Kiefer, Thomas;
Krüger, William H.;
Montemurro, Michael;
Schüler, Frank;
Hirt, Carsten;
Pasold, Rita;
Niederwieser, Dietger;
Schwenke, Matthias;
Dölken, Gottfried
Mobilization of hemopoietic stem cells with high‐dose methotrexate plus granulocyte–colony‐stimulating factor in patients with primary central nervous system lymphoma
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Media type:
E-Article
Title:
Mobilization of hemopoietic stem cells with high‐dose methotrexate plus granulocyte–colony‐stimulating factor in patients with primary central nervous system lymphoma
Contributor:
Kiefer, Thomas;
Krüger, William H.;
Montemurro, Michael;
Schüler, Frank;
Hirt, Carsten;
Pasold, Rita;
Niederwieser, Dietger;
Schwenke, Matthias;
Dölken, Gottfried
Description:
<jats:p><jats:bold>BACKGROUND:</jats:bold> High‐dose therapy with autologous stem cell support after standard dose induction is a promising approach for therapy of primary central nervous system lymphoma (PCNSL). High‐dose methotrexate (HD‐MTX) is a standard drug for induction of PCNSL; however, data about the capacity of HD‐MTX plus granulocyte–colony‐stimulating factor (G‐CSF) to mobilize hemopoietic progenitors are lacking.</jats:p><jats:p><jats:bold>STUDY DESIGN AND METHODS:</jats:bold> This investigation describes the data from stem cell mobilization and apheresis procedures after one or two cycles of HD‐MTX for induction of PCNSL within the East German Study Group for Haematology and Oncology 053 trial. Eligible patients proceeded to high‐dose busulfan/thiotepa after induction therapy and mobilization.</jats:p><jats:p><jats:bold>RESULTS:</jats:bold> Data were available from nine patients with a median age of 58 years. The maximal CD34+ cell count per µL of blood after the first course of HD‐MTX was 13.89 (median). Determination was repeated in six patients after the second course with a significantly higher median CD34+ cell count of 33.69 per µL. Five patients required two apheresis procedures and in four patients a single procedure was sufficient. The total yield of CD34+ cells per kg of body weight harvested by one or two leukapheresis procedures was 6.60 × 10<jats:sup>6</jats:sup> (median; range, 2.68 × 10<jats:sup>6</jats:sup>‐15.80 × 10<jats:sup>6</jats:sup>). The yield of CD34+ cells exceeded the commonly accepted lower threshold of 3 × 10<jats:sup>6</jats:sup> cells per kg of body weight in eight of nine cases. Even in the ninth, hemopoietic recovery after stem cell reinfusion was rapid and safe.</jats:p><jats:p><jats:bold>CONCLUSION:</jats:bold> HD‐MTX plus G‐CSF is a powerful combination for stem cell mobilization in patients with PCNSL and permits safe conduction of time‐condensed and dose‐intense protocols with high‐dose therapy followed by stem cell reinfusion after HD‐MTX induction.</jats:p>