Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy plus G-CSF in patients with chronic myelogenous leukemia in first chronic phase
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The aim of the study was to investigate the feasibility of mobilizing Philadelphia chromosome negative (Ph-) blood stem cells (BSC) with intensive chemotherapy and lenograstim (G-CSF) in patients with CML in first chronic phase (CP1). During 1994-1999 12 centers included 37 patients 556 years. All patients received 6 months' IFN, stopping at median 36 (1-290) days prior to the mobilization chemotherapy. All received one cycle of daunorubicin 50 mg/m(2) and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m(2) 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 mu g s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34(+) cells was > 5/ml blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m(2)/day and 1 hour i.v infusion, etoposide 100 mg/m(2)/day and 1 hour i.v. infusion and ara-C 1g/m(2)/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 mg s.c once daily from day 8 after the start of chemotherapy. Twenty-seven patients received one cycle of chemotherapy and G-CSF, whereas 10 were mobilized twice. Twenty-three patients (62%) were successfully (MNC > 3.5 x 10(8)/kg, CFU-GM > 1.0 x 10(4)/kg, CD34(+) cells > 2.0 x 10(6)/kg and no Ph+ cells in the apheresis product) [n=16] or partially successfully ( as defined above but 1-34% Ph+ cells in the apheresis product) [n=7] mobilized. There was no mortality during the mobilization procedure. Twenty-one/23 patients subsequently underwent auto-SCT. The time with PMN < 0.5 x 10(9)/l was 10 (range 7-49) and with platelets 520610 9/1 was also 10 (2-173) days. There was no transplant related mortality. The estimated 5-year overall survival after auto-SCT was 68% (95% CI 47-90%), with a median follow-up time of 5.2 years. We conclude that in a significant proportion of patients with CML in CP 1, intensive chemotherapy combined with G-CSF mobilizes Ph-BSC sufficient for use in auto-SCT.
|Research areas and keywords||
Subject classification (UKÄ) – MANDATORY
|Journal||Leukemia & Lymphoma|
|Publication status||Published - 2006|