Stem cell mobilization in resistant or relapsed lymphoma: superior yield of progenitor cells following a salvage regimen comprising ifosphamide, etoposide and epirubicin compared to intermediate‐dose cyclophosphamide

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Abstract
We analysed the factors influencing the efficacy of peripheral blood stem cell (PBSC) collection in patients with lymphoma. Sixty‐six patients underwent initial PBSC collection following mobilization with chemotherapy plus recombinant granulocyte colony‐stimulating factor (300 μg/d). Patients were mobilized with one of two chemotherapy regimens, either cyclophophamide (3 g/m2 or 4 g/m2) (n=50) or ifosphamide, etoposide and epirubicin (IVE; n=16). The target of collecting >2.0×106 CD34+ cells/kg was achieved in 43/66 (65%) patients with a median of two apheresis procedures. The IVE plus G‐CSF mobilization regimen gave a significantly higher median yield of CD34+ cells (8.62 × 106/kg) compared with cyclophosphamide plus G‐CSF (3.59 × 106/kg) (P=0.045). The median yield of CD34+ cells per leukapheresis was almost twice as high in patients receiving IVE (1.94 × 106/kg) compared to cyclophosphamide (1.03 ×106/kg) (P= 0.035). In a univariate analysis of the factors affecting mobilization, the subtype of lymphoma (high‐grade NHL) and the mobilization regimen were the only factors associated with high CD34+ cell yield. However, in a multivariate analysis of factors affecting mobilization including age, lymphoma subtype, previous chemotherapy and radiotherapy, only the use of the IVE protocol was predictive of a high yield of CD34+ cells. In 13 patients undergoing a second mobilization procedure the use of IVE was associated with a significantly higher yield of CD34+ cells compared to cyclophosphamide; three patients who failed cyclophosphamide plus G‐CSF mobilization were able to proceed to transplantation following success‐ful mobilization with IVE + G‐CSF. These results demon‐strate that IVE is a highly effective mobilization regimen which is superior to cyclophophamide and has the benefit of being effective salvage therapy for lymphoma patients.

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