High dose etoposide with granulocyte colony-stimulating factor for mobilization of peripheral blood progenitor cells: efficacy and toxicity at three dose levels

被引:25
作者
Kanfer, EJ
McGuigan, D
Samson, D
Abboudi, Z
Abrahamson, G
Apperley, JF
Chilcott, S
Craddock, C
Davis, J
MacDonald, C
Macdonald, D
Olavarria, E
Philpott, N
Rustin, GJS
Seckl, MJ
Sekhar, M
Stern, S
Newlands, ES
机构
[1] Univ London Imperial Coll Sci Technol & Med, Dept Haematol, NHS Trust, Hammersmith Hosp,Sch Med, London W12 0NN, England
[2] Univ London Imperial Coll Sci Technol & Med, Dept Med Oncol, NHS Trust, Hammersmith Hosp,Sch Med, London W12 0NN, England
关键词
etoposide; progenitor cell; mobilization;
D O I
10.1038/bjc.1998.603
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
High-dose etoposide (2.0-2.4 g m(-2)) with granulocyte colony-stimulating factor (G-CSF) is an effective strategy to mobilize peripheral blood progenitor cells (PBPCs), although in some patients this is associated with significant toxicity. Sixty-three patients with malignancy were enrolled into this non-randomized sequential study. The majority (55/63, 87%) had received at least two prior regimens of chemotherapy, and seven patients had previously failed to mobilize following high-dose cyclophosphamide with G-CSF. Consecutive patient groups received etoposide at three dose levels [2.0 g m(-2) (n = 22), 1.8 g m(-2) (n = 20) and 1.6 g m(-2) (n = 21)] followed by daily G-CSF. Subsequent leukaphereses were assayed for CD34(+) cell content, with a target total collection of 2.0 x 10(6) CD34(+) cells kg(-1). Toxicity was assessed by the development of significant mucositis, the requirement for parenteral antibiotics or blood component support and rehospitalization incidence. Ten patients (16%) had less than the minimum target yield collected. Median collections in the three groups were 4.7 (2 g m(-2)), 5.7 (1.8 g m(-2)) and 6.5 (1.6 g m(-2)) x 10(6) CD34(+) cells kg(-1), Five of the seven patients who had previously failed cyclophosphamide mobilization achieved more than the target yield, Rehospitalization incidence was significantly lower in patients receiving 1.6 g m(-2) etoposide than in those receiving 2.0 g m(-2) (P = 0.03). These data suggest that high-dose etoposide with G-CSF is an efficient mobilization regimen in the majority of heavily pretreated patients, including those who have previously failed on high-dose cyclophosphamide with G-CSF. An etoposide dose of 1.6 g m(-2) appears to be as effective as higher doses but less toxic.
引用
收藏
页码:928 / 932
页数:5
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