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Remobilization of hematopoietic stem cells with high‐dose methotrexate and cytarabine in patients with non‐ H odgkin's lymphoma and multiple myeloma after failure to mobilize with chemotherapy and cytokines
Author(s) -
Park Seong Joon,
Yoon Dok Hyun,
Kim Shin,
Lee Kyungmin,
Park Jung Sun,
Jang Seongsoo,
Park ChanJeoung,
Chi HuynSook,
Park ChanSik,
Huh Jooryung,
Suh Cheolwon
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12314
Subject(s) - cytarabine , medicine , multiple myeloma , chemotherapy , granulocyte colony stimulating factor , cd34 , apheresis , autologous stem cell transplantation , gastroenterology , plerixafor , hematopoietic stem cell transplantation , antimetabolite , lymphoma , transplantation , haematopoiesis , surgery , stem cell , oncology , biology , platelet , chemokine , receptor , cxcr4 , genetics
Background High‐dose chemotherapy supported by autologous stem cell transplantation is an effective treatment for patients with relapsed or refractory non‐Hodgkin's lymphomas ( NHLs ) and fit patients with multiple myeloma ( MM ). However, failure rates of hematopoietic stem cell mobilization are estimated to be between 5 and 30%, respectively. Thus, we investigated the efficacy of the combination chemotherapy of high‐dose methotrexate (MTX) and cytarabine with granulocyte‐colony‐stimulating factor (G‐CSF) as a remobilization method in those who failed a prior mobilization and collection with chemotherapy and G ‐ CSF . Study Design and Methods Mobilization failure was defined as a collection of fewer than 5 × 10 6 CD 34+ cells after three to five apheresis procedures. MTX (3500 mg/m 2 in a 120‐min infusion) on D ay 1 and cytarabine (3000 mg/m 2 infusion for 120 min) on D ay 4 and D ay 5 were followed by G ‐ CSF (10 μg/kg daily). Results A total of eight patients (six NHL and two MM ; median age, 55 years) who had failed in prior mobilization with conventional chemotherapy and G ‐ CSF underwent the second mobilization as described in the method. Successful collection of CD 34+ cells (> 5 × 10 6 /kg) was achieved in six patients (75%) with three to five apheresis procedures. The total yield of CD 34+ cells/kg body weight was 6.28 × 10 6 /kg (median; range, 1.53 × 10 6 ‐10.09 × 10 6 /kg). Conclusions This preliminary result warrants further investigation of high‐dose MTX and cytarabine plus G ‐ CSF as a means to remobilize stem cells in those with prior failure to mobilize stem cells with chemotherapy and G ‐ CSF .