A randomized trial of two doses of cyclophosphamide with etoposide and G-CSF for mobilization of peripheral blood stem cells in 318 patients with stage II-III breast cancer
| Autor: | Robert Birch, T. Greco, C. Manner, J. Schwerkoske, M.N. Murphy, C. Morgan-Ihrig, Lee S. Schwartzberg, R Leff, C.H. Weaver, R. Smith, C.D. Buckner, B. MacANENY, T Beeker, Kurt W. Tauer, John D. Hainsworth |
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| Rok vydání: | 1998 |
| Předmět: |
Adult
medicine.medical_specialty Cyclophosphamide Nausea medicine.medical_treatment Immunology Antigens CD34 Breast Neoplasms Gastroenterology Breast cancer Internal medicine Antineoplastic Combined Chemotherapy Protocols Granulocyte Colony-Stimulating Factor medicine Mucositis Humans Prospective Studies Etoposide Neoplasm Staging Chemotherapy Dose-Response Relationship Drug business.industry Hematology Middle Aged medicine.disease Hematopoietic Stem Cell Mobilization Surgery Regimen Treatment Outcome Vomiting Leukocytes Mononuclear Female medicine.symptom business medicine.drug |
| Zdroj: | Journal of hematotherapy. 7(2) |
| ISSN: | 1061-6128 |
| Popis: | The purpose of this study was to develop a less toxic outpatient chemotherapy regimen for mobilizing peripheral blood stem cells (PBSC). Three hundred eighteen patients with newly diagnosed stage II-III breast cancer who had received conventional dose adjuvant chemotherapy were randomized to receive intermediate-dose cyclophosphamide (2 g/m2), etoposide (600 mg/m2), and granulocyte colony-stimulating factor (G-CSF) 6 micrograms/kg/day (ID-Cy, n = 162) or high-dose cyclophosphamide (4 g/m2) and the same doses of etoposide and G-CSF (HD-Cy, n = 156) followed by collection of PBSC. Three hundred seventeen of 318 patients had apheresis performed, and 315 received high-dose chemotherapy (HDC) followed by PBSC support. The median numbers of CD34+ cells collected in a median of two apheresis following ID-Cy and HD-Cy were 19.9 and 22.2 x 10(6)/kg, respectively (p = 0.04). The fractions of patients achieving CD34+ cell doses > or = 2.5 or > or = 5.0 x 10(6)/kg were not different between the two regimens. More patients receiving HD-Cy had grade 3-4 nausea (p = 0.001), vomiting (p = 0.03), and mucositis (p = 0.04). The fractions of patients having a neutrophil nadir < 0.5 x 10(9)/L following ID-Cy and HD-Cy were 0.83 and 0.95, respectively (p = < 0.001). The fractions of patients having a platelet nadir < 25 x 10(9)/L following ID-Cy and HD-Cy were 0.13 and 0.51, respectively (p = < 0.001). More patients in the HD-Cy group received platelet (p < 0.001) and red blood cell (p < 0.001) transfusions and were admitted to the hospital more frequently (p = 0.03) than patients receiving ID-Cy. Three hundred fifteen patients received HDC followed by infusion of PBSC. There were no significant differences in the incidence of transplant-related death or early survival between patients receiving ID-Cy or HD-Cy followed by HDC. It was concluded that a regimen of Cy 2 g/m2 with etoposide and G-CSF was effective for mobilization of PBSC with low morbidity and resource utilization in patients with limited prior chemotherapy exposure. |
| Databáze: | OpenAIRE |
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