Randomized comparison of mobilization kinetics of circulating CD34+cells between biweekly CHOP and dose-escalated CHOP with the prophylactic use of lenograstim (glycosylated rHuG-CSF) in aggressive non-Hodgkin's lymphoma

High-dose chemotherapy with autologous hematopoietic stern cell transplanta tion has been expected to result in a promising outcome in high risk aggres sive non-Hodgkin's lymphoma (NHL). However, it remains unknown what type of initial chemotherapy is optimal, especially regarding progenitor cell mobi lization. Sixty-three untreated patients with aggressive NI-IL in a high ri sk group were randomized to either a biweekly arm with 8 cycles of standard CHOP or 6 cycles of the dose-escalated CHOP arm with cyclophosphamide 1.5 g/m(2) and doxorubicin 70 mg/m(2). Lenograstim (glycosylated rHuG-CSF 2.0 m u g/kg/day) was administered daily from day 3 to patients in both arms. The mobilization effect of the two regimens on circulating CD34+ cells was eva luated. Twenty-seven of 29 patients in the biweekly CHOP arm and 33 of 34 p atients in the dose-escalated CHOP were assessable. Dose-escalated CI-IOP y ielded a significantly higher number of circulating CD34+ cells in the firs t cycle compared with biweekly CHOP (p=0.05). The peak number of circulatin g CD34+ cells with biweekly CHOP did not significantly change from cycle to cycle; however, in dose-escalated CHOP, the peak number of circulating CD3 4+ cells mobilized after the fifth and sixth cycle was lower than after the first cycle (p=0.07 and 0.009, respectively). Routine conventional-dose ch emotherapy and low-dose G-CSF can mobilize sufficient CD34+ cells in patien ts with aggressive NHL. The mobilization kinetics of circulating progenitor cells in patients with aggressive NHL is dependent on the dosage and sched ule of CHOP.