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PBPC mobilization with intermediate-dose cyclophosphamide, sequential CSF and granulocyte-CSF, and scheduled commencement of LP in 225 patients undergoing autologous transplantation

Bashey A, Donohue M, Liu L, Medina B, Corringham S, Ihasz A, Carrier E, Castro JE, Holman PR, Xu R, Law P, Ball ED, Lane TA. Transfusion. 2007 Nov;47(11):2153-60.

Abstract

Background: Interpatient variability in the kinetics of peripheral blood progenitor cell (PBPC) mobilization is commonly seen with conventional chemotherapy-based mobilization regimens. This necessitates the availability of leukapheresis (LP) facilities 7 days a week.
Study design and methods: The efficacy of an approach where LP was invariably commenced on Day 11 after intermediate-dose cyclophosphamide followed by sequential administration of granulocyte-macrophage-colony-stimulating factor (CSF) and granulocyte-CSF (Cy/GM/G) was retrospectively analyzed in 225 consecutive, unselected patients undergoing autologous hematopoietic stem cell transplantation for all diagnoses other than acute leukemia at our center. Cy/GM/G was scheduled to avoid weekend LP.
Results: After Cy/GM/G, a CD34+ cell yield of at least 2.0×10(6) per kg was achieved in 90.7 percent of patients. Optimal yield (OY; >or=5×10(6) or 10×10(6) CD34+ cells/kg depending on diagnosis) was achieved in 67.6 percent of patients. Only three patients (1.3%) required LP on Saturday or Sunday. Febrile neutropenia (FN) was encountered in 5.3 percent. PBPC yield was highest on Day 1 of LP (p<0.001). In multivariate analyses, platelet (PLT) count on Day 1 of LP (PLT-D1LP) was positively associated with achievement of OY (p<0.001). PLT-D1LP and diagnosis of myeloma were associated with a shorter time to achieve a CD34+ cell yield of at least 5x10(6) per kg (p<0.001 and p=0.002, respectively).

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