Phase II study of a single pegfilgrastim injection as an adjunct to chemotherapy to mobilize stem cells into the peripheral blood of pretreated lymphoma patients.

Abstract

BACKGROUND AND OBJECTIVES:

The aim of this study was to evaluate the efficacy of pegfilgrastim, in combination with salvage chemotherapy, in mobilizing CD34(+) stem cells into the peripheral blood of pretreated lymphoma patients.

DESIGN AND METHODS:

This was an open-label phase II study including 25 pretreated patients (Hodgkin's disease=4; aggressive non-Hodgkin's lymphoma=21). The primary end-point of the study was the successful mobilization of a target cell dose of 2x10(6) CD34(+) cells/kg in lymphoma patients receiving ifosfamide, epirubicin and etoposide (IEV) chemotherapy and a fixed dose (6 mg) of pegfilgrastim given as single subcutaneous injection.

RESULTS:

Following chemotherapy, all patients had grade 4 neutropenia that lasted a median of 1.5 days (1-3). Pegfilgrastim treatment was well tolerated and only 2/25 patients required pain-control medication. CD34+ cells were mobilized in all patients. The median (range) peak value of peripheral blood CD34+ cells after IEV chemotherapy and pegfilgrastim was 141x10(6)/L (12.8-386) and occurred almost invariably on day +14 (13-16). Twenty-three of the 25 patients underwent a single standard volume leukapheresis to collect a median of 8.7x10(6) CD34(+) cells/kg (1.78-17.3). Twenty four/25 patients (96%) reached the target cell dose of 2x10(6) CD34(+) cells/kg. High concentrations of circulating CD34+ cells (> 50x10(6)/L) were observed for several days after the achievement of the peak value. All the study patients were transplanted with their pegfilgrastim-mobilized CD34(+) cells and showed a rapid and sustained engraftment after high-dose chemotherapy.

INTERPRETATION AND CONCLUSIONS:

Our results show that pegfilgrastim as an adjunct to chemotherapy is a predictable and highly effective mobilization regimen in pretreated lymphoma patients.

• Authors: Alessandro Isidori, Monica Tani, Francesca Bonifazi, Pierluigi Zinzani, Antonio Curti, Maria Rosa Motta, Simonetta Rizzi, Valeria Giudice, Oriana Farese, Manuela Rovito, Lapo Alinari, Roberto Conte, Michele Baccarani, Roberto M Lemoli
• Journal: Haematologica (Haematologica) Vol. 90 Issue 2 Pg. 225-31 (Feb 2005) ISSN: 1592-8721 [Electronic] Italy
• PMID: 15710576 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, CD34
• Antineoplastic Agents
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• pegfilgrastim
• Polyethylene Glycols
• Filgrastim

Topics

• Adult
• Aged
• Antigens, CD34 (biosynthesis)
• Antineoplastic Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols
• Chemotherapy, Adjuvant
• Female
• Filgrastim
• Granulocyte Colony-Stimulating Factor (administration & dosage)
• Hematopoietic Stem Cell Mobilization (instrumentation, methods)
• Hematopoietic Stem Cells (drug effects, metabolism)
• Humans
• Lymphoma (therapy)
• Male
• Middle Aged
• Polyethylene Glycols
• Recombinant Proteins
• Transplantation Conditioning