Usefulness of Recombinant Human Erythropoietin during Induction-Consolidation Chemotherapy for Chronic Hematological Lymphoid Malignancies: Improving Stem Cell Harvest and Reducing Blood-Product Support for Patients Receiving Autologous Stem-Cell Transplantation.

Many discrepancies remain on how to use the combination of G-CSF and Epo in patients (pts) with hematological malignancies. Some studies have shown efficacy of this combination in autologous stem cell transplantation (ASCT) when they are used throughout the procedure, while other have demonstrated no benefit when this combination is used after ASCT particularly for Epo. We reviewed retrospectively 30 pts (NHL= 6, HD= 2, MM= 22)who received ASCT for myeloma and lymphoma between September 2003 and May 2005. The main goal of this observation was to evaluate the impact of Epo combination (epoetin beta, alfa or darbepoetin) with G-CSF during chemotherapy administered before ASCT in order to achieve a better hemoglobin (Hb) level before the ASCT procedure. We also evaluated a possible efficacy of this combination upon hematopoietic recovery, transfusion support and stem cell harvest for this population of pts. We used G-CSF (5 μg/kg) alone after stem cell reinfusion in our therapeutic scheme. Patients characteristics were F/M 19/11; 6 pts were in complete response and 24 in partial response of their disease. Conditioning regimen preparations were standard with Melphalan at doses between 140–200 mg/m² (22 pts), BEAM (7 pts), Cyclophosphamide and Total Body Irradiation (1 pt). After at least 12 weeks of treatment, median Hb level before ASCT was 11.6 g/dl (8.5–14.8) and epoetin beta was used in most patients. Median CD34 cells reinfused were 4.4 (1.2–13.7) with a median number of leukapheresis of 3 (2–9). Hematopoietic reconstitution was fast according to published data and local experience, with a median duration of neutropenia (absolute neutrophils count < 0.5 x 10⁹/l) of 7 days (5–11); the median number of days with platelets counts < 20 x 10⁹ /l and 50 x 10⁹/l was 3 (0–14) and 7 (2–17) respectively. Median transfusion requirement was 1 red cells unit (0–6) and 2 platelets units (0–8) respectively. Median duration of hospitalization was 18 days (15–26).

In conclusion, the use of combined G-CSF and Epo has probably improved clinical course of ASCT by reducing transfusion requirement, duration of hospitalization and neutropenia even when it is used before ASCT. Attempts have to be made to identify the place of Epo administration during ASCT procedure. Randomized prospective study might bring some important information about influence of this combination upon stem cell harvest particularly when it is used before the ASCT during induction and consolidation chemotherapy.