Successful mobilization of Ph-negative blood stem cells with intensive chemotherapy+ G-CSF in patients with chronic myelogenous leukemia in first chronic phase
2006 (English)In: Leukemia and Lymphoma, ISSN 1042-8194, Vol. 47, no 9, 1768-1773 p.Article in journal (Refereed) Published
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 <56 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/m2 and 1 hour infusion on days 1-3, and cytarabine (ara-C) 200 mg/m2 24 hours' i.v. infusion on days 1-7 (DA) followed by G-CSF 526 μg s.c. once daily from day 8 after the start of chemotherapy. Leukaphereses were initiated when the number of CD 34+ cells was >5/μ blood. Patients mobilizing poorly could receive a 4-day cycle of chemotherapy with mitoxantrone 12 mg/m2/day and 1 hour i.v infusion, etoposide 100 mg/m2/day and 1 hour i.v. infusion and ara-C 1 g/m2/twice a day with 2 hours' i.v infusion (MEA) or a second DA, followed by G-CSF 526 μg 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 × 108/kg, CFU-GM >1.0 × 104/kg, CD34+ cells >2.0 × 106/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 × 109/l was 10 (range 7-49) and with platelets <20 × 109/l 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.
Place, publisher, year, edition, pages
2006. Vol. 47, no 9, 1768-1773 p.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-37789DOI: 10.1080/10428190600611117Local ID: 38628OAI: oai:DiVA.org:liu-37789DiVA: diva2:258638