Safe mobilization of normal progenitors in advanced chronic myeloid leukemia with intensive chemotherapy and granulocyte-colony stimulating factor

Twenty-one patients with advanced chronic myeloid leukemia (late chronic ph ase (n = 8), accelerated phase (n = 11) and blast crisis (n = 2)) were trea ted with idarubicin, cytarabine, and etoposide followed by G-CSF and subseq uent collection of peripheral blood progenitor cells in the early recovery phase. Treatment was reasonably well tolerated with no deaths or intensive care admissions. Despite the advanced phase of disease and heavy pretreatme nt with cytotoxics and interferon-alfa, 11 of 21 patients (52%) achieved a cytogenetic response. Of the nine major cytogenetic responses (complete (n = 3) and partial (n = 6)), seven achieved adequate progenitor collections f or consideration for autologous transplantation. The only predictor of resp onse was disease duration (P = 0.02). With a median follow-up of 1171 days from treatment it appears unlikely that G-CSF contributed to disease progre ssion. Survival post-IcE was predicted by disease stage (P = 0.0001). Inten sive chemotherapy followed by G-CSF allowed adequate yields of predominantl y Philadelphia chromosome negative progenitor cells to be obtained from one -third of patients with advanced CML. (C) 1999 Elsevier Science Ltd. All ri ghts reserved.