Stem cell mobilization regimens
Section editor | |
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Aric C. Hall, MD Madison, WI AricHall1 |
Unlike the other chemotherapy regimen pages, this one is not disease-specific. Rather, this is meant to be a gathering point for all stem cell mobilization regimens.
11 regimens on this page
13 variants on this page
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Stem cell mobilization, all lines of therapy
These are regimens intended to mobilize stem cells, very incomplete right now but will be filled in over time.
CAD & G-CSF
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CAD: Cyclophosphamide, Adriamycin (Doxorubicin), Dexamethasone
Regimen
Study | Evidence |
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Lokhorst et al. 2009 (HOVON-50) | Non-randomized portion of RCT |
This is reported as a stem cell mobilization regimen but presumably has anti-myeloma activity.
Preceding treatment
Chemotherapy
- Cyclophosphamide (Cytoxan) 1000 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 15 mg/m2 IV once per day on days 1 to 4
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
Growth factor therapy
- Filgrastim (Neupogen) 5 mcg/kg SC twice per day until collection completed
One course
Subsequent treatment
- High-dose melphalan, then auto HSCT or tandem high-dose melphalan, then auto HSCT (this was not a randomization but was pre-determined by the treating center)
References
- HOVON-50: Lokhorst HM, van der Holt B, Zweegman S, Vellenga E, Croockewit S, van Oers MH, von dem Borne P, Wijermans P, Schaafsma R, de Weerdt O, Wittebol S, Delforge M, Berenschot H, Bos GM, Jie KS, Sinnige H, van Marwijk-Kooy M, Joosten P, Minnema MC, van Ammerlaan R, Sonneveld P; Dutch-Belgian Hemato-Oncology Group (HOVON). A randomized phase 3 study on the effect of thalidomide combined with adriamycin, dexamethasone, and high-dose melphalan, followed by thalidomide maintenance in patients with multiple myeloma. Blood. 2010 Feb 11;115(6):1113-20. Epub 2009 Oct 30. link to original article contains verified protocol PubMed
- Update: van de Donk NW, van der Holt B, Minnema MC, Vellenga E, Croockewit S, Kersten MJ, von dem Borne PA, Ypma P, Schaafsma R, de Weerdt O, Klein SK, Delforge M, Levin MD, Bos GM, Jie KG, Sinnige H, Coenen JL, de Waal EG, Zweegman S, Sonneveld P, Lokhorst HM. Thalidomide before and after autologous stem cell transplantation in recently diagnosed multiple myeloma (HOVON-50): long-term results from the phase 3, randomised controlled trial. Lancet Haematol. 2018 Oct;5(10):e479-e492. link to original article PubMed
Cyclophosphamide & G-CSF
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Variant #1
Study | Evidence |
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Oakervee et al. 2005 | Phase II |
Chemotherapy
- Cyclophosphamide (Cytoxan) 1500 mg/m2 IV once on day 1
Growth factor therapy
- Lenograstim (Granocyte) 263 mcg SC once per day, starting on day 4
Stem cell collection begins on day 10 and continues until at least 2 × 106 CD34+ cells/kg are collected.
Variant #2
Study | Evidence |
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Royer et al. 2016 | Phase II |
Chemotherapy
- Cyclophosphamide (Cytoxan) 3000 mg/m2 IV once
Growth factor therapy
- Filgrastim (Neupogen) 10 mcg/kg SC once per day and continued until at least 4 × 106 CD34+ cells/kg are collected
References
- Oakervee HE, Popat R, Curry N, Smith P, Morris C, Drake M, Agrawal S, Stec J, Schenkein D, Esseltine DL, Cavenagh JD. PAD combination therapy (PS-341/bortezomib, doxorubicin and dexamethasone) for previously untreated patients with multiple myeloma. Br J Haematol. 2005 Jun;129(6):755-62. link to original article contains verified protocol PubMed
- Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. link to original article contains protocol PubMed
Cytarabine & G-CSF
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Variant #1, 2000 mg/m2 x 8
Study | Evidence |
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Yanada et al. 2013 | Phase II |
Target CD34+ cell dose: 2.0 × 106/kg
Chemotherapy
- Cytarabine (Ara-C) 2000 mg/m2 IV over 3 hours twice per day on days 1 to 4 (total dose: 16,000 mg/m2)
Growth factor therapy
- Filgrastim (Neupogen) starting on day 6 (dose, frequency not specified)
Variant #2, 3000 mg/m2 x 2
Study | Evidence |
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Abrey et al. 2003 | Phase II |
Chemotherapy
- Cytarabine (Ara-C) 3000 mg/m2 IV once per day on days 1 & 2
Growth factor therapy
- Filgrastim (Neupogen) 10 mcg/kg SC once per day, starting on day 4 and continued until stem cell collection complete
References
- Abrey LE, Moskowitz CH, Mason WP, Crump M, Stewart D, Forsyth P, Paleologos N, Correa DD, Anderson ND, Caron D, Zelenetz A, Nimer SD, DeAngelis LM. Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis. J Clin Oncol. 2003 Nov 15;21(22):4151-6. link to original article contains verified protocol PubMed
- Yanada M, Tsuzuki M, Fujita H, Fujimaki K, Fujisawa S, Sunami K, Taniwaki M, Ohwada A, Tsuboi K, Maeda A, Takeshita A, Ohtake S, Miyazaki Y, Atsuta Y, Kobayashi Y, Naoe T, Emi N; Japan Adult Leukemia Study Group. Phase 2 study of arsenic trioxide followed by autologous hematopoietic cell transplantation for relapsed acute promyelocytic leukemia. Blood. 2013 Apr 18;121(16):3095-102. Epub 2013 Feb 14. link to original article contains verified protocol PubMed
Cytarabine, Ifosfamide, G-CSF
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Regimen
Study | Evidence |
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Colombat et al. 2006 | Phase II |
Chemotherapy
- Cytarabine (Ara-C) 1000 mg/m2 IV every 12 hours on days 1 & 2
- Ifosfamide (Ifex) 1500 mg/m2 IV once per day on days 1 to 3
Growth factor therapy
- Filgrastim (Neupogen) (dose/frequency not specified)
References
- Colombat P, Lemevel A, Bertrand P, Delwail V, Rachieru P, Brion A, Berthou C, Bay JO, Delepine R, Desablens B, Camilleri-Broët S, Linassier C, Lamy T. High-dose chemotherapy with autologous stem cell transplantation as first-line therapy for primary CNS lymphoma in patients younger than 60 years: a multicenter phase II study of the GOELAMS group. Bone Marrow Transplant. 2006 Sep;38(6):417-20. link to original article contains verified protocol PubMed
CYVE & G-CSF
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CYVE & G-CSF: CYtarabine, VEpesid (Etoposide), Granulocyte Colony Stimulating Factor
Regimen
Study | Evidence |
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Soussain et al. 2001 | Pilot, >20 pts |
Soussain et al. 2008 | Phase II |
Target collection dose not described; mobilization took place after the first course of CYVE salvage for CNS lymphoma.
Chemotherapy
- Cytarabine (Ara-C) as follows:
- 2000 mg/m2 IV over 3 hours once per day on days 2 to 5
- 50 mg/m2 IV over 12 hours once per day on days 1 to 5
- Etoposide (Vepesid) 200 mg/m2 IV over 2 hours once per day on days 2 to 5
Growth factor therapy
- Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting 48 hours after end of chemotherapy
References
- Soussain C, Suzan F, Hoang-Xuan K, Cassoux N, Levy V, Azar N, Belanger C, Achour E, Ribrag V, Gerber S, Delattre JY, Leblond V. Results of intensive chemotherapy followed by hematopoietic stem-cell rescue in 22 patients with refractory or recurrent primary CNS lymphoma or intraocular lymphoma. J Clin Oncol. 2001 Feb 1;19(3):742-9. link to original article contains verified protocol PubMed
- Soussain C, Hoang-Xuan K, Taillandier L, Fourme E, Choquet S, Witz F, Casasnovas O, Dupriez B, Souleau B, Taksin AL, Gisselbrecht C, Jaccard A, Omuro A, Sanson M, Janvier M, Kolb B, Zini JM, Leblond V; Société Française de Greffe de Moëlle Osseuse-Thérapie Cellulaire. Intensive chemotherapy followed by hematopoietic stem-cell rescue for refractory and recurrent primary CNS and intraocular lymphoma: Société Française de Greffe de Moëlle Osseuse-Thérapie Cellulaire. J Clin Oncol. 2008 May 20;26(15):2512-8. Epub 2008 Apr 14. link to original article contains verified protocol PubMed
DCEP & G-CSF
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DCEP & G-CSF: Dexamethasone, Cyclophosphamide, Etoposide, Platinol (Cisplatin), Granulocyte Colony Stimulating Factor
Regimen
Study | Evidence |
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Corso et al. 2004 | Phase II |
Stem cells are mobilized and collected after each course of therapy.
Chemotherapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
- Cyclophosphamide (Cytoxan) 400 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 1600 mg/m2)
- Etoposide (Vepesid) 40 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 160 mg/m2)
- Cisplatin (Platinol) 10 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 40 mg/m2)
Supportive medications
- Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting 48 hours after chemotherapy and continuing through stem cell collection
2 cycles (length not specified)
References
- Corso A, Barbarano L, Zappasodi P, Cairoli R, Alessandrino EP, Mangiacavalli S, Ferrari D, Fava S, Fiumanò M, Frigerio G, Isa L, Luraschi A, Klersy C, De Paoli A, Vergani C, Banfi L, Perego D, Ucci G, Pinotti G, Savarè M, Uziel L, Vismara A, Morra E, Lazzarino M. The VAD-DCEP sequence is an effective pre-transplant therapy in untreated multiple myeloma. Haematologica. 2004 Sep;89(9):1124-7. link to original article contains verified protocol PubMed
EAR & G-CSF
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EAR & G-CSF: Etoposide, Ara-C (Cytarabine), Rituximab, Granulocyte Colony Stimulating Factor
Regimen
Study | Evidence |
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Damon et al. 2009 (CALGB 59909) | Phase II |
Note: Text specified that PJP prophylaxis started during mobilization --although table 1 did not list it-- to continue until 3 months after auto HSCT.
Preceding treatment
- R-M-CHOP x 2 to 3 cycles
Chemotherapy
- Etoposide (Vepesid) 10 mg/kg/day IV continuous infusion over 96 hours, started on day 1 (total dose: 40 mg/kg)
- Cytarabine (Ara-C) 2000 mg/m2 IV over 2 hours twice per day on days 1 to 4 (8 total doses)
- Rituximab (Rituxan) 375 mg/m2 IV once per day on days 6 & 13
Supportive medications
- Filgrastim (Neupogen) 10 mcg/kg SC once per day, starting on day 14, to continue until peripheral blood stem cell collection is complete
- Levofloxacin (Levaquin) 500 mg PO once per day, starting on day 7, to continue until ANC greater than or equal to 500/uL
- Fluconazole (Diflucan) 200 mg PO once per day, starting on day 6, to continue until ANC greater than or equal to 500/uL
- Acyclovir (Zovirax) 200 mg PO three times per day, starting on day 6, to continue until 1 year after auto HSCT
- Trimethoprim/Sulfamethoxazole (Bactrim DS) prophylaxis
Daily leukapheresis to start when WBC count greater than or equal to 5 x 109/L
Subsequent treatment
- Patients with adequate collection and meeting criteria: CBV with autologous HSCT
References
- CALGB 59909: Damon LE, Johnson JL, Niedzwiecki D, Cheson BD, Hurd DD, Bartlett NL, Lacasce AS, Blum KA, Byrd JC, Kelly M, Stock W, Linker CA, Canellos GP. Immunochemotherapy and autologous stem-cell transplantation for untreated patients with mantle-cell lymphoma: CALGB 59909. J Clin Oncol. 2009 Dec 20;27(36):6101-8. Epub 2009 Nov 16. link to original article contains protocol link to PMC article PubMed
IGEV & G-CSF
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IGEV & G-CSF: Ifosfamide, GEmcitabine, Vinorelbine, Granulocyte Colony Stimulating Factor
Regimen
Study | Evidence |
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Magagnoli et al. 2007 | Phase II |
Chemotherapy
- Ifosfamide (Ifex) 2000 mg/m2 IV over 2 hours once per day on days 1 to 4
- Gemcitabine (Gemzar) 800 mg/m2 IV once per day on days 1 & 4
- Vinorelbine (Navelbine) 20 mg/m2 IV once on day 1
- Prednisolone (Millipred) 100 mg PO once per day on days 1 to 4
Supportive medications
- Mesna (Mesnex) 900 mg/m2 IV three times per day on days 1 to 4, given at 0, 2, 4 hours after Ifosfamide (Ifex) (total dose: 10,800 mg/m2)
- Lenograstim (Granocyte) 263 mcg SC once per day on days 7 until at least 3 x 106 CD34+ cells per kg of body weight were collected
Apheresis was performed when the peripheral blood CD34+ cell count exceeded 10 cells/ul.
References
- Magagnoli M, Spina M, Balzarotti M, Timofeeva I, Isa L, Michieli M, Capizzuto R, Morenghi E, Castagna L, Tirelli U, Santoro A. IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkin's lymphoma patients. Bone Marrow Transplant. 2007 Dec;40(11):1019-25. Epub 2007 Oct 1. link to original article contains verified protocol PubMed
DexaBEAM & G-CSF
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DexaBEAM & G-CSF: Rituximab, Dexamethasone, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan, Granulocyte Colony Stimulating Factor
Regimen
Study | Evidence |
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Dreyling et al. 2004 | Non-randomized portion of RCT |
Chemotherapy
- Dexamethasone (Decadron) 8 mg PO three times per day on days 1 to 10
- Carmustine (BCNU) 60 mg/m2 IV once on day 2
- Etoposide (Vepesid) 75 mg/m2 IV once per day on days 4 to 7
- Cytarabine (Ara-C) 100 mg/m2 IV twice per day on days 4 to 7
- Melphalan (Alkeran) 20 mg/m2 IV once on day 3
Growth factor therapy
- G-CSF starting on day 11
A minimum of 1 × 106 CD34+ cells/kg are collected.
References
- Dreyling M, Lenz G, Hoster E, Van Hoof A, Gisselbrecht C, Schmits R, Metzner B, Truemper L, Reiser M, Steinhauer H, Boiron JM, Boogaerts MA, Aldaoud A, Silingardi V, Kluin-Nelemans HC, Hasford J, Parwaresch R, Unterhalt M, Hiddemann W. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood. 2005 Apr 1;105(7):2677-84. Epub 2004 Dec 9. link to original article contains verified protocol PubMed