ESHAP and G-CSF is a superior blood stem cell mobilizing regimen compared to cyclophosphamide 1.5 g m(-2) and G-CSF for pre-treated lymphoma patients: a matched pairs analysis of 78 patients

Cyclophosphamide 1.5 g m(-2) followed by granulocyte, colony-stimulating fa ctor (G-CSF) is an effective peripheral blood stem cell (PBSC) mobilizing r egimen, but has limited anti-lymphoma activity. We therefore assessed the m obilizing potential of ESHAP (etoposide, araC, methylprednisolone and cispl atin), a potent second-line lymphoma regimen followed by G-CSF. The results were compared in 78 patients with relapsed or resistant lymphomas with the use of cyclophosphamide 1.5 g m(-2) followed by G-CSF in a matched pairs a nalysis, matching the ESHAP recipients (for predetermined prognostic factor s) from a cohort of 178 lymphoma patients mobilized with cyclophosphamide a nd G-CSF; The total numbers of mononuclear cells collected at apheresis was similar with both regimens but ESHAP plus G-CSF resulted in-a significantl y higher percentage of CD34+ cells, absolute number of CD34+ cells and GM-C FC (all with P-values < 0.001). The number of patients requiring only one a pheresis harvest to achieve a CD34+ cell yield of > 2.0 x 10(6) kg(-1) was greatly increased in the ESHAP recipients (56/78 vs 17/78, P < 0.001). The total number of progenitor cells collected was not significantly different with the two mobilization regimens because of this higher number of apheres is in the cyclophosphamide group. The proportion of patients who failed to achieve a minimum CD34+ cell target of 1 x 10(6) kg(-1) with the pooled har vests was less in the ESHAP arm (four patients vs nine patients) despite an increased number of aphereses in the cyclophosphamide recipients. ESHAP pl us G-CSF is well tolerated and is an excellent mobilization regimen in pati ents with pre treated lymphoma. (C) 2000 Cancer Research Campaign.