Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma

Craig Moskowitz, Jill R. Glassman, David Wuest, Peter Maslak, Lilian Reich, Anthony Gucciardo, Nancy Coady-Lyons, Andrew D. Zelenetz, Stephen D Nimer

Research output: Contribution to journalArticle

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Abstract

The objective of this study was to identify factors associated with poor mobilization of peripheral blood progenitor cells (PBPCs) or delayed platelet engraftment after high-dose therapy and autologous stem cell transplantation in patients with lymphoma. Fifty-eight patients with Hodgkin's disease or non-Hodgkin's lymphoma underwent PBPC transplantation as the 'best available therapy' at Memorial Sloan-Kettering Cancer Center (New York, NY) between 1993 and 1995. PBPCs were mobilized with either granulocyte colony- stimulating factor (G-CSF) alone (n = 19) or G-CSF following combination chemotherapy (n = 39). Forty-eight of these patients underwent a PBPC transplant, receiving a conditioning regimen containing cyclophosphamide, etoposide, and either total body irradiation, total lymphoid irradiation, or carmustine. A median number of 4.6 x 106 CD34+ cells/kg were obtained with a median of three leukapheresis procedures. Mobilization of PBPCs using chemotherapy plus G-CSF was superior to G-CSF alone (6.7 x 106 versus 1.5 x 106 CD34+ cells/kg; P = 0.0002). Poorer mobilization of progenitor cells was observed in patients who had previously received stem cell-toxic chemotherapy, including (a) nitrogen mustard, procarbazine, melphalan, carmustine or >7.5 g of cytarabine chemotherapy premobilization (2.0 x 106 versus 6.0 x 106 CD34+ cells/kg; P = 0.005), or (b) ≤11 cycles of any previous chemotherapy (2.6 x 106 versus 6.7 x 106 CD34+ cells/kg; P = 0.02). Platelet recovery to >20,000/μl was delayed in patients who received <2.0 x 106 CD34+ cells (median, 13 versus 22 days; P = 0.06). Patients who received ≤11 cycles of chemotherapy prior to PBPC mobilization tended to have delayed platelet recovery to > 20,000/μl and to require more platelet transfusions than less extensively pretreated patients (median, 13.5 versus 23.5 days; P = 0.15; median number of platelet transfusion episodes, 13 versus 9; P = 0.17). These data suggest that current strategies to mobilize PBPCs may be suboptimal in patients who have received either stem cell-toxic chemotherapy or ≤11 cycles of chemotherapy prior to PBPC mobilization. Alternative approaches, such as ex vivo expansion or the use of other growth factors in addition to G-CSF, may improve mobilization of progenitor cells for PBPC transplantation.

Original languageEnglish
Pages (from-to)311-316
Number of pages6
JournalClinical Cancer Research
Volume4
Issue number2
StatePublished - Feb 1 1998
Externally publishedYes

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Lymphoma
Blood Cells
Stem Cells
Granulocyte Colony-Stimulating Factor
Drug Therapy
Carmustine
Platelet Transfusion
Poisons
Cell Transplantation
Blood Platelets
Lymphatic Irradiation
Procarbazine
Leukapheresis
Mechlorethamine
Melphalan
Whole-Body Irradiation
Cytarabine
Stem Cell Transplantation
Etoposide
Combination Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma. / Moskowitz, Craig; Glassman, Jill R.; Wuest, David; Maslak, Peter; Reich, Lilian; Gucciardo, Anthony; Coady-Lyons, Nancy; Zelenetz, Andrew D.; Nimer, Stephen D.

In: Clinical Cancer Research, Vol. 4, No. 2, 01.02.1998, p. 311-316.

Research output: Contribution to journalArticle

Moskowitz, C, Glassman, JR, Wuest, D, Maslak, P, Reich, L, Gucciardo, A, Coady-Lyons, N, Zelenetz, AD & Nimer, SD 1998, 'Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma', Clinical Cancer Research, vol. 4, no. 2, pp. 311-316.
Moskowitz C, Glassman JR, Wuest D, Maslak P, Reich L, Gucciardo A et al. Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma. Clinical Cancer Research. 1998 Feb 1;4(2):311-316.
Moskowitz, Craig ; Glassman, Jill R. ; Wuest, David ; Maslak, Peter ; Reich, Lilian ; Gucciardo, Anthony ; Coady-Lyons, Nancy ; Zelenetz, Andrew D. ; Nimer, Stephen D. / Factors affecting mobilization of peripheral blood progenitor cells in patients with lymphoma. In: Clinical Cancer Research. 1998 ; Vol. 4, No. 2. pp. 311-316.
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