Mobilization Scheme With Cytarabine In Poor Mobilizers Patients Diagnosed With Lymphoma

Mobilization regimens for hematopoietic stem cell transplantation have not undergone major changes except for the introduction of new drugs such as plerixafor. However, in patients receiving multiple lines of treatment, to obtain a suitable amount of hematopoietic progenitors (PH) is often difficult even with the addition of new drugs. We present our experience with a protocol of mobilization for poor mobilizer patients based on the use of cytarabine.

From a total of 111 patients diagnosed with lymphoma who underwent autologous hematopoietic progenitors in our center from January 2005 to March 2013, 32 patients (35% of total) with previous mobilization failure, received cytarabine 400 mg/m2 /day x3 days + G-CSF (filgrastim or lenograstim) 10-16 mg /kg/day from day 7 to the end of collection. Cell blood cound and CD34 assays in peripheral blood were performed from day +11 postchemotherapy, and apheresis was started when CD34 > 10 x10e6/L.

30 patients had non-Hodgkin lymphoma (NHL) (13 diffuse large B-cell lymphoma, 7 mantle cell lymphoma, 5 follicular lymphoma, 2 MALT lymphoma, 1 angioimmunoblastic lymphoma, 2 cutaneous lymphomas) and 2 Hodgkin's lymphoma (HL). Median age was 49 years (range 27-67). Median number of treatment lines prior to mobilization was 3 (1-5). In all 30 patients with NHL, an adequate amount of CD34 + cells was obtained. Only one patient with HL, who had previously received 5 lines of chemotherapy, did not mobilize. The average time from the end of chemotherapy to start of apheresis was 13.7 days (12-20). The average number of CD34 + cells circulating the starting day of apheresis was 41/μL (11-109). The mean of apheresis performed was 1.8 (1-3) with an average amount of CD34 obtained of 4.69 x10e6/kg (1.5-6.8). All patients received outpatient treatment and only 2 required hospitalization: one for short-term neutropenic fever and another due to a limited cutaneous hemorrhage during the neutropenia phase. All patients were transplanted without incidence and successfully engrafted. None required G-CSF early postransplant.

Mobilization with intermediate-dose cytarabine has proven to be a cost-effective regimen in lymphoma patients with prior mobilization failure.

No relevant conflicts of interest to declare.