Stem cell mobilization

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Aric C. Hall, MD
Madison, WI

Twitter: 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.

9 regimens on this page
11 variants on this page


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
Lokhorst et al. 2009 (HOVON 50/GMMG-HD3) Non-randomized portion of RCT

This is reported as a stem cell mobilization regimen but presumably has anti-myeloma activity.

Preceding treatment

Chemotherapy

Growth factor therapy

One cycle

Subsequent treatment

References

  1. HOVON 50/GMMG-HD3: 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 PubMed

Cyclophosphamide & G-CSF

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Variant #1

Study Evidence
Oakervee et al. 2005 Phase II

Chemotherapy

Growth factor therapy

Stem cell collection begins on day 10 and continues until at least 2 × 106 CD34+ cells/kg are collected.

Variant #2

Study Evidence
Royer et al. 2016 Phase II

Chemotherapy

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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Variant #1, 2000 mg/m2 x 8

Study Evidence
Yanada et al. 2013 Phase II

Target CD34+ cell dose: 2.0 × 106/kg

Chemotherapy

Growth factor therapy

Variant #2, 3000 mg/m2 x 2

Study Evidence
Abrey et al. 2003 Phase II

Chemotherapy

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
  2. 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
Colombat et al. 2006 Phase II

Chemotherapy

Growth factor therapy

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 & G-CSF: CYtarabine, VEpesid (Etoposide), Granulocyte Colony Stimulating Factor

Regimen

Study Evidence
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 (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

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

DCEP & G-CSF

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DCEP & G-CSF: Dexamethasone, Cyclophosphamide, Etoposide, Platinol (Cisplatin), Granulocyte Colony Stimulating Factor

Regimen

Study Evidence
Corso et al. 2004 Phase II

Stem cells are mobilized and collected after each course of therapy.

Chemotherapy

Supportive medications

  • Filgrastim (Neupogen) 5 mcg/kg SC once per day, starting 48 hours after chemotherapy and continuing through stem cell collection

Two courses; time intervals were not specified.

References

  1. 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
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

Chemotherapy

Supportive medications

Daily leukapheresis to start when WBC count greater than or equal to 5 x 109/L

Subsequent treatment

References

  1. 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
Magagnoli et al. 2007 Phase II

Chemotherapy

Supportive medications

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 & G-CSF: Rituximab, Dexamethasone, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan, Granulocyte Colony Stimulating Factor

Regimen

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

Chemotherapy

Growth factor therapy

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