The optimal mobilization strategy prior to autologous
stem cell transplantation (auto-SCT) for patients with
lymphoma is yet to be determined. We reviewed our institutional experience using chemomobilization with high-dose (HD)
etoposide (1.6 g/m(2) ) and
G-CSF (300 μg/day) in 79 patients with
lymphoma. The majority (76%) had received at least two prior regimens of
chemotherapy, and 12 (15.2%) patients had previously failed to mobilize following HD
cyclophosphamide or DHAP or
ICE with
G-CSF. HD
etoposide and
G-CSF chemomobilization resulted in successful collection (>2 × 10(6) CD34+ cells/kg) in 82.3% of patients within a median 2 (1-6)
apheresis days. Patients had stem cells collected between days +8 and +15, with a median +12 day. Median total CD34+ cells/kg collected was 5.95 × 10(6) (0.1-36.8). Seventy-one percent of patients yielded >2 × 10(6) CD34+ cells/kg in ≤2 d of
apheresis and were defined as good mobilizers. While median CD34+ cells/kg collected for good mobilizers was 7.6 × 10(6) , it was 2.6 × 10(6) for poor mobilizers (P < 0.001). This regimen was safe with a low rate of
febrile neutropenia (7.6%) and acceptable rates of RBC (40.5%) and
platelet transfusions (22.8%). Hematopoietic recovery after auto-SCT was achieved on expected time.
Therapy-related
myelodysplastic syndrome/acute myeloid leukemia occurred in only one patient (1.3%) with in a median follow-up of 16 months after chemomobilization. We conclude that HD
etoposide and
G-CSF chemomobilization appear to result in effective, tolerable, and safe stem cell collection in the majority of heavily pretreated
lymphoma patients.