The Hyper-CVAD chemotherapy regimen has an adverse long-term impact on the ability to mobilize peripheral blood stem cells, which can be readily circumvented by using the early cycles for mobilization

✍ Scribed by Colm Keane; Simon Gibbs; John F Seymour; Anthony K Mills; Karen Grimmett; Rosita Van Kuilenberg; Russell Saal; Devinder Gill; H Miles Prince; Paula Marlton; Peter Mollee

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 117 KB
• Volume: 24
• Category: Article
• ISSN: 0278-0232
• DOI: 10.1002/hon.784

✦ Synopsis

Abstract

The Hyper‐CVAD chemotherapy regimen is being increasingly applied to a number of haematological malignancies. We assessed the impact of Hyper‐CVAD on peripheral blood stem cell (PBSC) yields and examined the optimal timing of PBSC collection when using this regimen. Seventy‐four consecutive patients were identified in whom an attempt was made to collect PBSC, usually on recovery from cycle A or B. Where PBSC collection was attempted after cycle 3B, only 18% (3/17) of patients successfully mobilized. Fifty‐seven patients were mobilized on recovery from cycle 1B (n = 13), 2A (n = 22), 2B (n = 14) or 3A (n = 8). Compared with cycle 2A, 1B was not superior in achieving the minimum of ≥2 × 10^6^/kg CD34+ cells (100% vs. 77%, p = 0.13), but was superior in terms of total CD34+ yield (21.4 vs. 3.2 × 10^6^/kg, p < 0.001), achieving the target CD34+ cell count of ≥5 × 10^6^/kg (92% vs 36%, p = 0.002), and obtaining both a minimum (92% vs. 18%, p < 0.001) and target (77% vs. 0%, p < 0.001) graft with a single apheresis. There were no significant differences in PBSC yields following cycles 2A, 2B and 3A. Hyper‐CVAD has substantial stem cell toxicity which can be readily circumvented by using the early chemotherapy cycles for mobilization. Copyright © 2006 John Wiley & Sons, Ltd.