Mobilization of autologous peripheral blood stem cells by combined chemotherapy and rhG-CSF

Objective: To study the effect of cyclophosphamide (CTX) combination chemotherapy and recombinant human granulocyte colony-stimulating factor (rhG-CSF) on autologous peripheral blood stem cells (APBSC) mobilization.

Methods: CTX(2.5 +/- 1.0) g/m2 on day 1, VP-16,600-800 mg and/or Ara-C 1.0-2.0 g/m2 on day 2 were injected i.v. rhG-CSF 300 micrograms/d was injected s.c. when the white blood cell (WBC) count reached nadir until one day before APBSC harvest. When the WBC count was over 3.0 x 10(9)/L, peripheral blood mononuclear cell (MNC) collection was performed once per day until the number of MNC collected was > 4 x 10(8)/kg. CFU-GM colony formation and CD34+ cell enumeration were performed.

Results: Twenty cases were studied. The lowest level of WBC was (1.2 +/- 0.8) x 10(9)/L on day 8.5 +/- 1.5 following chemotherapy. rhG-CSF was given from day 9.0 +/- 2.0 and continued for 6.0 +/- 1.0 days. APBSC harvest began on day 12.0 +/- 2.0 and continued for 4.0 +/- 1.0 days. A total of (6.14 +/- 2.34) x 10(8)/kg MNC and (23.25 +/- 30.56) x 10(6)/kg CD34+ cells was procured. Peak level of CD34+ cells was observed 14.6 +/- 1.8 days after chemotherapy and 4.9 +/- 1.6 days after rhG-CSF administration. CFU-GM was (21.68 +/- 15.39) x 10(4)/kg when rhG-CSF was given for 4.9 +/- 1.6 days. No severe toxic reaction was observed. Hematopoietic reconstitution was very well in all patients received APBSC transplantation.

Conclusions: CTX combination chemotherapy followed by rhG-CSF was safe and feasible for APBSC mobilization.