Factors determining pbsc mobilization efficiency and nonmobilization following ICE with or without rituximab (R‐ICE) salvage therapy for refractory or relapsed lymphoma prior to autologous transplantation

ICE/R‐ICE (ifosfamide, carboplatin, and etoposide without or with rituximab) chemotherapy followed by autologous stem cell transplantation is an established regimen in refractory/relapsed lymphoma. Few studies have addressed which factors are important in determining peripheral blood stem cell (PBSC) mobilization efficiency or nonmobilization following ICE/R‐ICE. Between 2004 and 2013, 88 patients with refractory/relapsed lymphoma who received ICE/R‐ICE salvage‐chemotherapy prior to granulocyte colony stimulating factor (G‐CSF) stimulated PBSC mobilization at a single center were identified. Mobilization efficiency was assessed by time from ICE/R‐ICE to day of harvest, duration of G‐CSF use, days to peripheral blood (PB) CD34 + ≥15/µL, PB CD34 + number on harvest day, CD34 + yield and nonmobilization rate. Median PB CD34 + at harvest were 54/μL (7–524); median days to first apheresis was 15 (11–30); median harvested total CD34 + were 5.46 × 10 6 /kg (0.96–44.36); 71 patients (80.7%) successfully mobilized; 20 (22.7%) patients were poor mobilizers; 14 (15.9%) patients were considered nonmobilizers with maximal PB CD34 + <7/µL and did not proceed to apheresis. Six of 20 poor mobilizers were apheresed with PB CD34 + 7–12/µL, 50% were successfully harvested. No differences were found between ICE and R‐ICE regimens. Impaired mobilization efficiency was associated with age, remission status, >1 line of induction chemotherapy, four cycles ICE/R‐ICE and grade 4 neutropenia. Prior bone marrow (BM) involvement was associated with nonmobilization. The majority of patients can be successfully mobilized with ICE/R‐ICE. Prior BM involvement is associated with high rates of nonmobilization following ICE/R‐ICE. Such patients may benefit from novel mobilization agents and/or alternative salvage regimens to ICE/R‐ICE. J. Clin. Apheresis 29:322–330 2014. © 2014 Wiley Periodicals, Inc.