ORIGINAL ARTICLE Comparison between filgrastim and lenograstim plus chemotherapy for mobilization of PBPCs R Ria, T Gasparre, G Mangialardi, A Bruno, G Iodice, A Vacca and F Dammacco Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy Recombinant human (rHu) G-CSF has been widely used to treat neutropenia and mobilize PBPCs for their autologous and allogeneic transplantation. It shortens neutropenia and thus reduces the frequency of neutropenic fever. We compared the efficiency of glycosylated rHu and non-glycosylated Hu G-CSF in mobilizing hemato- poietic progenitor cells (HPCs). In total, 86 patients were consecutively enrolled for mobilization with CY plus either glycosylated or non-glycosylated G-CSF, and under- went leukapheresis. The HPC content of each collection, toxicity, days of leukapheresis needed to reach the minimum HPC target and days to recover WBC (X500 and 41000/mm 3 ) and plts (450 000/mm 3 ) were evalu- ated. Glycosylated G-CSF mobilized more CD34 þ cells than did the non-glycosylated form. The ability to reach a collection target of 43  10 6 CD34 þ /kg body weight in two leukaphereses was higher for glycosylated G-CSF. No significant differences between the two regimens were observed with regard to toxicity and days to WBC and plt recovery. High-dose CY plus glycosylated G-CSF achieved adequate mobilization and the collection target more quickly and with fewer leukaphereses. Bone Marrow Transplantation (2010) 45, 277–281; doi:10.1038/bmt.2009.150; published online 6 July 2009 Keywords: G-CSF; mobilization; PBPCs; recombinant human glycosylated G-CSF; recombinant non-glycosylated G-CSF Introduction GG-CSF-mobilized PBPCs have become the most widely used source of hematopoietic progenitor cells (HPCs) for transplantation procedures, and their mobilization is clinically safe. G-CSF is used to mobilize PBPCs in patients with malignancies, as well as in healthy donors for autologous and allogeneic PBPC transplantation. 1–3 It reduces the aplasia period and hence fever and infections during transplantation. 4 However, the use of G-CSF after autologous PBPC transplantation has been queried, as its further reduction in time to a safe neutrophil count 5,6 does not always imply fewer significant clinical events, such as infections, length of hospitalization, extrahematological toxicities or mortality. 7,8 Even so, the ASCO guidelines still recommend the use of growth factors after autologous PBPC transplantation. 9 G-CSF induces the proliferation and differentiation of myeloid precursor cells, and also provides a functional activity that influences chemotaxis, respiratory burst and Ag expression of neutrophils. Comparison of HPC- mobilizing regimens is greatly impeded by the considerable variability of their responses. The two G-CSF recombinant preparations (lenograstim and filgrastim) currently avail- able for HPC mobilization are produced in different ways. Lenograstim is obtained from Chinese hamster ovarian cells, and consists of 174 amino acids with 4% glycosyla- tion. 10 Filgrastim is produced using Escherichia coli, has a methionine group at its N-terminal end and is not glycosylated. 11 In this study, we compared the HSC-mobilizing efficacy of glycosylated vs non-glycosylated G-CSF in terms of the number of CD34 þ cells collected and the number of leukaphereses needed to reach their collection target. Secondary end points were the following: days to recover WBC and plts, and assessment of toxicity and percentage of patients who achieved the collection target in a single course of mobilization (high-dose CY plus G-CSF plus three leukaphereses). Patients and methods Patients A total of 86 patients (48 men and 38 women, Table 1) who underwent auto-SCT for multiple myeloma (MM: 44 patients), non-Hodgkin’s lymphoma (NHL: 31 patients) or Hodgkin’s lymphoma (HL: 11 patients) between 2000 and 2008 were consecutively included in this controlled, non-randomized study. Inclusion criteria were the same as those for auto-SCT: age o70 years, serum creatinine o200 mmol/l, cardiac ejection fraction 450%, DLCO (diffusing capacity of the lung for carbon monoxide) 450% and no active infection or other disease causing comorbidity. 12 Received 6 October 2008; revised 5 May 2009; accepted 26 May 2009; published online 6 July 2009 Correspondence: Dr R Ria, Department of Internal Medicine and Clinical Oncology, University of Bari Medical School, Policlinico— Piazza Giulio Cesare, 11, I-70124 Bari, Italy. E-mail: ria@dimo.uniba.it Bone Marrow Transplantation (2010) 45, 277–281 & 2010 Macmillan Publishers Limited All rights reserved 0268-3369/10 $32.00 www.nature.com/bmt