Mobilization kinetics of peripheral blood progenitor cells after IAPVP-16 salvage chemotherapy plus G-CSF in lymphoproliferative disorders

We have explored the efficacy of salvage chemotherapy combination, IAPVP-16 (ifosfamide 5 g/m(2) on day 1; VP-16 100 mg/m(2) on days 1-3; ara-C 1.2 g/m(2)/12 h on days 1 and 2; methylprednisolone 80 mg/m(2) on days 1-5) plus G-CSF for PBPC mobilization, This protocol was used in 45 patients with relapsed or refractory lymphoproliferative diseases who underwent 85 leukaphereses, Tn 41 patients >2 x 10(6)/kg CD34(+) cells were obtained after a median of two procedures. The median number of CD34(+) cells harvested was 3.2 x 10(6)/kg per apheresis and 8.4 x 10(6)/kg per patient. Seven of 10 patients who had failed previous mobilization attempts achieved more than 2 x 10(6) CD34(+) cells/kg in a maximum of three aphereses, A history of previous mobilization failure and a low platelet count (<150 x 10(9)/1) negatively influenced the CD34(+) cell yield in univariate and multivariate analyses. A good correlation was found between the circulating CD34(+) cells/mu l and the CD34(+) cells and CFU-GM in the leukaphereses products (r = 0.93 and r = 0.73, P < 0.001), and greater than or equal to 17 CD34(+) cells/mu l predicted the achievement of >2 x 10(6)/kg CD34(+) cells in a single leukapheresis in more than 90% of cases. IAPVP-16 plus G-CSF may be specially indicated in tandem transplantations or CD34(+) selection and in patients who have failed previous mobilization attempts.