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Biol Blood Marrow Transplant. 2014 Jan;20(1):73-9. doi: 10.1016/j.bbmt.2013.10.012. Epub 2013 Oct 17.

High-dose etoposide plus granulocyte colony-stimulating factor as an effective chemomobilization regimen for autologous stem cell transplantation in patients with non-Hodgkin Lymphoma previously treated with CHOP-based chemotherapy: a study from the Consortium for Improving Survival of Lymphoma.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
2
Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea.
3
Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
4
Daegu Catholic University Medical Center, Daegu, Korea.
5
Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
6
Kosin University Gospel Hospital, Busan, Korea.
7
Gachon University Gil Medical Center, Incheon, Korea.
8
Dong-A University College of Medicine, Busan, Korea.
9
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
10
Chonbuk National University Medical School, Jeonju, Korea.
11
Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea. Electronic address: hemakim@yuhs.ac.

Abstract

We conducted a multicenter retrospective study to compare the efficacy and toxicity of various chemomobilization regimens: high-dose (HD) cyclophosphamide, HD etoposide (VP-16), and platinum-based chemotherapies. We reviewed the experiences of 10 institutions with 103 non-Hodgkin lymphoma patients who had previously only been treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy. The mobilization yields for each regimen were analyzed. HD VP-16 mobilized a significantly higher median number of CD34(+) cells (16.22 × 10(6) cells/kg) than HD cyclophosphamide (4.44 × 10(6) cells/kg) or platinum-based chemotherapies (6.08 × 10(6) cells/kg, P < .001). The rate of successful mobilization (CD34(+) cell count ≥ 5.0 × 10(6) cells/kg) was also significantly higher for HD VP-16 (86%) than for HD cyclophosphamide (45%) or platinum-based chemotherapies (61%, P = .004). The successful mobilization rate on day 1 of 72% for HD VP-16 was significantly higher than the rates for HD cyclophosphamide (13%) and platinum-based chemotherapies (26%, P < .001). In multivariate analysis, HD VP-16 was a significant predictor of successful mobilization (P = .014; odds ratio, 5.25; 95% confidence interval, 1.40 to 19.63). Neutropenic fever occurred in 67% of patients treated with HD VP-16. The incidence was similar for HD cyclophosphamide (58%, P = .454) but was significantly lower for platinum-based chemotherapies (12%, P < .001). However, fatal (grade ≥ 4) infection and treatment-related mortality were not observed in this study. In conclusion, the mobilization yield was significantly influenced by the chemomobilization regimen, and HD VP-16 was a highly effective mobilization regimen in patients with non-Hodgkin lymphoma.

KEYWORDS:

Cyclophosphamide; Etoposide; Non-Hodgkin lymphoma; Platinum; Stem cell mobilization

PMID:
24141009
DOI:
10.1016/j.bbmt.2013.10.012
[Indexed for MEDLINE]
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