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Titolo:
Mobilization of peripheral blood stem cells following myelosuppressive chemotherapy: a randomized comparison of filgrastim, sargramostim, or sequential sargramostim and filgrastim
Autore:
Weaver, CH; Schulman, KA; Buckner, CD;
Indirizzi:
Duke Univ, Med Ctr, Clin Econ Res Unit, Durham, NC USA Duke Univ Durham NC USA niv, Med Ctr, Clin Econ Res Unit, Durham, NC USA CancerConsultants Com Inc, Ketchum, ID 83340 USA CancerConsultants Com Inc Ketchum ID USA 83340 Inc, Ketchum, ID 83340 USA
Titolo Testata:
BONE MARROW TRANSPLANTATION
, volume: 27, anno: 2001, supplemento:, 2
pagine: S23 - S29
SICI:
0268-3369(200105)27:<S23:MOPBSC>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
COLONY-STIMULATING FACTOR; HIGH-DOSE CHEMOTHERAPY; RECOMBINANT HUMAN GRANULOCYTE; ALLOGENEIC MARROW TRANSPLANTATION; HEMATOPOIETIC PROGENITOR CELLS; COMMUNITY CANCER CENTERS; AUTOLOGOUS BONE-MARROW; FACTOR G-CSF; MULTIPLE-MYELOMA; BREAST-CANCER;
Keywords:
filgrastim; sargramostim; stem cell mobilization;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
41
Recensione:
Indirizzi per estratti:
Indirizzo: Weaver, CH CancerConsultants Com Inc, Ketchum, ID 83340 USA CancerConsultants Com Inc Ketchum ID USA 83340 m, ID 83340 USA
Citazione:
C.H. Weaver et al., "Mobilization of peripheral blood stem cells following myelosuppressive chemotherapy: a randomized comparison of filgrastim, sargramostim, or sequential sargramostim and filgrastim", BONE MAR TR, 27, 2001, pp. S23-S29

Abstract

Myelosuppressive chemotherapy is frequently used for mobilization of autologous CD34(+) progenitor cells into the peripheral blood for subsequent collection and support of high-dose chemotherapy. The administration of myelosuppressive chemotherapy is typically followed by a myeloid growth factor and is associated with variable CD34 cell yields and morbidity. The two most commonly used myeloid growth factors for facilitation of CD34 cell harvestsare granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF). We performed a randomized phase III clinical trial comparing G-CSF, GMCSF, and sequential administration of GM-CSF and G-CSF following administration of myelosuppressive chemotherapy. Weevaluated CD34 yields, morbidity, and cost-effectiveness of the three cytokine schedules. One hundred and fifty-six patients with multiple myeloma, breast cancer, or lymphoma received cyclophosphamide with either paclitaxel or etoposide and were randomized to receive G-CSF 6 mug/kg/day s.c., GMCSF 250 mug/m(2)/day s.c., or GM-CSF for 6 days followed by G-CSF until completion of the stem cell harvest. Compared with patients who received GM-CSF, patients who received G-CSF had faster recovery of absolute neutrophil countto 0.5 x 10(9) per liter (median of 11 vs 14 days, P = 0.0001) with fewer patients requiring red blood cell transfusions (P = 0.008); fewer patients with fever (18% vs 52%, P = 0.001); fewer hospital admissions (20% vs 42%, P = 0.13); and less intravenous antibiotic therapy (24% vs 59%, P = 0.001). Patients who received G-CSF also yielded more CD34 cells (median 7.1 vs 2.0 x 10(6) kg per apheresis, P = 0.0001) and a higher percentage achieved 2.5 x 10(6) CD34 cells per kilogram (94% vs 78%, P = 0.21) and 5 x 10(6) CD34cells per kilogram (88% vs 53%, P = 0.01) or more CD34 cells per kilogram with fewer aphereses (median 2 vs 3, P = 0.002) and fewer days of growth factor treatment (median 12 vs 14, P = 0.0001). There were no significant differences in outcomes between groups receiving G-CSF alone and the sequential regimen. After high-dose chemotherapy, patients who had peripheral blood stem cells mobilized with G-CSF or the sequential regimen received higher numbers of CD34 cells and had faster platelet recovery with fewer patients requiring platelet transfusions than patients receiving peripheral blood stem cells mobilized by GMCSF. In summary, G-CSF alone is superior to GM-CSF alone for the mobilization of CD34(+) cells and reduction of toxicities following myelosuppressive chemotherapy. An economic analysis evaluating the cost-effectiveness of these three effective schedules is ongoing at the time of this writing.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/03/20 alle ore 11:14:58