Summary
Background
Mobilization of haematopoietic stem cells for autologous transplantation in lymphoma patients currently lacks optimal and universally accepted protocol guidelines. Available mobilization procedures use either cytokines alone, predominantly granulocyte colony-stimulating factor, or cytokines in combination with chemotherapy. Chemomobilization may increase the CD34+ cell yield, and some studies indicate that a higher number of CD34+ cells reinfused is associated with better outcome after autologous haematopoietic stem cells transplantation. We aimed to compare the peak of CD34+ cells in peripheral blood between two alternative mobilization therapies in a retrospective cohort of patients affected by lymphoma.
Methods
Between 2001–2012, 125 retrospectively observed lymphoma patients were treated with either cytarabine (\(n = 36\)) or cyclophosphamide (\(n = 89\)), both combined with granulocyte colony-stimulating factor. The difference in the peak of circulating CD34+ cells was the study primary endpoint.
Results
The peak of circulating CD34+ cells were significantly higher in the cytarabine group compared with the cyclophosphamide group (median 129/μL vs 77/μL; \(p < 0.05\)), even when accounting for the timing at collection (169% higher in the cytarabine group, \(p < 0.01\)). Haematopoietic stem cells median time collection started 3 days later in the cytarabine group (16 vs 13 days; \(p < 0.01\)). A leukaphaeresis single session was adequate to collect an optimal number of CD34+ cells (greater than \(5 \times 10^{6}/\text{kg}\)) in 69% patients in the cytarabine group compared with 57% in the cyclophosphamide group (\(p = 0.21\)).
Conclusions
Cytarabine gives a higher peak of circulating CD34+ cells in comparison with cyclophosphamide in a retrospective observational cohort of lymphoma patients submitted to chemomobilization.
Riassunto
Premesse
Attualmente la mobilizzazione di cellule staminali emopoietiche autologhe in pazienti affetti da linfoma manca di linee guida ottimali e universalmente riconosciute. Le procedure di mobilizzazione disponibili si basano sulla sola stimolazione con citochine, prevalentemente fattore stimolante le colonie granulocitarie, o una combinazione di citochine e chemioterapia. La chemiomobilizzazione può incrementare il numero di cellule CD34+ raccolte, inoltre alcuni studi indicano come una maggior dose di CD34+ reinfuse si associ a un migliore outcome dopo il trapianto autologo di cellule staminali emopoietiche. Scopo del nostro studio è stato confrontare il picco di cellule CD34+ periferiche ottenuto con due differenti regimi di chemiomobilizzazione in una coorte retrospettiva di pazienti affetti da linfoma.
Metodi
Tra il 2001 e il 2012, 125 pazienti affetti da linfoma sono stati mobilizzati con citarabina (\(n = 36\)) o ciclofosfamide (\(n = 89\)), entrambe associate con fattore stimolante le colonie granulocitarie. La differenza nel picco delle cellule CD34+ circolanti è stato l’obiettivo primario dello studio.
Risultati
Il picco di cellule CD34+ circolanti era significativamente più elevato nel gruppo trattato con citarabina rispetto a quello trattato con ciclofosfamide (mediana 129/μL vs 77/μL; \(p < 0{,}05\)), anche considerando il giorno di raccolta (169% più elevato nel gruppo citarabina, \(p < 0{,}01\)). La raccolta di cellule staminali emopoietiche iniziava con una mediana di 3 giorni di ritardo nel gruppo citarabina (16 vs 13 giorni; \(p < 0{,}01\)). Una singola staminaferesi permetteva la raccolta di un numero ottimale di cellule CD34+ (\(> 5 \times 10^{6}/\text{kg}\)) nel 69% dei pazienti trattati con citarabina rispetto al 57% di quelli con ciclofosfamide \((p = 0{,}21)\).
Conclusioni
Citarabina fornisce un picco di cellule CD34+ circolanti più elevato rispetto a ciclofosfamide in una coorte retrospettiva di pazienti affetti da linfomi sottoposti a chemiomobilizzazione.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Salvadori, U., Melotti, R., Al-Khaffaf, A. et al. Cytarabine assures a high concentration of circulating CD34+ cells during haematopoietic stem cells mobilization in lymphoma patients. Riv Ital Med Lab 13, 173–179 (2017). https://doi.org/10.1007/s13631-017-0165-7
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DOI: https://doi.org/10.1007/s13631-017-0165-7
Keywords
- Haematopoietic stem cell mobilization
- Peripheral blood stem cell transplantation
- Cytarabine
- Cyclophosphamide