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High-dose therapy and peripheral blood progenitor cell transplantation:
effects of recombinant human granulocyte-macrophage colony-stimulating
factor on the autograft
MR Bishop, JR Anderson, JD Jackson, PJ Bierman, EC Reed, JM Vose, JO Armitage, PI Warkentin and A Kessinger
Department of Internal Medicine, University of Nebraska Medical Center,
Omaha 68198-3330.
Between June 1989 and June 1992, 144 patients participated in sequential
clinical trials using peripheral blood progenitor cells (PBC) as their sole
source of hematopoietic rescue following high-dose chemotherapy. All
patients had received prior extensive combination chemotherapy and had
marrow defects that precluded autologous bone marrow transplantation
(ABMT). PBC were collected according to a single apheresis protocol. The
initial 86 patients (group 1) had PBC collected without mobilization.
Beginning in April 1991, PBC were mobilized solely with recombinant human
granulocyte-macrophage colony-stimulating factor (rHuGM-CSF). Thirty-four
patients (group 2) received rHuGM-CSF at a dose of 125 micrograms/m2/d by
continuous intravenous infusion, and 24 patients (group 3) received
rHuGM-CSF at a dose of 250 micrograms/m2/d by continuous intravenous
infusion. Patients underwent at least six aphereses and had a minimum of
6.5 x 10(8) mononuclear cells (MNC)/kg collected. Cytokines were not
routinely administered immediately after transplantation. A median of nine
aphereses were required to collect PBC in group 1 and seven aphereses for
groups 2 and 3 (P = .03). The time required to recover 0.5 x 10(9)/L
granulocytes after transplant was significantly shorter (P = .0004) for the
mobilized groups; the median time to recovery was 26 days for group 1, 23
days for group 2, and 18 days for group 3. Transplantation of PBC mobilized
with rHuGM-CSF resulted in a shorter time to platelet (P = .04) and red
blood cell (P = .01) transfusion independence. Mobilization with rHuGM-CSF
alone resulted in efficient collection of PBC, that provided rapid and
sustained restoration of hematopoietic function following high-dose
chemotherapy. Mobilization of PBC with rHuGM-CSF alone is an effective
method for patients who have received prior chemotherapy and have bone
marrow abnormalities.
Volume 83,
Issue 2,
pp. 610-616,
01/15/1994
Copyright © 1994 by The American Society of Hematology
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