Effective progenitor cell mobilization in lymphoproliferative disorders using ifosfamide, epirubicin and etoposide (IEV)

The combination of ifosfamide, epirubicin and etoposide (IEV) is an effecti ve salvage regimen for lymphoproliferative disease. We report our experienc e with this combination in mobilization of peripheral blood stem cells (PBS C) in patients with relapsed or refractory/high-risk lymphoma. The median t ime to leukapheresis was 14 days, with 85% of patients commencing PBSC coll ection in the range of 13-15 days. Mobilization was successful in 26 of 28 patients (93%), who achieved the minimum transplant dose of 2 x 10(6)/kg CD 34(+) cells in a median of 2 leukaphereses. Overall, the median CD34(+) cel l yield was 6.94 x 10(6)/kg (range 0.73-27.4). In 15 of 27 patients (54%), the yield was sufficient (>6 x 10(6)/kg) to permit CD34(+) cell selection a nd/or a second autogl aft. IEV was given as an inpatient in all cases. Pati ents were scheduled for discharge after chemotherapy. This: was achieved in 71%, with readmission 1 week later for harvest. Therapy was complicated by neutropenic fever in 13 patients and mild nausea. In autografts carried ou t using IEV-mobilized PBSC (n=20), the median time to neutrophils >0.5 x 10 (9)/L was 10 days (range 7-13 days), and to platelets > 20 x 10(9)/L was 13 days (range 11-18 days). There was no mobilization- or transplant-related mortality. We conclude that IEV is a safe, predictable and highly effective mobilization regimen in patients with lymphoma.