Types of Mobilization Chemotherapy Regimens

Chemotherapy-produced mobilization is a process used to mobilize hematopoietic progenitor cells, which are immature cells produced in the peripheral blood and bone marrow. Those produced in peripheral blood are known as peripheral blood stem cells, or PBSC. These cells eventually develop into any type of specialized blood cells: red blood cells, white blood cells or platelets. Chemotherapy drugs not only reduce diseased cells, but also increase the production of stem cells in peripheral blood. The chemotherapy regimen is administered prior to harvesting cells. Cells can be harvested either from peripheral blood or bone marrow, although harvesting from peripheral blood is the preferred method. Once the cells are harvested, they are frozen for later re-infusion back into the body via a central line, where they graft to the bone marrow and develop into healthy blood cells. This process speeds recovery by reducing effects from high-dose chemotherapy.

VAD

• VAD chemotherapy consists of the following chemotherapy agents: V incristine, doxorubicin (originally known as A driamycin) and D examethasone, a steroid. This regimen is typically used in cases of multiple myeloma. The regimen mobilizes PBSC with reduced toxicity as compared to other methods. In studies of this regimen, patients were shown to achieve successful peripheral blood stem cell mobilization.

ESHAP

• ESHAP treatment consists of four chemotherapy agents: cytarabine, cisplatin, etoposide and a steroid. This regimen is sometimes used as a standard means of preparing peripheral blood stem cells. The regimen is also considered when other methods have proven ineffective in collecting cells. In such cases, ESHAP enables clinicians another opportunity to extract peripheral blood stem cells. The treatment is performed in the hospital over a period of five days and requires a double-lumen central line for the large amount of fluid necessary for the therapy. While undergoing this regimen, patients receive a growth factor drug that stimulates bone marrow to produce more stem cells.

ICE

• The ICE chemotherapy regimen consists of an infusion of ifosfamide along with a bolus of carboplatin and etoposide (ICE). This regimen is used in patients with refractory or relapsed non-Hodgkin's lymphoma and who are eligible for stem cell transplantation. Three cycles of ICE therapy are given at two-week intervals prior to collecting peripheral blood progenitor cells. Infusions are given over a 24-hour period to reduce the chance of side effects. In studies, 66.3 percent of patients had a favorable enough response to proceed to stem cell transplantation, and reported minimal side effects.