Comparison of various hematopoietic stem cell mobilization regimens in patients with lymphoma and myeloma

The aim of this study was to compare the collected numbers of peripheral stem cell, the factors affecting stem cell sufficiency, and the toxicity profiles of IEV, a little known mobilization regimen, to well known platin- or cyclophosphamide-based mobilization protocols those were proved to be effective in various studies. The study population was composed by the patients who underwent stem cell mobilization before autologous hematopoietic stem cell transplantation (SCT) with the diagnoses of multiple myeloma (MM), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) in the hospital of School of Medicine, Akdeniz University, Antalya. Data about the peripheral stem cell mobilization procedures of 94 patients with MM, 37 with HL, and 72 with NHL, which performed between January 2000 and April 2010, were retrospectively analyzed. When compared, there were no differences between platin-or cyclophosphamide-based mobilization regimens and IEV chemotherapy schema in terms of sufficiency of peripheral stem cell harvest that was predefined as the collected number of peripheral stem cells ≥3x106/kg for single SCT and 5x106 for tandem SCT.There were also no significant differences between low dose cyclophosphamide, high dose cyclophosphamide, and HCVAD among the subgroups of cyclophosphamide-based regimens. The number of peripheral blood stem cells collected by use of ESHAP, a platin-based regimen, was significantly higher than the other platin-based regimens including DHAP, ICE, and EDAP. The toxicity profiles of cyclophosphamide-, platin-based chemotherapies, and IVE were similar. In order to determine the independent predictors of efficacy of stem cell harvest procedure and count of collected stem cells, age, sex, diagnosis, number of mobilization lines, number of salvage therapies, duration of disease were included into multiple logistic regression analysis. However, no association was obtained. Although the retrospective nature and relatively small sample size of this study are the major limitations, our results give important information about the different mobilization regimens used in myeloma and lymphomas. Use of ESHAP may be preferable with an acceptable toxicity profile for peripheral stem cell mobilization in patients with lymphoma. However, data about the independent predictors of successful stem cell collection remain obscure. Key words: Lymphoma, Myeloma, Stem Cell Mobilization, IEV Regimen