We assessed the hematopoietic recovery and
transplantation-related mortality (TRM) of patients who had failed peripheral blood stem cell mobilization and subsequently received high-dose
chemotherapy supported by
granulocyte colony-stimulating factor (
G-CSF)-primed bone marrow (BM). Studied were 86 heavily pretreated consecutive patients with acute
leukemia (n = 21), refractory/relapsed
non-Hodgkin lymphoma (n = 41) and
Hodgkin disease (n = 17), and
multiple myeloma (n = 7). There were 78 patients who showed insufficient mobilization of CD34+ cells (< 10 cells/microL), whereas 8 patients collected less than 1 x 106 CD34+ cells/kg. BM was primed in vivo for 3 days with 15 to 16 microg/kg of subcutaneous
G-CSF. Median numbers of nucleated cells, colony-forming unit cells (CFU-Cs), and CD34+ cells per kilogram harvested were 3.5 x 10(8), 3.72 x 10(4), and 0.82 x 10(6), respectively. Following myeloablative
chemotherapy, median times to achieve a granulocyte count higher than 0.5 x 10(9)/L and an unsupported platelet count higher than 20 and 50 x 10(9)/L were 13 (range, 8-24), 15 (range, 12-75), and 22 (range, 12-180) days, respectively, for
lymphoma/myeloma patients and 23 (range, 13-53), 52 (range, 40-120), and 90 (range, 46-207) days, respectively, for
leukemia patients. Median times to hospital discharge after
transplantation were 17 (range, 12-40) and 27 (range, 14-39) days for
lymphoma/myeloma and acute
leukemia patients, respectively. TRM was 4.6%, whereas 15 patients died of disease.
G-CSF-primed BM induces effective multilineage hematopoietic recovery after high-dose
chemotherapy and can be safely used in patients with poor
stem cell mobilization.