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High dose cyclophosphamide: stem cell mobilizing capacity in 21 patients
A Indovina1, I Majolino, R Scimè
1Dipartimento di Ematologia, Ospedale V. Cervello, Palermo, Italy.
Leukemia & Lymphoma
|June 1, 1994
Summary
High-dose cyclophosphamide (HDCY) shows antitumor effects and mobilizes circulating stem cells (CSC) for transplantation in hematologic malignancies. While effective, HDCY presents significant toxicity that warrants further investigation into alternative dosing strategies.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- High-dose chemotherapy is used in treating hematologic malignancies.
- Mobilizing circulating stem cells (CSC) is crucial for autologous blood stem cell transplantation (ABSCT).
Purpose of the Study:
- To assess the antitumor effect of high-dose cyclophosphamide (HDCY).
- To evaluate the circulating stem cell (CSC) mobilizing capacity of HDCY.
- To determine the toxicity profile of HDCY in patients with hematologic malignancies.
Main Methods:
- HDCY (5-7 gr/m2) was administered to 21 patients with hematologic malignancies.
- Granulocyte-macrophage colony-stimulating factor (GM-CSF) was used in 5 patients to mitigate hematologic toxicity.
- Tumor response was defined as >50% reduction in tumor mass.
- Cell collection yields and hematologic recovery parameters were analyzed.
Main Results:
- HDCY demonstrated antitumor activity in 3/12 HD/NHL and 1/3 MM patients.
- Variable but significant yields of CSC (CFU-GM and MNC) were collected post-HDCY.
- Hematologic recovery was rapid and sustained; GM-CSF accelerated granulocyte recovery.
- Non-hematologic toxicities included nausea and vomiting, with two fatal complications.
Conclusions:
- HDCY is effective in mobilizing CSC for ABSCT but is associated with considerable toxicity.
- Further research is needed to explore lower intermediate doses for similar efficacy with reduced toxicity.