Myelosuppressive chemotherapy to mobilize normal stem cells in chronic myeloid leukemia

J. Mehta*, A. Mijović, R. Powles, A. Pagliuca, S. Singhal, B. Czepulkowski, G. J. Swansbury, J. Treleaven, G. J. Mufti

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Ten patients with Ph+ chronic myeloid leukemia (CML) were treated with idarubicin, cytarabine and etoposide followed by G-CSF to harvest Ph-negative progenitor cells. Six were in first chronic phase (CP1), and four beyond CP1. Between two and six aphereses (median 3, total 36) were performed starting 9-26 days (median 14.5) after chemotherapy when the leukocyte count was 0.6-4.7 x 109/l (median 1.2), 1.3-3.6 x 108 mononuclear cells/kg (median 2.8), 0-128.4 x 104 CFU-GM/kg (median 1.2; seven patients) and 0.3-25.1 x 106 CD34+ cells/kg (median 9.8; seven patients) were collected. Seven of 27 harvests showing metaphases were 100% Ph-negative, 11 partially Ph-negative, and nine were 100% Ph+. All three patients with 100% Ph-negative collections were in CP1 and within 4-26 months of diagnosis. Four of six CP1 patients showed significant cytogenetic response compared with none of four beyond CP1 (P = 0.036). The absolute neutrophil count remained < 0.5 x 109/l for 9-44 days (median 15.5) following chemotherapy. Four patients (three Ph-negative) were autografted after 16 mg/kg busulfan (n = 2) or 200 mg/m2 melphalan (n = 2). One of the three patients receiving Ph-negative cells died of graft failure, and two are alive with 15% and 50% Ph-negative cells at 15 and 11 months on interferon-α. We conclude that it is possible to harvest Ph-negative cells after myelosuppressive chemotherapy in some CML patients treated early in the course of CP1. However, in view of lack of consistent response, investigation of alternative approaches is necessary.

Original languageEnglish (US)
Pages (from-to)25-29
Number of pages5
JournalBone Marrow Transplantation
Volume17
Issue number1
StatePublished - Jan 1996

Keywords

  • Autograft
  • Chronic myeloid leukemia
  • G-CSF
  • Peripheral blood stem cell transplantation
  • Philadelphia chromosome

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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