Journal Article

High-dose cyclophosphamide with or without etoposide for mobilization of peripheral blood progenitor cells in patients with multiple myeloma: efficacy and toxicity

Sarkodee-Adoo, C, Gojo, I, Guo, C, Meisenberg, B, Cottler-Fox, M, Heyman, M, Rapoport, A P, Tricot, G, Fassas, A, Takebe, N

2004

Overview

The purpose of the study was to examine the yield of CD34(+) cells, response rates, and toxicity of high-dose cyclophosphamide with or without etoposide in patients with multiple myeloma. In total, 77 myeloma patients received either cyclophosphamide 4.5 g/m(2) (n=28) alone or with etoposide 2 g/m(2) (n=49) in a nonrandomized manner, followed by G-CSF 10 microg/kg/day for the purpose of stem cell mobilization. The effects of various factors on CD34(+) cell yield, response rate and engraftment were explored. A median of 22.39 x 10(6) CD34(+) cells/kg were collected on the first day of leukapheresis (range 0.59-114.71 x 10(6)/kg) in 71 (92%) of patients. Greater marrow plasma cell infiltration (P=0.02) or prior radiation therapy (P=0.02) adversely affected CD34(+) cell yield. In total, 45% of patients receiving cyclophosphamide and 56% of those receiving cyclophosphamide/etoposide had at least a minimum response by EBMT criteria. In all, 25% of patients who received cyclophosphamide alone vs 75.5% of patients who received combined chemotherapy required hospitalization mainly for treatment of neutropenic fever. Cyclophosphamide alone is associated with impressive CD34(+) cell yields and clear antimyeloma activity. The addition of etoposide resulted in increased toxicity without significant improvement in CD34(+) cell yield or response rates.

• Publisher: Nature Publishing Group
• Subject: Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antigens, CD34 - analysis / Antineoplastic Combined Chemotherapy Protocols - administration & dosage / Antineoplastic Combined Chemotherapy Protocols - toxicity / Biological and medical sciences / Bone marrow, stem cells transplantation. Graft versus host reaction / Care and treatment / Cyclophosphamide / Cyclophosphamide - administration & dosage / Cyclophosphamide - toxicity / Diagnosis / Dosage and administration / Etoposide - administration & dosage / Etoposide - toxicity / Female / Granulocyte Colony-Stimulating Factor - administration & dosage / Hematopoietic Stem Cell Mobilization - methods / Hematopoietic Stem Cell Mobilization - standards / Hematopoietic stem cells / Humans / Immunodeficiencies. Immunoglobulinopathies / Immunoglobulinopathies / Immunopathology / Leukapheresis - methods / Male / Medical sciences / Middle Aged / Multiple myeloma / Multiple Myeloma - complications / Multiple Myeloma - therapy / Peripheral Blood Stem Cell Transplantation - adverse effects / Peripheral Blood Stem Cell Transplantation - methods / Physiological aspects / Stem cell transplantation / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Treatment Outcome