Circulation of progenitor cells after intensive chemotherapy followed by combination G-CSF and EPO in breast carcinoma

Hematologic effects of granulocyte colony-stimulating factor (G-CSF) and erythropoietic (EPO) combination after priming intensive chemotherapy in the treatment of female breast carcinoma are presented. In a previous group treated with G-CSF alone, 36% of patients became anemic and to be transfused for correction of their anemia. To the present study consecutive patients with different stages of breast carcinoma were admitted. All were given priming intensive chemotherapy (epirubicin 150 m/m2 and cyclophosphamide 1300 mg/m2) followed by subcutaneous application of G-CSF at a dose of 5 μg/kg/day and EPO 250 IU/kg/day. In cases where leucocyte counts dropped below 1 x 109/dm3 and hemoglobin level fell to 85 g/dm3 administration of growth factors was started. The therapy was stopped when normal leukocyte count reached 4 x 109/dm3 for G-CSF and hemoglobin level rose to 115 g/dm3 for EPO. Our results show significant difference between MNC/Tl (min.), CD34+ cells/μl (min.), CFU-GM/ml (min.), BFU-E/ml (min) and MNC/μl (max.), CD34+ cells/μl (max.), CFU-GM/ml (max.), BFU-E/ml (ml) p<0.01, with mean peak values of 16.9-fold circulating MNC/μl, 7.8-fold for CD34+ cells/μl, 23.4-fold for CFU-GM/ml and 28.7-fold increase for BFU-E/ml. Side effects were minimal, no infectious complications occurred, body temperature did not rise over 3 grad C and no corrections of anemia were needed. It is concluded that the administration of G-CSF plus EPO combination following intensive chemotherapy reduces hematologic toxicity and induces large amount of hemopoietic progenitors suitable for autologous transplantation in women with breast carcinoma. (author)