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Samaras P, Pfrommer S, Seifert B, Petrausch U, Mischo A, Schmidt A, Schanz U, Nair G, Bargetzi M, Taverna C, Stupp R, Stenner-Liewen F, Renner C. Efficacy of vinorelbine plus granulocyte colony-stimulation factor for CD34+ hematopoietic progenitor cell mobilization in patients with multiple myeloma. Biol Blood Marrow Transplant 2014; 21:74-80. [PMID: 25278456 DOI: 10.1016/j.bbmt.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/19/2014] [Indexed: 01/08/2023]
Abstract
We aimed to assess the efficacy of vinorelbine plus granulocyte colony-stimulating factor (G-CSF) for chemo-mobilization of CD34(+) hematopoietic progenitor cells (HPC) in patients with multiple myeloma and to identify adverse risk factors for successful mobilization. Vinorelbine 35 mg/m(2) was administered intravenously on day 1 in an outpatient setting. Filgrastim 5 μg/kg body weight (BW) was given twice daily subcutaneously from day 4 until the end of the collection procedure. Leukapheresis was scheduled to start on day 8 and be performed for a maximum of 3 consecutive days until at least 4 × 10(6) CD34(+) cells per kg BW were collected. Overall, 223 patients were mobilized and 221 (99%) patients proceeded to leukapheresis. Three (1.5%) patients required an unscheduled hospitalization after chemo-mobilization because of neutropenic fever and renal failure (n = 1), severe bone pain (n = 1), and abdominal pain with constipation (n = 1). In 211 (95%) patients, the leukaphereses were started as planned at day 8, whereas in 8 (3%) patients the procedure was postponed to day 9 and in 2 (1%) patients to day 10. In the great majority of patients (77%), the predefined amount of HPC could be collected with 1 leukapheresis. Forty-four (20%) patients needed a second leukapheresis, whereas only 6 (3%) patients required a third leukapheresis procedure. The median number of CD34(+) cells collected was 6.56 × 10(6) (range, .18 to 25.9 × 10(6)) per kg BW at the first day of leukapheresis and 7.65 × 10(6) (range, .18 to 25.9 × 10(6)) per kg BW in total. HPC collection was successful in 212 (95%) patients after a maximum of 3 leukaphereses. Patient age (P = .02) and prior exposition to lenalidomide (P < .001) were independent risk factors for a lower HPC amount collected in multiple regression analysis. Vinorelbine plus G-CSF enables a very reliable prediction of the timing of leukapheresis and results in successful HPC collection in 95% of the patients.
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Affiliation(s)
- Panagiotis Samaras
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Sarah Pfrommer
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Ulf Petrausch
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Axel Mischo
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Adrian Schmidt
- Medical Oncology and Hematology, Triemli City Hospital, Zurich, Switzerland
| | - Urs Schanz
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Gayathri Nair
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Mario Bargetzi
- Center of Oncology, Hematology and Transfusion Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christian Taverna
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Roger Stupp
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christoph Renner
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Kim SS, Renteria AS, Steinberg A, Banoff K, Isola L. Pharmacoeconomic impact of up-front use of plerixafor for autologous stem cell mobilization in patients with multiple myeloma. Cytotherapy 2014; 16:1584-1589. [PMID: 24927717 DOI: 10.1016/j.jcyt.2014.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/21/2014] [Accepted: 05/02/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND AIMS Stem cell collection can be a major component of overall cost of autologous stem cell transplantation (ASCT). Plerixafor is an effective agent for mobilization; however, it is often reserved for salvage therapy because of its high cost. We present data on the pharmacoeconomic impact of the use of plerixafor as an up-front mobilization in patients with multiple myeloma (MM). METHODS Patients with MM who underwent ASCT between January 2008 and April 2011 at the Mount Sinai Medical Center were reviewed retrospectively. In April 2010, practice changes were instituted for patients with MM to delay initiation of granulocyte-colony-stimulating factor (G-CSF) support from day 0 to day +5 and to add plerixafor to G-CSF as an up-front autologous mobilization. Targets of collection were 5-10 × 10(6) CD34(+) cells/kg. RESULTS Of 50 adults with MM who underwent ASCT, 25 received plerixafor/filgrastim and 25 received G-CSF alone as an up-front mobilization. Compared with the control, plerixafor mobilization yielded higher CD34(+) cell content (16.1 versus 8.4 × 10(6) CD34(+) cells/kg; P = 0.0007) and required fewer sessions of apheresis (1.9 versus 3.1; P = 0.0001). In the plerixafor group, the mean number of plerixafor doses required per patient was 1.8. Although the overall cost of medications was higher in the plerixafor group, the cost for blood products and overall cost of hospitalization were similar between the two groups. CONCLUSIONS Up-front use of plerixafor is an effective mobilization strategy in patients with MM and does not have a substantial pharmacoeconomic impact in overall cost of hospitalization combined with the apheresis procedure.
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Affiliation(s)
- Sara S Kim
- Department of Pharmacy, The Mount Sinai Medical Center, New York, New York, USA.
| | - Anne S Renteria
- Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA
| | - Amir Steinberg
- Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA
| | - Karen Banoff
- Business and Strategic Planning, The Mount Sinai Medical Center, New York, New York, USA
| | - Luis Isola
- Blood and Marrow Transplantation Program, The Mount Sinai Medical Center, New York, New York, USA
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53
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Haverkos BM, McBride A, O'Donnell L, Scholl D, Whittaker B, Vasu S, Penza S, Andritsos LA, Devine SM, Jaglowski SM. An effective mobilization strategy for lymphoma patients after failed upfront mobilization with plerixafor. Bone Marrow Transplant 2014; 49:1052-5. [PMID: 24797182 DOI: 10.1038/bmt.2014.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 02/20/2014] [Accepted: 03/16/2014] [Indexed: 11/09/2022]
Abstract
In an otherwise eligible patient, inadequate mobilization of PBSCs is a limiting factor to proceeding with an auto-ASCT. In such situations, plerixafor is commonly added to improve PBSC collection yields along with cytokine (G-CSF alone) or chemomobilization (chemotherapy+G-CSF). Individually, both strategies are proven to be safe and effective. Here we report six patients who underwent successful mobilization with combination chemomobilization plus plerixafor after upfront failure of cytokine mobilization plus plerixafor. The median CD34(+) cell yield after chemomobilization was 2.48 × 10(6)/kg (range 0.99-8.49) after receiving one to two doses of plerixafor. All patients subsequently underwent ASCT without major unforeseen toxicities and engrafted successfully. No significant delays in time to neutrophil recovery were observed. Our experience highlights the safety and effectiveness of chemomobilization with plerixafor after G-CSF plus plerixafor (G+P) failure and suggests this is a viable salvage strategy after initial failed G+P mobilization.
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Affiliation(s)
- B M Haverkos
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - A McBride
- Department of Pharmacy, The University of Arizona Cancer Center, Tuczon, AZ, USA
| | - L O'Donnell
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - D Scholl
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - B Whittaker
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S Vasu
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S Penza
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - L A Andritsos
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S M Devine
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - S M Jaglowski
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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54
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Hyun SY, Cheong JW, Kim SJ, Min YH, Yang DH, Ahn JS, Lee WS, Ryoo HM, Do YR, Lee HS, Lee JH, Oh SY, Suh C, Yhim HY, Kim JS. High-Dose Etoposide Plus Granulocyte Colony-Stimulating Factor as an Effective Chemomobilization Regimen for Autologous Stem Cell Transplantation in Patients with Non-Hodgkin Lymphoma Previously Treated with CHOP-based Chemotherapy: A Study from the Consortium for Improving Survival of Lymphoma. Biol Blood Marrow Transplant 2014; 20:73-9. [DOI: 10.1016/j.bbmt.2013.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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55
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Giralt S, Costa L, Schriber J, Dipersio J, Maziarz R, McCarty J, Shaughnessy P, Snyder E, Bensinger W, Copelan E, Hosing C, Negrin R, Petersen FB, Rondelli D, Soiffer R, Leather H, Pazzalia A, Devine S. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant 2013; 20:295-308. [PMID: 24141007 DOI: 10.1016/j.bbmt.2013.10.013] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) is a well-established treatment for malignancies such as multiple myeloma (MM) and lymphomas. Various changes in the field over the past decade, including the frequent use of tandem aHSCT in MM, the advent of novel therapies for the treatment of MM and lymphoma, and the addition of new stem cell mobilization techniques, have led to the need to reassess current stem cell mobilization strategies. Mobilization failures with traditional strategies are common and result in delays in treatment and increased cost and resource utilization. Recently, plerixafor-containing strategies have been shown to significantly reduce mobilization failure rates, but the ideal method to maximize stem cell yields and minimize costs associated with collection has not yet been determined. A panel of experts convened to discuss the currently available data on autologous hematopoietic stem cell mobilization and transplantation and to devise guidelines to optimize mobilization strategies. Herein is a summary of their discussion and consensus.
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Affiliation(s)
- Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Luciano Costa
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - John Dipersio
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - John McCarty
- Adult Bone Marrow Transplant, Virginia Commonwealth University, Richmond, Virginia
| | - Paul Shaughnessy
- Adult Bone Marrow Transplant, Texas Transplant Institute, San Antonio, Texas
| | - Edward Snyder
- Yale University Medical School, New Haven, Connecticut
| | | | - Edward Copelan
- Levine Cancer Institute I, Carolinas HealthCare System, Charlotte, North Carolina
| | | | | | - Finn Bo Petersen
- Intermountain Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Damiano Rondelli
- Section of Hematology/Oncology, University of Illinois at Chicago Cancer Center, Chicago, Illinois
| | - Robert Soiffer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Amy Pazzalia
- Adult Bone Marrow Transplant, University of Florida, Gainesville, Florida
| | - Steven Devine
- Department of Internal Medicine/Hematology/Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Smith VR, Popat U, Ciurea S, Nieto Y, Anderlini P, Rondon G, Alousi A, Qazilbash M, Kebriaei P, Khouri I, de Lima M, Champlin R, Hosing C. Just-in-time rescue plerixafor in combination with chemotherapy and granulocyte-colony stimulating factor for peripheral blood progenitor cell mobilization. Am J Hematol 2013; 88:754-7. [PMID: 23749720 DOI: 10.1002/ajh.23499] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/16/2013] [Accepted: 05/23/2013] [Indexed: 12/22/2022]
Abstract
Plerixafor, a recently approved peripheral blood progenitor cell mobilizing agent, is often added to granulocyte-colony stimulating factor (G-CSF) to mobilize peripheral blood progenitor cells in patients with lymphoma or myeloma who cannot mobilize enough CD34+ cells with G-CSF alone to undergo autologous stem cell transplantation. However, data are lacking regarding the feasibility and efficacy of just-in-time plerixafor in combination with chemotherapy and G-CSF. We reviewed the peripheral blood stem cell collection data of 38 consecutive patients with lymphoma (Hodgkin's and non-Hodgkin's) and multiple myeloma who underwent chemomobilization and high-dose G-CSF and just-in-time plerixafor to evaluate the efficacy of this treatment combination. All patients with multiple myeloma and all but one patient with lymphoma collected the minimum required number of CD34+ cells to proceed with autologous stem cell transplantation (>2 × 10(6) /kg of body weight). The median CD34+ cell dose collected in patients with non-Hodgkin lymphoma was 4.93 × 10(6) /kg of body weight. The median CD34+ cell dose collected for patients with multiple myeloma was 8.81 × 10(6) /kg of body weight. Plerixafor was well tolerated; no grade 2 or higher non-hematologic toxic effects were observed.
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Affiliation(s)
- Veronica R. Smith
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Stefan Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Amin Alousi
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Issa Khouri
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Marcos de Lima
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy; The University of Texas MD Anderson Cancer Center; Houston; Texas
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Talhi S, Osmani S, Brahimi M, Yafour N, Bouhass R, Arabi A, Bekadja M. The use of granulocyte colony stimulating factoR (G-CSF) (filgrastim) alone in the mobilization of stem cell in the autologous stem cell transplantation. Transfus Apher Sci 2013; 49:97-9. [DOI: 10.1016/j.transci.2013.02.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/13/2013] [Indexed: 11/16/2022]
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58
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Current World Literature. Curr Opin Oncol 2013; 25:205-208. [DOI: 10.1097/cco.0b013e32835ec49f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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59
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Tanhehco YC, Vogl DT, Stadtmauer EA, O'Doherty U. The evolving role of plerixafor in hematopoietic progenitor cell mobilization. Transfusion 2013; 53:2314-26. [PMID: 23362980 DOI: 10.1111/trf.12102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 11/09/2012] [Accepted: 11/19/2012] [Indexed: 12/21/2022]
Abstract
The introduction of plerixafor as a peripheral blood stem cell mobilization agent has allowed more patients with multiple myeloma, non-Hodgkin's lymphoma, and Hodgkin's disease to mobilize sufficient hematopoietic progenitor cells (HPCs) to proceed to autologous transplantation. Because of the high cost of plerixafor, it is not routinely used in all patients undergoing HPC mobilization. If cost were not an issue, an argument could be made that plerixafor could be added to every mobilization regimen, but cost is an issue so in an attempt to be more cost-effective, many centers have limited plerixafor use to patients who have failed or who are predicted to fail collection of adequate numbers of cells by other methods. Additionally, plerixafor is now under investigation both for HPC collection of healthy donors for allogeneic stem cell transplantation and as an adjunct therapy (i.e., chemosensitizing agent) for acute leukemias. This article briefly reviews the role of plerixafor in autologous and allogeneic transplantation as well as its emerging role in the treatment of acute leukemias. Emphasis is placed on the choice of appropriate patients for plerixafor use to assure an adequate stem cell yield while maximizing the cost effectiveness of using plerixafor. The role of prophylactic collections and future areas of research are also presented.
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Affiliation(s)
- Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University, New York, New York; Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Gandolfi F, Pennarossa G, Maffei S, Brevini T. Why is it so difficult to derive pluripotent stem cells in domestic ungulates? Reprod Domest Anim 2013; 47 Suppl 5:11-7. [PMID: 22913556 DOI: 10.1111/j.1439-0531.2012.02106.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pluripotent stem cells are the focus of an extremely active field of investigation that is bringing new light on our understanding of the mechanisms that control pluripotency and differentiation. Rodent and primates are the only species where true, or bona fide, pluripotent stem cells have been derived. The attempts to derive pluripotent stem cells from domestic ungulates have been going on for more than 20 years with little progress. Cell lines from these species present a series of limitations that have precluded their use for both basic and clinically oriented studies. However, in the last 3 years, some substantial progress have been made making the currently available ungulate pluripotent stem cells closest than ever before to their human and mouse counterpart. This result has been achieved through both conceptual and technical progress that will be illustrated and discussed in this review.
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Affiliation(s)
- F Gandolfi
- Department of Health, Animal Science and Food Safety, Università degli Studi di Milano, Milan, Italy.
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Giebel S, Kruzel T, Czerw T, Sadus-Wojciechowska M, Najda J, Chmielowska E, Grosicki S, Jurczyszyn A, Pasiarski M, Nowara E, Glowala-Kosinka M, Chwieduk A, Mitrus I, Smagur A, Holowiecki J. Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers. Bone Marrow Transplant 2013; 48:915-21. [DOI: 10.1038/bmt.2012.269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/06/2012] [Accepted: 11/28/2012] [Indexed: 11/09/2022]
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