Mobilisation of peripheral blood stem cells with IVE and G-CSF improves CD34(+) cell yields and engraftment in patients with non-Hodgkin's lymphomas and Hodgkin's disease

The transplantation of mobilised peripheral blood stem cells is associated with more rapid engraftment than marrow transplantation. We have previously reported that G-IVE (G-CSF, ifosphamide, VP-16, epirubicin) improves the y ield of CD34(+) cells mobilised in patients with lymphoproliferative disord ers compared with cyclophosphamide 3 g/m(2) and G-CSF (G/CYCLO). In this st udy we have extended these observations to a larger series of patients incl uding different lymphoma subtypes. Ninety-seven patients undergoing stem ce ll mobilisation were studied. Forty-two patients with Lymphoproliferative d isorders received G-IVE for mobilisation and 55 patients G/CYCLO. The media n number of mobilised CD34+ cells per leucapheresis was significantly highe r for those patients receiving G-IVE: 5.82 x 10(6)/kg (0.19-36) compared wi th 1.2 x 10(6)/kg (0.04-17), P < 0.001 which resulted in a significantly re duced number of leucapheresis procedures performed in the G-IVE group. When patients were analysed dependent on underlying disease G-IVE mobilised sig nificantly more CD34(+) cells per leucapheresis for all lymphoma types reac hing 8.41 x 10(6)/kg (0.2-32) compared to 1.32 x 10(6)/kg (0.06-17) for pat ients with high-grade NHL mobilised with G-IVE and C-GCSF respectively (P = 0.012). For patients with low-grade NHL 3.12 x 10(6)/kg (0.10-24.39) compa red to 1.08 x 10(6)/kg (0.04-9.74) were collected (P = 0.04) and for patien ts with Hodgkin's disease 3.02 x 10(6)/kg (1.48-36) and 1.04 x 10(6)/kg (0. 1-12.3) (P = 0.001). Mobilisation with G-IVE resulted in the achievement of clinically significant CD34(+) cell thresholds in a significantly higher p ro; portion of patients compared to cyclophosphamide and G-CSF reaching >2. 5 x 10(6)/kg CD34(+) cells in 88% vs 62% (P = 0.004), >5 x 10(6)/kg in 67% vs 18% (P = 0.001) and >10 x 10(6)/kg in 31% vs 14.5% (P = 0.05). Furthermo re, an analysis of engraftment demonstrated that there was a significant re duction in the time to achieve platelet counts of >20 and >50 x 10(9)/l in patients receiving each incremental dose of CD34(+) cells. We conclude that G-IVE mobilises significantly more CD34(+) cells than G/CYCLO in patients with lymphoproliferative disorders. This effect is consistent in patients w ith high-grade NHL, low-grade NHL and HD and results in fewer failed stem c ollections and increased CD34(+) cells available for transplantation which results in significantly accelerated platelet engraftment post transplant.