Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia

A. Mahindra, B. J. Bolwell, L. Rybicki, P. Elder, M. Kalaycio, R. Dean, B. Avalos, R. Sobecks, S. Tench, S. Andresen, B. Pohlman, J. Sweetenham, S. Devine, E. Copelan

Research output: Contribution to journalArticle

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Abstract

The use of etoposide (VP-16) for stem cell mobilization has been reported as a significant risk factor for the development of therapy-related myelodysplasia/therapyrelated AML (tMDS/tAML) after transplantation. We compared the safety and effectiveness of VP-16+G-CSF (VP+G) to G-CSF alone for PBPC mobilization in patients with non-Hodgkin's lymphoma and Hodgkin's lymphoma who underwent autologous transplantation at the Cleveland Clinic and Ohio State University. In the VP+G group, median total CD34+ cells collected were 9.34×10 6 per kg (range 0.97-180.89), with 42% of all patients having adequate (2×10 6 cells per kg) CD 34+ collection after 2 days of apheresis compared with a median in the G-CSF group of 3.83×10 6 per kg (range, 0.72-50.38), with only 16% patients having adequate collection after 2 days (P<0.001). tMDS/tAML occurred in 15 patients (2.3%) in the VP+G and in 12 patients (3.8%) receiving G-CSF alone. (P=0.62). Increased number of days of apheresis was associated with the risk of tMDS/tAML (hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.08-1.30, P<0.001). Priming regimen was not a significant variable for relapse-free survival or OS. The addition of etoposide significantly improves the effectiveness of mobilization at the cost of an increased incidence of neutropenic fever though with no mortalities. There is no evidence of increased incidence of tMDS/tAML in patients receiving VP+G compared with those mobilized with G-CSF alone.

Original languageEnglish (US)
Pages (from-to)231-235
Number of pages5
JournalBone Marrow Transplantation
Volume47
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

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Granulocyte Colony-Stimulating Factor
Etoposide
Lymphoma
Leukemia
Blood Component Removal
Hematopoietic Stem Cell Mobilization
Autologous Transplantation
Incidence
Therapeutics
Hodgkin Disease
Non-Hodgkin's Lymphoma
Fever
Transplantation
Confidence Intervals
Safety
Recurrence
Survival
Mortality

Keywords

  • etoposide
  • lymphoma
  • priming
  • secondary malignancies

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia. / Mahindra, A.; Bolwell, B. J.; Rybicki, L.; Elder, P.; Kalaycio, M.; Dean, R.; Avalos, B.; Sobecks, R.; Tench, S.; Andresen, S.; Pohlman, B.; Sweetenham, J.; Devine, S.; Copelan, E.

In: Bone Marrow Transplantation, Vol. 47, No. 2, 01.02.2012, p. 231-235.

Research output: Contribution to journalArticle

Mahindra, A, Bolwell, BJ, Rybicki, L, Elder, P, Kalaycio, M, Dean, R, Avalos, B, Sobecks, R, Tench, S, Andresen, S, Pohlman, B, Sweetenham, J, Devine, S & Copelan, E 2012, 'Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia', Bone Marrow Transplantation, vol. 47, no. 2, pp. 231-235. https://doi.org/10.1038/bmt.2011.73
Mahindra, A. ; Bolwell, B. J. ; Rybicki, L. ; Elder, P. ; Kalaycio, M. ; Dean, R. ; Avalos, B. ; Sobecks, R. ; Tench, S. ; Andresen, S. ; Pohlman, B. ; Sweetenham, J. ; Devine, S. ; Copelan, E. / Etoposide plus G-CSF priming compared with G-CSF alone in patients with lymphoma improves mobilization without an increased risk of secondary myelodysplasia and leukemia. In: Bone Marrow Transplantation. 2012 ; Vol. 47, No. 2. pp. 231-235.
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AU - Elder, P.

AU - Kalaycio, M.

AU - Dean, R.

AU - Avalos, B.

AU - Sobecks, R.

AU - Tench, S.

AU - Andresen, S.

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