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Double‐cycle high‐dose chemotherapy with peripheral blood stem cells and hematopoietic growth factor support in patients with advanced solid tumor. A pilot study by the Hong Kong biotherapy group
Author(s) -
Yeung Alex W.,
Pang Ying Ki,
Tsang Yin Chun,
Wong Sai Wah
Publication year - 1994
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19940401)73:7<1960::aid-cncr2820730730>3.0.co;2-h
Subject(s) - medicine , chemotherapy , etoposide , granulocyte colony stimulating factor , absolute neutrophil count , hematopoietic growth factor , haematopoiesis , cyclophosphamide , stem cell , bone marrow , leukapheresis , gastroenterology , surgery , urology , oncology , neutropenia , cd34 , biology , genetics
Background . High‐dose chemotherapy with autologous bone marrow transplantation has been useful in some patients with advanced breast, lymphoma, or germ cell tumors. Double‐cycle high‐dose chemotherapy may be able to deliver an even higher total dose within a given time period. It is important to determine whether peripheral blood stem cells and hematopoietic growth factors can diminish the hematopoietic toxicity of such a treatment. Methods . From November 1989 to May 1991, 14 patients were enrolled in two cycles of high‐dose chemotherapy consisting of cyclophosphamide, 4.5 g/m 2 ; cisplatin, 150 mg/m 2 ; and etoposide, 900 mg/m 2 in each cycle. The first five patients received peripheral blood stem cells harvested from 8–10 leukaphereses during steady state. The next nine patients, besides receiving peripheral blood stem cells mobilized by growth factors, also received either granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) at 250 μg/m 2 /day by two subcutaneous (s.c.) injections given 12 hours apart from day 6 until neutrophil recovery or granulocyte colony‐stimulating factor (G‐CSF) at 200 μg/m 2 as daily s.c. injections. Results . For the first five patients, there was a median of 14 days from the first day of absolute marrow suppression to neutrophil count exceeding 500/μl and a median of 15 days for a platelet count exceeding 20,000/μl. For the next nine patients, with the use of either G‐CSF or GM‐CSF, there was a median of 8 days for a neutrophil count exceeding 500/μl and and a median of 11 days for a platelet count exceeding 20,000/μl. Conclusion . With the use of peripheral stem cells and growth factors, high‐dose chemotherapy could be given safely every 30 days with acceptable toxicity. A high complete response rate was seen in patients with nasopharyngeal carcinoma and in patients with small cell and non‐small cell lung cancer who either had not received previous chemotherapy or who had responded to previous chemotherapy.