KEY TAKEAWAYS
- The study aimed to investigate the efficacy and safety of EA plus G-CSF for stem cell mobilization in patients with R/R lymphoma.
- Researchers noticed that EA plus G-CSF is an effective and well-tolerated mobilization strategy.
Autologous stem cell transplantation (ASCT) represents a potentially curative approach for relapsed or refractory (R/R) aggressive lymphoma. However, some patients at high risk of mobilization failure struggle to mobilize sufficient stem cells, hindering their ability to proceed with ASCT.
Zhijuan Zhu and the team aimed to investigate the efficacy and safety of combining Etoposide with Cytarabine (EA) and G-CSF for mobilization in patients deemed poor mobilizers (PMs) with r/r aggressive lymphoma.
They performed an inclusive analysis of chemo-mobilization outcomes based on EA (Etoposide 0.1 g/m², daily for days 1–3; AraC 0.5 g/m², every 12 hours for days 1–3) in 98 patients with R/R aggressive lymphoma. Among these patients, 39 were identified as predicted PMs according to criteria established by the Gruppo Italiano Trapianto di Midollo Osseo working group.
About the 39 predicted poor mobilizers, 38 (97.4%) patients achieved adequate mobilization (≥2×106 CD34+ cells/kg), while 31 (79.5%) reached optimal mobilization (≥5×106 CD34+ cells/kg). The mean number of CD34+ cells/kg collected was 17.99 (range: 1.08–83.07) ×106, with an average of 1.4 apheresis sessions. The number of CD34+ cells/kg collected during the 1 apheresis was 15.86 (range: 0.37–83.07) ×106.
A single apheresis procedure was sufficient to achieve the target yield for adequate mobilization in 35 (89.7%) of the poor mobilizers, while 76.9% achieved optimal collection within 2 apheresis sessions. Acceptable hematological toxicity and antibiotic usage were observed in 26 patients, with a mean duration of 3.6 days. No grade 4 infections or mobilization-related mortality were recorded.
Most patients proceeded to ASCT and experienced successful hematopoietic recovery with prompt engraftment duration, except for 1 NK/T-cell patient with lymphoma who died from severe septicemia following conditioning chemotherapy.
The study concluded that EA plus G-CSF is an effective and tolerable CD34+ stem cell mobilization strategy for patients with R/R lymphoma, including those predicted to be poor mobilizers. This regimen presents a viable option for patients with R/R lymphoma, particularly for those undergoing mobilization for salvage ASCT therapy.
The study was funded by the Fujian Provincial Natural Science Foundation of China (2023J01694); Fujian provincial health technology project (2021ZD01005); Joint Funds for the innovation of science and Technology, Fujian province (Grant number:2021Y9050); Fujian Province Science and Technology Major Special Project (2022YZ034016); National Key Clinical Specialty Discipline Construction Program (2021-76); National Key R&D Program of China (2022YFC2502700).
Source: https://pubmed.ncbi.nlm.nih.gov/39091501/
Zhu Z, Li X, Yuan X, et al. (2024). “Efficacy and safety of stem cell mobilization with etoposide +cytarabine plus G-CSF in poor mobilizers with relapsed or refractory lymphoma.” Front Immunol. 2024 Jul 18;15:1439253. doi: 10.3389/fimmu.2024.1439253. PMID: 39091501; PMCID: PMC11291192.
