Efficacité d'une chimiothérapie FEC à forte dose pour la mobilisation des cellules souches hématopoïétiques dans le sang périphérique

D'Hondt, Lionel [UCL] André, Marc [UCL] Canon, Jean-Luc [UCL] Guillaume, Thierry [UCL] Doyen, Chantal [UCL] Feyens, Anne Marie [UCL] Chatelain, Bernard [UCL] Dromelet, Alex [UCL] Humblet, Yves [UCL] Longueville, Jacques [UCL] Symann, Michel [UCL]

The best regimen for mobilizing hematopoietic stem cells (HSC) into peripheral blood is not yet defined. The efficiency of FEC chemotherapy in the treatment of breast cancer is well established and the effects of FEC on HSC mobilization have been characterized. We tested the feasibility and the toxicity of a high-dose FEC regimen which may improve the mobilizing capacity of conventional FEC. Twenty patients with poor prognosis breast cancer received high-dose FEC and filgrastim 5 micrograms/kg. Three leukaphereses were performed on each patient for 3 consecutive days. Total numbers of CFU-GM and CD34+ cells were assessed, and a retrospective analysis was made. The numbers of CFU-GM/kg and CD34+ cells/kg collected (mean +/- standard error) were respectively 12.2 x 10(5) (+/- 2.4) and 14.6 x 10(6) (+/- 2.5). Extra-hematologic toxicity was negligible. Hematologic recovery after CTCb high-dose chemotherapy and HSC infusion was rapid. High-dose FEC is efficient for collecting HSC in peripheral blood. Extra-hematologic toxicity is weak and hematologic recovery after autograft is normal. Increased dosage of epirubicin and cyclophosphamide could allow a single leukapheresis collection of sufficient HSC from peripheral blood.