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Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy plus G-CSF in patients with chronic myelogenous leukemia in first chronic phase

Olsson-Stromberg, Ulla ; Hoglund, Martin ; Bjorkholm, Magnus ; Braide, Inger ; Carlson, Karin ; Gahrton, Gosta ; Grimfors, Gunnar ; Hast, Robert ; Lerner, Rickard and Linder, Olle , et al. (2006) In Leukemia & Lymphoma 47(9). p.1768-1773
Abstract
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... (More)
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. (Less)
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Contribution to journal
publication status
published
subject
keywords
G-CSF, autologous transplantation, CML, stem cell mobilization
in
Leukemia & Lymphoma
volume
47
issue
9
pages
1768 - 1773
publisher
Taylor & Francis
external identifiers
  • wos:000241600200012
  • scopus:33750479897
ISSN
1042-8194
DOI
10.1080/10428190600611117
language
English
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yes
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8ceed374-7265-4c40-8d7e-00900d6c6c09 (old id 378698)
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2016-04-01 16:25:07
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2019-11-20 03:38:19
@article{8ceed374-7265-4c40-8d7e-00900d6c6c09,
  abstract     = {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 &gt; 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 &gt; 3.5 x 10(8)/kg, CFU-GM &gt; 1.0 x 10(4)/kg, CD34(+) cells &gt; 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 &lt; 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.},
  author       = {Olsson-Stromberg, Ulla and Hoglund, Martin and Bjorkholm, Magnus and Braide, Inger and Carlson, Karin and Gahrton, Gosta and Grimfors, Gunnar and Hast, Robert and Lerner, Rickard and Linder, Olle and Ljungman, Per and Lofvenberg, Eva and Malm, Claes and Nilsson, Per-Gunnar and Paul, Christer and Rodjer, Stig and Stenke, Leif and Tidefeldt, Ulf and Turesson, Ingemar and Uden, Ann-Marie and Wahlin, Anders and Vilen, Lars and Winqvist, Ingemar and Zettervall, Olle and Oberg, Gunnar and Simonsson, Bengt},
  issn         = {1042-8194},
  language     = {eng},
  number       = {9},
  pages        = {1768--1773},
  publisher    = {Taylor & Francis},
  series       = {Leukemia & Lymphoma},
  title        = {Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy plus G-CSF in patients with chronic myelogenous leukemia in first chronic phase},
  url          = {http://dx.doi.org/10.1080/10428190600611117},
  doi          = {10.1080/10428190600611117},
  volume       = {47},
  year         = {2006},
}