Related Experiment Videos
A comparative study of sequential priming and mobilisation of progenitor cells with rhG-CSF alone and high-dose
L Meldgaard Knudsen1, L Jensen, E Gaarsdal
1Department of Haematology, L Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Insights
High-dose cyclophosphamide (HDCy) plus rhG-CSF increases CD34+ cell yield and reduces B cells compared to rhG-CSF alone, but HDCy causes significant toxicity. Further studies on lower HDCy doses are needed.
Area of Science:
- Hematology
- Stem Cell Transplantation
- Oncology
Background:
- Stem cell mobilization is crucial for patients undergoing hematopoietic stem cell transplantation.
- Current methods include rhG-CSF alone or high-dose cyclophosphamide (HDCy) plus rhG-CSF.
- Comparing the efficacy and toxicity of these mobilization strategies is essential.
Purpose of the Study:
- To intra-individually compare stem cell mobilization procedures using rhG-CSF alone versus HDCy plus rhG-CSF.
- To evaluate the CD34+ cell yield and B cell reduction.
- To register and assess the toxicity associated with each mobilization regimen.
Main Methods:
- Intra-individual comparison of mobilization procedures in 43 patients with hematological malignancies.
- Administration of rhG-CSF alone followed by HDCy plus rhG-CSF.
- Analysis of CD34+ cell yield, B cell counts (CD10+, CD19+, CD20+), and toxicity data.
Main Results:
- Higher CD34+ cell yield was observed after HDCy plus rhG-CSF compared to rhG-CSF alone in most patients.
- A reduced number of B cells in bone marrow and leukapheresis products was noted with HDCy plus rhG-CSF.
- HDCy regimen was associated with significant toxicity, including hospitalization, neutropenic fever, and seizure-like episodes in some patients.
Conclusions:
- HDCy plus rhG-CSF enhances CD34+ cell mobilization and reduces B cell contamination, potentially lowering tumor burden.
- The efficacy of HDCy is limited by its substantial toxicity and morbidity.
- Further research is warranted to evaluate the safety and efficacy of lower doses of cyclophosphamide for stem cell mobilization.
Abstract:
Stem cell mobilisation can be achieved either by administration of rhG-CSF alone or after high-dose cyclophosphamide (HDCy) plus rhG-CSF. We have compared both mobilisation procedures intra-individually in 43 patients with haematological malignancies. Furthermore, the toxicity data were registered. The CD34+ cell yield was higher after mobilisation with HDCy plus rhG-CSF than after rhG-CSF alone in 21 out of 22 patients who were actually harvested after both procedures. If a patient mobilised insufficiently after rhG-CSF alone, the yield of CD34+ cells after the following HDCy priming was lower compared to patients who mobilised sufficiently after rhG-CSF priming alone. In 12 patients with B cell malignancies a reduced number of B cells such as CD10+, CD19+, CD20+ cells in bone marrow as well as in leukapheresis products was observed after HDCy plus rhG-CSF compared to rhG-CSF alone. Toxicity data revealed HDCy as a relatively toxic priming regimen with all patients hospitalised and 74% experiencing neutropenic fever and administration of intravenous antibiotics. In two patients, seizure-like episodes were observed during cyclophosphamide bolus infusion. In conclusion, HDCy increased the yield of CD34+cell and reduced B cells in leukapheresis products indicating reduced tumour cell load compared with rhG-CSF priming alone. The efficacy of HDCy priming is limited by its profound toxicity and morbidity. Studies evaluating efficacy and safety of lower doses of cyclophosphamide are needed. Bone Marrow Transplantation (2000) 26, 717-722.