ADMINISTRATION OF G-CSF AND CHEMOTHERAPY IN PATIENTS WITH LYMPHOMA AND MYELOMA OPTIMIZED SUCCESSFUL MOBILIZATION OF HEMATOPOETIC PROGENITOR CELLS FOR AUTOLOGOUS BLOOD STEM CELL TRANSPLANTATION

Abstract

Introduction. Hematopoetic stem cell mobilization and collection have been optimized in numerous clinical trials, but significant proportion of patients mobilize an insufficient number of hematopoetic stem cell, resulting in an inadequate graft. Classical strategies for peripheral blood stem cell mobilization include administration of growth factors, mainly G-CSF alone or in combination with marrow suppressive chemotherapy. The administration of a combination of chemotherapy and cytokines G-CSF is associated with a significantly increased efficacy of stem cell mobilization compared with either modality alone. Method. The aim of this study was to evaluate the efficacy of G-CSF preceded by chemotherapy (cyclophosphamide 4g/m sq for 1 dose) for hematopoetic progenitor cell mobilization for lymphoma and myeloma patients. We started G-CSF as a fixed dose 480MU SQ every day as soon as the leukocyte counts began to rise after chemotherapy induced myelosupression. Leukapheresis was commenced at the time when leukocyte count rose up to 1000/uL, and repeated for 2-4 consecutive days until target number of CD34+ cell, at least 2×106/kg was collected. Results. 39 (male to female, 21:18, age range 21-65, lymphoma 25, myeloma 14) underwent a total of 86 courses of leukapheresis for hematopoetic progenitor cell collection prior to autologous transplantation from April 2002 through October 2006. The target amount of marrow was harvest in all patients. All the patients achieved good engraftment after autologous transplantation. The mean days required for WBC count to be over 1,000/uL was 8-16 days. Patient’s age, sex, underlying malignancy, exposure to chemotherapy before mobilization did not show any statistically significant correlation. Conclusion. We can conclude that chemotherapy followed by G-CSF administration is an effective way for mobilization of hematopoetic progenitor cell and verified itself as a good mobilization method.