intermediate dose etoposide with the late addition of G-CSF may be an effective mobilization strategy. However, high cumulative doses of etoposide, including systemic chemotherapy, mobilization, and conditioning of autoSCT may delay platelet engraftment.
Session topic: E-poster
Keyword(s): Autologous stem cell collection, Etoposide, G-CSF, Stem cell mobilization
Abstract: PB2161
Type: Publication Only
Background
Successful collection of adequate hematopoietic stem cells is necessary for autologous stem cell transplantation (AutoSCT). However, the optimal mobilization strategy for transplantation has still not been established. High dose cyclophosphamide with granulocyte-colony stimulating factor (G-CSF) is one of the most widely used mobilization strategies; however, in a proportion of patients, it fails to secure the collection of sufficient cells. Therefore, effective and safe alternative mobilization strategies are required.
Aims
We conducted a retrospective study to determine the impact of etoposide mobilization strategy for AutoSCT in patients with lymphoid malignacies.
Methods
We compared the effectiveness and safety profiles of chemomobilization using three regimens: intermediate-dose etoposide (750 mg/m2) followed by the late addition of G-CSF, high dose cyclophosphamide and G-CSF, and G-CSF alone. A total of 116 patients (60 multiple myeloma, 56 lymphoma) who underwent autologous stem cell transplantation (autoSCT) were included in this study.
Results
Median CD34+ cell yield was significantly higher in the etoposide group (12.3×106 cells/kg) compared to the cyclophosphamide group (4.99×106 cells/kg) and the G-CSF group (3.8×106 cells/kg) (p < .001). The rate of successful mobilization (≥5×106 cells/kg) was also significantly higher in the etoposide group (86.1%) compared to the cyclophosphamide (49.1%) and the G-CSF group (22.2%) (p < .001). There were no significant differences in neutrophil and platelet counts at the nadir between the etoposide and the cyclophosphamide group. Severe febrile neutropenia and mobilization-related mortality were not observed in any group. However, platelet engraftment was slower in the etoposide group compared to the other groups (p = 0.029). Furthermore, the proportion of delayed platelet engraftment (≥30 days) was also greater in the etoposide group than in the cyclophosphamide and the G-CSF group (20.6% vs 6.7% vs 3.8%, p = 0.032). In multivariate analysis, the etoposide mobilization strategy (p = 0.025) and the high cumulative etoposide dose (≥ 2500 mg, p = 0.003) were significantly associated with delayed platelet recovery.
Conclusion
Intermediate dose etoposide with the late addition of G-CSF may be an effective mobilization strategy. However, high cumulative doses of etoposide, including systemic chemotherapy, mobilization, and conditioning of autoSCT may delay platelet engraftment.
Session topic: E-poster
Keyword(s): Autologous stem cell collection, Etoposide, G-CSF, Stem cell mobilization
Type: Publication Only
Background
Successful collection of adequate hematopoietic stem cells is necessary for autologous stem cell transplantation (AutoSCT). However, the optimal mobilization strategy for transplantation has still not been established. High dose cyclophosphamide with granulocyte-colony stimulating factor (G-CSF) is one of the most widely used mobilization strategies; however, in a proportion of patients, it fails to secure the collection of sufficient cells. Therefore, effective and safe alternative mobilization strategies are required.
Aims
We conducted a retrospective study to determine the impact of etoposide mobilization strategy for AutoSCT in patients with lymphoid malignacies.
Methods
We compared the effectiveness and safety profiles of chemomobilization using three regimens: intermediate-dose etoposide (750 mg/m2) followed by the late addition of G-CSF, high dose cyclophosphamide and G-CSF, and G-CSF alone. A total of 116 patients (60 multiple myeloma, 56 lymphoma) who underwent autologous stem cell transplantation (autoSCT) were included in this study.
Results
Median CD34+ cell yield was significantly higher in the etoposide group (12.3×106 cells/kg) compared to the cyclophosphamide group (4.99×106 cells/kg) and the G-CSF group (3.8×106 cells/kg) (p < .001). The rate of successful mobilization (≥5×106 cells/kg) was also significantly higher in the etoposide group (86.1%) compared to the cyclophosphamide (49.1%) and the G-CSF group (22.2%) (p < .001). There were no significant differences in neutrophil and platelet counts at the nadir between the etoposide and the cyclophosphamide group. Severe febrile neutropenia and mobilization-related mortality were not observed in any group. However, platelet engraftment was slower in the etoposide group compared to the other groups (p = 0.029). Furthermore, the proportion of delayed platelet engraftment (≥30 days) was also greater in the etoposide group than in the cyclophosphamide and the G-CSF group (20.6% vs 6.7% vs 3.8%, p = 0.032). In multivariate analysis, the etoposide mobilization strategy (p = 0.025) and the high cumulative etoposide dose (≥ 2500 mg, p = 0.003) were significantly associated with delayed platelet recovery.
Conclusion
Intermediate dose etoposide with the late addition of G-CSF may be an effective mobilization strategy. However, high cumulative doses of etoposide, including systemic chemotherapy, mobilization, and conditioning of autoSCT may delay platelet engraftment.
Session topic: E-poster
Keyword(s): Autologous stem cell collection, Etoposide, G-CSF, Stem cell mobilization
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