Superior autologous blood stem cell mobilization from dose-intensive cyclophosphamide, etoposide, cisplatin plus G-CSF than from less intensive chemotherapy regimens

The study purpose was to determine if G-CSF plus dose-intensive cyclophosph amide 5.25 g/m(2), etoposide 1.05 g/m(2) and cisplatin 105 mg/m(2) (DICEP) results in superior autologous blood stem cell mobilization (BSCM) than les s intensive chemotherapy. From January 1993 until May 1997, 152 consecutive patients with non-Hodgkin's lymphoma (n = 55), breast cancer (n = 47), Hod gkin's disease (n = 14), multiple myeloma (n = 9), AML (n = 9), or other ca ncers (n = 18) initially underwent BSCM by one of three methods: Group 1: G -CSF alone x 4 days (n = 30). Group 2: disease-oriented chemotherapy, dosed to avoid blood transfusions, followed by G-CSF starting day 7 or 8, and ap heresis day 13 or 14 (n = 82). Group 3: DICEP days 1-3, G-CSF starting day 14, and apheresis planned day 19, 20 or 21 (n = 40). A multivariate analysi s nas performed to determine which factors independently predicted BSCM. Th e median peripheral blood CD34(+) (PB CD34(+)) cell count the morning of ap heresis linearly correlated with the number of CD34(+) cells removed per li tre of apheresis that day. The median PB CD34(+) cell count and median CD34 (+) cells x 10(6) removed per litre of apheresis were highest for Group 3, intermediate for Group 2, and lowest for Group 1. By multivariate analysis, mobilization group (3 > 2 > 1), disease other than AML, no prior melphalan or mitomycin-C, and less than two prior chemotherapy regimens predicted be tter BSCM. Out of 15 Group 3 patients who had infiltrated marrows, 11 had n o detectable cancer in marrow and apheresis products after DICEP. These dat a suggest that DICEP results in superior BSCM than less intensive chemother apy regimens.