Blood stem cell collection using chemotherapy with or without systematic G-CSF: experience in 52 patients with multiple myeloma

Bone Marrow Transplant. 1999 Sep;24(5):463-6. doi: 10.1038/sj.bmt.1701910.

Abstract

Harvesting of peripheral blood stem cells (PBSCs) following chemotherapy and G-CSF administration is currently performed for hematological therapies. However, a procedure based on the use of a large quantity of G-CSF is relatively costly. Therefore, we retrospectively compared the effects of two PBSC mobilization procedures in a population with recently diagnosed multiple myeloma. The first procedure consisted of chemotherapy and systematic G-CSF administration (group 1: 24 patients). The second consisted of chemotherapy alone, G-CSF having been administered only in the case of failure of PBSC mobilization or delayed white blood cell (WBC) recovery (group 2: 28 patients). Leukapheresis was performed when WBC recovery reached 1 x 10(9)/l if the peripheral blood CD34+ cell count was over 10/microl. Leukapheresis was maintained until a total of 2.5 x 10(6) CD34+ cells/kg was harvested. A significant difference was observed between the two groups only in regard to the median period of WBC recovery (delayed for group 2) and the number of CD34+ cells/kg collected on the first leukapheresis (higher for group 1) but not to the proportion of patients with failure of PBSC collection. Ten group 2 patients, who had insufficient CD34+ cells after WBC recovery or delayed WBC recovery, received G-CSF which resulted in sufficient PBSC harvesting in nine. To obtain a sufficient CD34+ cell level, the patients without systematic G-CSF administration had more leukaphereses (2.1 vs 1.5) but the mean consumption of G-CSF per patient was eight times less than in the other group. Nonsystematic use of G-CSF before WBC recovery or preferentially its introduction just after, could be an interesting economical alternative in PBSC mobilization but should be assessed by a prospective controlled study of cost/efficacy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Blood Cells*
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / pharmacology
  • Doxorubicin / administration & dosage
  • Doxorubicin / pharmacology
  • Drug Administration Schedule
  • Evaluation Studies as Topic
  • Female
  • Granulocyte Colony-Stimulating Factor / pharmacology*
  • Hematopoietic Stem Cell Mobilization / economics
  • Hematopoietic Stem Cell Mobilization / methods*
  • Hematopoietic Stem Cells* / drug effects
  • Humans
  • Leukapheresis*
  • Male
  • Middle Aged
  • Multiple Myeloma / blood*
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / therapy
  • Prednisone / administration & dosage
  • Prednisone / pharmacology
  • Retrospective Studies
  • Vincristine / administration & dosage
  • Vincristine / pharmacology

Substances

  • Granulocyte Colony-Stimulating Factor
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol