Stem cell mobilization regimens

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Unlike the other chemotherapy regimen pages, this one is not disease-specific. Rather, this is a gathering point for all stem cell mobilization regimens.

11 regimens on this page 13 variants on this page

Stem cell mobilization

These are regimens intended to mobilize stem cells, very incomplete right now but will be filled in over time.

Cyclophosphamide & G-CSF

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Regimen #1

Study	Evidence
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.

Regimen #2

Study	Evidence
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

1. 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
2. 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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Regimen

Study	Evidence
Abrey et al. 2003	Phase II

Chemotherapy

• Cytarabine (Cytosar) 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

1. 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

Cytarabine, Ifosfamide, G-CSF

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Regimen

Study	Evidence
Colombat et al. 2006	Phase II

Chemotherapy

• Cytarabine (Cytosar) 1000 mg/m² IV Q12H 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

1. 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: CYtarabine, VEpesid (Etoposide)

Regimen

Study	Evidence
Soussain et al. 2001	#ffffbe|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 (Cytosar) 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

1. 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
2. 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

EAR & G-CSF

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EAR: Etoposide, Ara-C (Cytarabine), Rituximab

Regimen

Study	Evidence
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 on days 1 to 4 (total dose: 40 mg/kg)
• Cytarabine (Cytosar) 2000 mg/m² IV over 2 hours BID 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 TID, 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

Patients with adequate collection and meeting criteria proceeded to CBV with autologous HSCT.

References

1. 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: Ifosfamide, GEmcitabine, Vinorelbine

Regimen

Study	Evidence
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 at 0, 2, 4 hours after Ifosfamide (Ifex) on days 1 to 4
• 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

1. 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: Rituximab, Dexamethasone, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan

Regimen

Study	Evidence
Dreyling et al. 2004	Non-randomized portion of RCT

Chemotherapy

• Dexamethasone (Decadron) 8 mg PO TID on days 1 to 10
• Carmustine (BiCNU) 60 mg/m² IV once on day 2
• Etoposide (Vepesid) 75 mg/m² IV once per day on days 4 to 7
• Cytarabine (Cytosar) 100 mg/m² IV BID 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

1. 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