Combination chemotherapy containing mitoguazone, ifosfamide, methotrexate,etoposide (MIME) and G-CSF efficiently mobilize peripheral blood progenitor cells in heavily pre-treated relapsed lymphoma patients

In this study we explored whether a standard chemotherapy regimen consistin g of mitoguazone, ifosfamide, methotrexate and etoposide (MIME) combined wi th 5 mug/kg or 10 mug/kg G-CSF was capable of mobilizing peripheral blood p rogenitor cells (PBPC) in lymphoma patients. Thirty-three patients with Hod gkin's disease (HD) and 108 patients with non-Hodgkin's lymphoma (NHL) were mobilized with MIME/G-CSF. Most patients were heavily treated with differe nt chemotherapy regimens receiving a median of 11 cycles (range 3-40) of ch emotherapy prior to mobilization. Eight of 141 patients failed to mobilize PBPC and bone marrow was harvested. In addition, 10 patients obtained a har vest of <2.0 x 10(6) CD34(+) cells/kg. More than 2.0 x 10(6) CD34(+) cells/ kg were achieved in all IID patients and in 83% of the NHL patients. Fifty- eight per cent of the patients harvested greater than or equal to5 x 10(6) CD34(+) cells/kg. Eleven per cent of the patients developed neutropenic fev er during the mobilization and 3% had nadir platelet values below 20 x 10(9 )/L. An inverse correlation was observed in high-grade NHL (H-NHL) patients between the number of chemotherapy cycles given before mobilization and yi eld of CD34(+) cells. Such an association was not seen among patients with HD, transformed and low-grade NHL. When G-CSF 10 mug/kg, was used in combin ation with MIME, this correlation was no longer seen in patients with H-NHL . There was also association between CD34(+) cell yield and prior radiother apy in patients with HD or transformed NHL or low-grade NHL. These results demonstrate that an ordinary salvage chemotherapy regimen, such as MIME com bined with G-CSF, can be successfully used to mobilize PBPC. Although no si gnificant effect of increased dose of G-CSF was found, our data suggest tha t MIME/ G-CSF 10 mug/kg should preferentially be used to mobilize PBPC in H -NHL patients pre-treated with greater than or equal to 12 cycles of chemot herapy, in irradiated HD patients and in all low-grade and transformed lymp homas.