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Intermediate-dose cyclophosphamide and bortezomib for PBSC mobilization in multiple myeloma. Transfus Apher Sci 2023:103649. [PMID: 36739175 DOI: 10.1016/j.transci.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Although the incorporation of bortezomib into induction regimens has improved, response rates in patients with multiple myeloma (MM), the role of bortezomib in the, peripheral blood stem cell (PBSC) mobilization remains unclear. We assessed the, PBSC mobilization efficacy, safety, and disease response of intermediate-dose, cyclophosphamide and bortezomib in the PBSC mobilization. Twenty-one patients with, newly diagnosed MM were enrolled in a phase II, non-randomized study that used, bortezomib (1.3 mg/m2/day on days 1, 4, 8, and 11) and intermediate-dose, cyclophosphamide (2 g/m2/day on days 2, 3) (Bor-ID-CY). The data from 15 patients, who received intermediate-dose cyclophosphamide (ID-CY) were used as a historical, control group. The total CD34 + cell yield of Bor-ID-CY and ID-CY groups were not, significantly different (median 6.3 ×106/kg vs. 6.5 ×106/kg, p = 0.19). All three patients, with mobilization failure of two groups had t(11;14). Six patients in Bor-ID-CY group, were upgraded from a status that was less than a very good partial response (VGPR), at the time of PBSC mobilization to a VGPR or better after PBSC mobilization, (p = 0.014). Four patients in Bor-ID-CY group developed sepsis. The time to, engraftment was similar in the two groups. The addition of bortezomib to ID-CY did not, impact the stem cell yield or quality.
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Rybinski B, Rapoport AP, Badros AZ, Hardy N, Kocoglu M. Prolonged Lenalidomide Induction Does Not Significantly Impair Stem Cell Collection in Multiple Myeloma Patients Mobilized With Cyclophosphamide or Plerixafor: A Report From The Covid Era. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2022; 22:e716-e729. [PMID: 35504807 PMCID: PMC8958842 DOI: 10.1016/j.clml.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
Introduction Induction therapy for multiple myeloma is traditionally capped at 6 cycles of lenalidomide due to concerns that longer treatment compromises the ability to collect sufficient stem cells for autologous stem cell transplantation (ASCT). However, during the COVID-19 pandemic, many of our patients received prolonged lenalidomide induction due to concerns about proceeding to ASCT. We investigated whether prolonged induction with lenalidomide affects the efficacy of stem cell collection among patients mobilized with cyclophosphamide and/or plerixafor. Patients and methods This single center, retrospective study included patients who were treated with lenalidomide induction regimens, received mobilization with cyclophosphamide or plerixafor, and underwent apheresis in preparation for ASCT. 94 patients were included, 40 of whom received prolonged induction with >6 cycles of lenalidomide containing regimen. Results Patients who received prolonged induction were more likely to require >1 day of apheresis (38% vs. 15%; OR 3.45; P = .0154), and there was a significant correlation between the duration of lenalidomide treatment and the apheresis time required to collect sufficient cells for transplant (R2 = 0.06423, P = .0148). However, there was no significant difference between patients who received prolonged induction and those who did not with respect to CD34+ stem cell yields at completion of apheresis (9.99 vs. 10.46 cells/Kg, P = .5513) or on the first day of collection (8.29 vs. 9.59 cells/Kg, P = .1788). Conclusion Among patients treated with >6 cycles of lenalidomide, mobilization augmented with cyclophosphamide and/or plerixafor will likely facilitate sufficient stem cell harvest to permit ASCT.
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Patterson AM, Zhang S, Liu L, Li H, Singh P, Liu Y, Farag SS, Pelus LM. Meloxicam with Filgrastim may Reduce Oxidative Stress in Hematopoietic Progenitor Cells during Mobilization of Autologous Peripheral Blood Stem Cells in Patients with Multiple Myeloma. Stem Cell Rev Rep 2021; 17:2124-2138. [PMID: 34510361 DOI: 10.1007/s12015-021-10259-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
Autologous stem cell transplantation (ASCT) is a potentially curative therapy but requires collection of sufficient blood stem cells (PBSC). Up to 40 % of patients with multiple myeloma (MM) fail to collect an optimum number of PBSC using filgrastim only and often require costly plerixafor rescue. The nonsteroidal anti-inflammatory drug meloxicam mobilizes PBSC in mice, nonhuman primates and normal volunteers, and has the potential to attenuate mobilization-induced oxidative stress on stem cells. In a single-center study, we evaluated whether a meloxicam regimen prior to filgrastim increases collection and/or homeostasis of CD34+ cells in MM patients undergoing ASCT. Mobilization was not significantly different with meloxicam in this study; a median of 2.4 × 106 CD34+ cells/kg were collected in the first apheresis and 9.2 × 106 CD34+ cells/kg were collected overall for patients mobilized with meloxicam-filgrastim, versus 4.1 × 106 in first apheresis and 7.2 × 106/kg overall for patients mobilized with filgrastim alone. CXCR4 expression was reduced on CD34+ cells and a higher CD4+/CD8+ T-cell ratio was observed after mobilization with meloxicam-filgrastim. All patients treated with meloxicam-filgrastim underwent ASCT, with neutrophil and platelet engraftment similar to filgrastim alone. RNA sequencing of purified CD34+ cells from 22 MM patients mobilized with meloxicam-filgrastim and 10 patients mobilized with filgrastim only identified > 4,800 differentially expressed genes (FDR < 0.05). Enrichment analysis indicated significant attenuation of oxidative phosphorylation and translational activity, possibly mediated by SIRT1, suggesting meloxicam may counteract oxidative stress during PBSC collection. Our results indicate that meloxicam was a safe, low-cost supplement to filgrastim mobilization, which appeared to mitigate HSPC oxidative stress, and may represent a simple means to lessen stem cell exhaustion and enhance graft quality.
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Affiliation(s)
- Andrea M Patterson
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 980 West Walnut St, Indianapolis, IN, 46202, USA.,Department of Microbiology & Immunology, Indiana University School of Medicine, 950 West Walnut St, Indianapolis, IN, 46202, USA
| | - Shuhong Zhang
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 980 West Walnut St, Indianapolis, IN, 46202, USA
| | - Liqiong Liu
- Department of Microbiology & Immunology, Indiana University School of Medicine, 950 West Walnut St, Indianapolis, IN, 46202, USA
| | - Hongge Li
- Department of Microbiology & Immunology, Indiana University School of Medicine, 950 West Walnut St, Indianapolis, IN, 46202, USA
| | - Pratibha Singh
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 980 West Walnut St, Indianapolis, IN, 46202, USA.,Department of Microbiology & Immunology, Indiana University School of Medicine, 950 West Walnut St, Indianapolis, IN, 46202, USA
| | - Yunlong Liu
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, 46202, Indianapolis, IN, USA.,Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sherif S Farag
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 980 West Walnut St, Indianapolis, IN, 46202, USA.
| | - Louis M Pelus
- Department of Medicine, Division of Hematology/Oncology, Indiana University School of Medicine, 980 West Walnut St, Indianapolis, IN, 46202, USA. .,Department of Microbiology & Immunology, Indiana University School of Medicine, 950 West Walnut St, Indianapolis, IN, 46202, USA.
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Chen L, Xiong X, Hou X, Wei H, Zhai J, Xia T, Gong X, Gao S, Feng G, Tao X, Zhang F, Chen W. Wuzhi capsule regulates chloroacetaldehyde pharmacokinetics behaviour and alleviates high-dose cyclophosphamide-induced nephrotoxicity and neurotoxicity in rats. Basic Clin Pharmacol Toxicol 2019; 125:142-151. [PMID: 30793490 DOI: 10.1111/bcpt.13211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/04/2019] [Indexed: 12/12/2022]
Abstract
High-dose cyclophosphamide (HD-CTX) treatment often leads to severe nephrotoxicity and neurotoxicity, which are mainly caused by one of its metabolites, chloroacetaldehyde (CAA). However, there are no effective antidotes to prevent these side effects. The objective of this study was to evaluate the effect of Wuzhi Capsule (WZC) on the pharmacokinetics of CTX and its metabolites in rats, and the attenuation of CAA induced kidney and brain injuries, which was produced at equimolar with 2-dechloroethylcyclophosphamide. Rats were treated with single- or multiple-dose of WZC when giving HD-CTX, and the plasma concentration of CTX and its metabolites were quantitated by UHPLC-MS/MS Single-dose, not multiple-dose of WZC co-administration (300 mg/kg) significantly reduced Cmax and AUC0→24 h of DC-CTX by 33.10% and 35.51%, respectively. Biochemical assay suggested oxidative stress was involved in kidney and brain injuries by HD-CTX, which were attenuated by single-dose WZC (300 mg/kg) pre-treatment, with increased glutathione, glutathione peroxidase and superoxide dismutase contents/or activities in both tissues and plasma (P < 0.05). Meanwhile, WZC pre-treatment could also significantly decrease the plasma levels of creatinine, blood urea nitrogen and malondialdehyde (P < 0.05). Additionally, WZC treatment improved the morphology and pathology condition of the kidneys and brains in rats. In conclusion, single-dose WZC co-administration decreased CAA production and exerted protective effect on CTX-induced oxidative stress in kidney and brain, whereas repetitive WZC co-administration with CTX was probably not recommended.
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Affiliation(s)
- Li Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Key Laboratory of Jiangxi Province for Research on Active Ingredients in Natural Medicines, Bioengineering Research Institute, Yichun University, Yichun, China
| | - Xiaojuan Xiong
- Key Laboratory of Jiangxi Province for Research on Active Ingredients in Natural Medicines, Bioengineering Research Institute, Yichun University, Yichun, China
| | - Xingyun Hou
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua Wei
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianxiu Zhai
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.,School of Traditional Chinese Material, Shenyang Pharmaceutical University, Shenyang, China
| | - Tianyi Xia
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaobin Gong
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shouhong Gao
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ge Feng
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Key Laboratory of Jiangxi Province for Research on Active Ingredients in Natural Medicines, Bioengineering Research Institute, Yichun University, Yichun, China
| | - Xia Tao
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Feng Zhang
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wansheng Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China
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