[Jason]

Mobilization chemo therapy - IEV vs. CE vs. CAD

by Jason on Sun Sep 09, 2012 6:07 am

My dad (53) was treated with VCD so far and will start with a mobilization chemo therapy in order to collect stem cells and continue with an autologous stem cell transplant afterwards.

In general stem cell collection and mobilization chemo can be conducted via an IEV scheme:
Ifosfamid: 2500 mg/sqm on day 1-3 (i.v., 18hours infusion)
Etoposid: 150 mg/sqm on day 1-3 (i.v., 2 hours infusion)
Epirubicin: 100 mg/sqm on day 1 (i.v., 1 hour infusion)
G-CSF (5ug/kg) starting from day 5 onwards until the end of leukapharesis.

Alternatives could be a CE scheme:
Cyclophosphamid: 2500 mg/sqm on day 1 (i.v., infusion)
Etoposid: 200 mg/sqm on day 1-3 (i.v., infusion)
G-CSF (5ug/kg) starting from day 5 onwards until the end of leukapharesis.

or a CAD scheme:
Cyclophosphamid: 1000 mg/sqm on day 1 (i.v., infusion)
Adriamycin: 15 mg/sqm on day 1-4
Dexamethason: 40mg on day 1-4

For us, these schemes do look quite differently in terms of intensity/doses and we wonder what are the respective advantages/disadvantages. If we understand it correctly the primary purpose of the mobilization therapy is only to collect stem cells and not to combat the desease?!?

What kind of mobilizaton therapy is more common? There must be a kind of standard in the US? With what kind of mobilization therapy were you treated (precise dosis of the drugs, if known)?

Many thanks!
Best wishes from Europe,
Jason

[Dr. Peter Voorhees]

Re: Mobilization chemo therapy - IEV vs. CE vs. CAD

by Dr. Peter Voorhees on Sun Sep 09, 2012 9:51 pm

Dear Jason,

All of these regimens would be expected to have activity against the myeloma and serve to help mobilize stem cells. I suspect the third one would have the least side effects. In the US, cyclophosphamide (no other chemo drugs) with G-CSF is commonly used. Some centers do not use chemotherapy at all to help collect stem cells. In these instances, G-CSF (neupogen) or G-CSF + mozobil are used to collect stem cells. The regimens that you have outlined are not ones with which I am that familiar (at least as a means of mobilizing stem cells). I would have a detailed conversation with the transplant physician to see what regimen they prefer and why.

Good luck!

Pete V.