Peripheral Blood Stem Cell Mobilization by Chemotherapy with and without Recombinant Human Granulocyte Colony-Stimulating Factor

Lee Schwartzberg, Robert Birch, Bonni Hazelton, Kurt W. Tauer, Paul Lee, Rand Altemose, Christopher George, Ralph Blanco, Fred Wittlin, James Cohen, Joseph Muscato, William H. West

Research output: Contribution to journalArticle

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Abstract

Chemotherapy can serve as a stimulus for mobilizing hematopoietic progenitor cells to the peripheral blood for harvest via leukapheresis. Mobilized peripheral blood stem cells (PBSC) support rapid hematologic reconstitution after bone marrow aplasia induced by intensive myelosuppressive treatments. Our purpose was to develop effective mobilization regimens allowing collection of large quantities of PBSC. We administered high-dose cyclophosphamide (HDC, 4 gm/m2) or cyclophosphamide (4 gm/m2) plus etoposide (600 mg/m2) (HDCE) in a nonrandomized, sequential fashion to 94 patients with breast cancer, lymphoma, and other malignancies with collection of PBSC via leukapheresis during white blood cell (WBC) recovery from nadir counts. Each apheresis product was analyzed for total nucleated cell number, granulocyte-macrophage colony-forming units (CFU-GM) and CD34+ cells. Twenty-four additional patients with comparable pretreatment characteristics received HDCE plus recombinant human granulocyte colony-stimulating factor (HDCE + G) after chemotherapy through the end of apheresis. Patients receiving HDC were matched for age, sex, and disease but were more heavily pretreated. HDCE was superior to HDC in mean daily CFU-GM and CD34+ yield (p < 0.05), even when groups were adjusted for performance status and amount of prior therapy. HDCE + G led to 3.7 times more CFU-GM and 4.7 times more CD34+ cells than HDCE. Target PBSC yield, defined as >20 × 104 CFU-GM/kg and >4 × 108 cells/kg, was achieved by 92% of HDCE + G patients after a median of three aphereses, 56% of HDCE patients after five aphereses, and 16% of HDC patients after six aphereses (p < 0.0001). Prior chemotherapy inversely correlated with the quantity of PBSC harvested regardless of regimen utilized. Our results demonstrate effective chemotherapy regimens for harvesting hematopoietic progenitors in a diverse patient population. HDCE + G produced the highest number of progenitors, suggesting that increasing dose intensity and adding rhG-CSF enhances mobilization. Correlation between cumulative CD34+ and CFU-GM allows real-time flow cytometric analysis of the number of aphereses required to harvest target numbers of PBSC.

Original languageEnglish (US)
Pages (from-to)317-327
Number of pages11
JournalJournal of Hematotherapy and Stem Cell Research
Volume1
Issue number4
DOIs
StatePublished - Jan 1 1992

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Hematopoietic Stem Cell Mobilization
Granulocyte Colony-Stimulating Factor
Blood Component Removal
Granulocyte-Macrophage Progenitor Cells
Drug Therapy
Leukapheresis
Cyclophosphamide
Etoposide
Hematopoietic Stem Cells
Peripheral Blood Stem Cells
Lymphoma
Leukocytes
Cell Count
Bone Marrow
Breast Neoplasms

All Science Journal Classification (ASJC) codes

  • Immunology
  • Hematology

Cite this

Peripheral Blood Stem Cell Mobilization by Chemotherapy with and without Recombinant Human Granulocyte Colony-Stimulating Factor. / Schwartzberg, Lee; Birch, Robert; Hazelton, Bonni; Tauer, Kurt W.; Lee, Paul; Altemose, Rand; George, Christopher; Blanco, Ralph; Wittlin, Fred; Cohen, James; Muscato, Joseph; West, William H.

In: Journal of Hematotherapy and Stem Cell Research, Vol. 1, No. 4, 01.01.1992, p. 317-327.

Research output: Contribution to journalArticle

Schwartzberg, L, Birch, R, Hazelton, B, Tauer, KW, Lee, P, Altemose, R, George, C, Blanco, R, Wittlin, F, Cohen, J, Muscato, J & West, WH 1992, 'Peripheral Blood Stem Cell Mobilization by Chemotherapy with and without Recombinant Human Granulocyte Colony-Stimulating Factor', Journal of Hematotherapy and Stem Cell Research, vol. 1, no. 4, pp. 317-327. https://doi.org/10.1089/scd.1.1992.1.317
Schwartzberg, Lee ; Birch, Robert ; Hazelton, Bonni ; Tauer, Kurt W. ; Lee, Paul ; Altemose, Rand ; George, Christopher ; Blanco, Ralph ; Wittlin, Fred ; Cohen, James ; Muscato, Joseph ; West, William H. / Peripheral Blood Stem Cell Mobilization by Chemotherapy with and without Recombinant Human Granulocyte Colony-Stimulating Factor. In: Journal of Hematotherapy and Stem Cell Research. 1992 ; Vol. 1, No. 4. pp. 317-327.
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N2 - Chemotherapy can serve as a stimulus for mobilizing hematopoietic progenitor cells to the peripheral blood for harvest via leukapheresis. Mobilized peripheral blood stem cells (PBSC) support rapid hematologic reconstitution after bone marrow aplasia induced by intensive myelosuppressive treatments. Our purpose was to develop effective mobilization regimens allowing collection of large quantities of PBSC. We administered high-dose cyclophosphamide (HDC, 4 gm/m2) or cyclophosphamide (4 gm/m2) plus etoposide (600 mg/m2) (HDCE) in a nonrandomized, sequential fashion to 94 patients with breast cancer, lymphoma, and other malignancies with collection of PBSC via leukapheresis during white blood cell (WBC) recovery from nadir counts. Each apheresis product was analyzed for total nucleated cell number, granulocyte-macrophage colony-forming units (CFU-GM) and CD34+ cells. Twenty-four additional patients with comparable pretreatment characteristics received HDCE plus recombinant human granulocyte colony-stimulating factor (HDCE + G) after chemotherapy through the end of apheresis. Patients receiving HDC were matched for age, sex, and disease but were more heavily pretreated. HDCE was superior to HDC in mean daily CFU-GM and CD34+ yield (p < 0.05), even when groups were adjusted for performance status and amount of prior therapy. HDCE + G led to 3.7 times more CFU-GM and 4.7 times more CD34+ cells than HDCE. Target PBSC yield, defined as >20 × 104 CFU-GM/kg and >4 × 108 cells/kg, was achieved by 92% of HDCE + G patients after a median of three aphereses, 56% of HDCE patients after five aphereses, and 16% of HDC patients after six aphereses (p < 0.0001). Prior chemotherapy inversely correlated with the quantity of PBSC harvested regardless of regimen utilized. Our results demonstrate effective chemotherapy regimens for harvesting hematopoietic progenitors in a diverse patient population. HDCE + G produced the highest number of progenitors, suggesting that increasing dose intensity and adding rhG-CSF enhances mobilization. Correlation between cumulative CD34+ and CFU-GM allows real-time flow cytometric analysis of the number of aphereses required to harvest target numbers of PBSC.

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