81055
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Multicyclic , dose-intensive chemotherapy supported by sequential reinfusion of hematopoietic progenitors in whole blood . PURPOSE To support multicyclic , dose-intensive chemotherapy , we assessed the effects of reinfusing hematopoietic progenitors collected at each cycle in leukapheresis product or whole blood . PATIENTS AND METHODS Twenty-five patients with small-cell lung cancer ( SCLC ) were treated with six cycles of ifosfamide , carboplatin , and etoposide ( ICE ) with granulocyte colony-stimulating factor ( G-CSF ) 300 micrograms/d subcutaneously ( SC ) on days 4 to 15 . Hematopoietic progenitors collected during each cycle were reinfused on day 3 of the next cycle . Cohort 1 ( n = 6 ) was treated every 3 weeks , with leukapheresis after 2 weeks and cryopreservation of the leukapheresis product . Chemotherapy was given if the WBC count was > or = 3 x 10 ( 9 ) /L and platelet count > or = 100 x 10 ( 9 ) /L . Cohort 2 ( n = 7 ) was treated every 2 weeks , with leukapheresis on day 1 of the next cycle and storage of the leukapheresis product at 4 degrees C. Cohort 3 ( n = 12 ) was treated every 2 weeks , with 500 to 750 mL of blood drawn by venesection on day 1 of the next cycle and stored at 4 degrees C. In cohorts 2 and 3 , chemotherapy was given if the WBC count was > or = 3 x 10 ( 9 ) /L and platelet count > or = 30 x 10 ( 9 ) /L . Blood and leukapheresis products were assayed for hematopoietic progenitors . RESULTS ICE chemotherapy with G-CSF was effective in mobilizing blood progenitors ( median , 120-fold ) . Long-term cultures showed no evidence of stem-cell depletion . The cytotoxic dose-intensity of standard every-4-weeks ICE is 100 % . In the first three cycles , it was 134 % ( median ) in cohort 1 and 200 % in cohorts 2 and 3 ( P < .0001 ) . Toxicity and supportive care requirements were not increased . CONCLUSION The dose-intensity of ICE chemotherapy can be doubled by reinfusing hematopoietic progenitors collected by leukapheresis or venesection and stored at 4 degrees C .
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Intervention_Pharmacological
Multicyclic , dose-intensive chemotherapy
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Intervention_Pharmacological
hematopoietic progenitors
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Intervention_Pharmacological
dose-intensive chemotherapy
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Intervention_Pharmacological
reinfusing hematopoietic progenitors
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Intervention_Pharmacological
ifosfamide , carboplatin , and etoposide ( ICE ) with granulocyte colony-stimulating factor ( G-CSF )
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Intervention_Pharmacological
leukapheresis
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Intervention_Pharmacological
cryopreservation of the leukapheresis product . Chemotherapy
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Intervention_Pharmacological
leukapheresis
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Intervention_Pharmacological
leukapheresis product
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Intervention_Pharmacological
chemotherapy
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Intervention_Pharmacological
ICE chemotherapy
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Intervention_Pharmacological
ICE chemotherapy
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Outcome_Physical
Blood and leukapheresis products
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Outcome_Physical
mobilizing blood progenitors
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Outcome_Physical
stem-cell depletion .
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Outcome_Physical
cytotoxic dose-intensity
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Participant_Sample-size
Twenty-five
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Participant_Condition
with small-cell lung cancer ( SCLC )