HIGH-DOSE ETOPOSIDE AS AN EFFECTIVE MOBILIZATION AGENT IN NHL PREVIOUSLY TREATED WITH CHOP ± RITUXIMAB

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Abstract

Background

Etoposide is one of the effective mobilizing agents in non-Hodgkin's lymphoma (NHL), but safety and effectiveness of high-dose etoposide followed by G-CSF is not well defined. We conducted a retrospective study to evaluate the efficacy of high-dose etoposide plus G-CSF compared with other mobilizing agents in peripheral blood stem cell (PBSC) mobilization.

Methods

A total of 46 patients with NHL who were treated only with CHOP ± Rituximab and sequentially underwent PBSC mobilization between 2006 and 2011 were analyzed. Twenty-two patients received etoposide 500 mg/m2 at day 1, 2, 3 (VP16 group). Total 22 of other patients received ICE or DHAP or CHOP ± Rituximab and 2 patients received G-CSF only (others group). All patients administered G-CSF 10 µg/kg/day until apheresis completed. Chemotherapy-related toxic effects and PBSC mobilization results were compared between the groups.

Results

In the VP16 group, a median total CD34+ cells collected was 15.79 × 106 cells/kg, 77% of all patients having adequate (>2.0 × 106 cells/kg) CD34+ collections after first day of apheresis compared with a median in the others group of 4.1 × 106 cells/kg (P < 0.001), with 41% having adequate collection after first day (P = 0.015). None of 22 patients in VP16 group and 4 of 22 (19%) in others group failed to collect sufficient CD34+ cells (<2.0 × 106 cells/kg) (P = 0.038). Neutropenic fever developed in 14 patients (64%) in the VP16 groups, none of which were fatal, and 3 patients (14%) in the others group (P = 0.05).

Conclusions

High-dose etoposide improves the effectiveness of mobilization with more than three-fold higher stem cell yield compared with other mobilizing agents. Considering no mortalities in patients with neutropenic fever, high-dose etoposide plus G-CSF is a highly effective mobilizing agent with acceptable toxicity in patients with NHL who were previously treated with CHOP ± rituximab.

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