Standard- versus high-dose lenograstim in adults with hematologic malignancies for peripheral blood progenitor cell mobilization.

Abstract

BACKGROUND:

The aim of this retrospective, multicenter study was to compare high- versus standard-dose lenograstim after chemotherapy in collecting target dose of CD34+ peripheral blood progenitor cells (PBPCs) in adult candidates for autologous transplant.

STUDY DESIGN AND METHODS:

A total of 166 consecutive patients (28 acute leukemias [ALs], 77 lymphomas, 61 multiple myeloma [MM]) underwent 182 mobilization procedures. Only the first were analyzed. The CD34+ cell target was at least 2×10(6) , 4×10(6) , and 8×10(6) /kg and lenograstim started on days +19, +1, and +5 from the end of chemotherapy for AL, lymphomas, and MM, respectively. Eighty-seven and 79 patients, respectively, received 5 and 10µg/kg/day lenograstim subcutaneously (sc). An analysis to evaluate factors predicting satisfactory procedures and outcome of transplants performed with first-mobilization-procedure PBPCs was conducted. Most patients received 6mg of pegfilgrastim or 5µg/kg/day lenograstim sc after transplant.

RESULTS:

In multivariate analysis, high-dose lenograstim (p=0.053) in MM and male sex (p=0.028) were positive predictive factors for reaching cell target. Fludarabine negatively influenced stimulation length (p=0.002). Apheresis, CD34+ cells mobilized and collected, blood volume processed, side effects, transplants performed, and engraftment time were similar between lenograstim cohorts. Pegfilgrastim versus lenograstim delayed platelet (PLT) recovery times (13 days vs. 11 days, p=0.036).

CONCLUSIONS:

High-dose lenograstim more efficiently mobilized MM patients requiring the highest PBPC target but did not influence transplants performed and engraftment time. Male patients mobilized more efficiently. Fludarabine negatively influenced stimulation length. Finally, pegfilgrastim seems to delay PLT recovery.

• Authors: Azzurra Romeo, Anna Chierichini, Alessandra Spagnoli, Mariangela Vittori, Michele Vacca, Maria Gozzer, Antonio Spadea, Barbara Anaclerico, Maria Laura Dessanti, Mariella D'Andrea, Giuseppe Toglia, Luciana Annino, Maria Concetta Petti, Andrea Mengarelli, William Arcese, Rome Transplant Network
• Journal: Transfusion (Transfusion) Vol. 50 Issue 11 Pg. 2432-46 (Nov 2010) ISSN: 1537-2995 [Electronic] United States
• PMID: 20553434 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: © 2010 American Association of Blood Banks.

Chemical References

• Adjuvants, Immunologic
• Antigens, CD34
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• Lenograstim

Topics

• Adjuvants, Immunologic (administration & dosage, adverse effects)
• Adolescent
• Adult
• Aged
• Antigens, CD34 (metabolism)
• Dose-Response Relationship, Drug
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage, adverse effects)
• Hematologic Neoplasms (economics, therapy)
• Hematopoietic Stem Cell Mobilization (economics, methods)
• Hematopoietic Stem Cell Transplantation (economics, methods)
• Hematopoietic Stem Cells (cytology, metabolism)
• Hospital Costs
• Humans
• Lenograstim
• Male
• Middle Aged
• Predictive Value of Tests
• Recombinant Proteins (administration & dosage, adverse effects)
• Retrospective Studies
• Transplantation, Autologous
• Treatment Outcome
• Young Adult