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Olivieri A, Saraceni F, De Luca A. Focus on: Prognostic scores to predict stem cell mobilization. Transfus Apher Sci 2024; 63:103935. [PMID: 38735119 DOI: 10.1016/j.transci.2024.103935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Affiliation(s)
- Attilio Olivieri
- Dept &Stem Cell Transplant Unit, DISCLIMO-Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy.
| | - Francesco Saraceni
- Dept &Stem Cell Transplant Unit, DISCLIMO-Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy.
| | - Amalia De Luca
- Dept &Stem Cell Transplant Unit, DISCLIMO-Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy.
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Ye P, Cheng Y, Lian J, Tong H, Li L, Guo Q, Zhu W, Feng W, Huang L, Shou L, Chen D, Liu X, Li S, Du X, Yang M, Yu W, Qian J, Hu C, Wang H, Jin Y, Shen J, Hong P, Pei R, Jin J, Lu Y. Etoposide combined with cytarabine and pegfilgrastim for poorly mobilizing patients with multiple myeloma and lymphoma: A prospective multicentre study. Br J Haematol 2024; 204:2342-2350. [PMID: 38400570 DOI: 10.1111/bjh.19367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
A chemotherapy-based mobilization regimen in patients who mobilize poorly, based on etoposide, cytarabine and pegfilgrastim (EAP), has recently been introduced. The aim of this prospective study was to investigate the efficacy and safety of the EAP regimen in patients with poorly mobilizing multiple myeloma (MM) or lymphoma. This single-arm clinical trial was performed at eight public hospitals in China and was registered as a clinical trial (NCT05510089). The inclusion criteria were; (1) diagnosis of MM or lymphoma, (2) defined as a 'poor mobilizer' and (3) aged 18-75 years. The EAP regimen consisted of etoposide 75 mg/m2/day on days 1-2, cytarabine 300 mg/m2 every 12 h on days 1-2 and pegfilgrastim 6 mg on day 6. The primary endpoint of the study was the ratio of patients achieving adequate mobilization (≥2.0 × 106 CD34+ cells/kg). From 1 September 2022 to 15 August 2023, a total of 58 patients were enrolled, 53 (91.4%) achieved adequate mobilization, while 41 (70.7%) achieved optimal mobilization with a median number of cumulative collected CD34+ cells was 9.2 (range 2.1-92.7) × 106/kg and the median number of apheresis per patient of 1.2. The median time from administration of the EAP regimen to the first apheresis was 12 days. Approximately 8.6% of patients required plerixa for rescue, which was successful. Twelve (20.7%) of the 58 patients suffered grade 2-3 infections, while 25 (43.1%) required platelet transfusions. The duration of neutrophil and platelet engraftment was 11 days. In conclusion, these results suggest that the EAP mobilization regimen might be a promising option for poorly mobilizing patients with MM or lymphoma.
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Affiliation(s)
- Peipei Ye
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Yixuan Cheng
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Jiaying Lian
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Linjie Li
- Department of Hematology, The Central Hospital of Lishui City, Lishui, Zhejiang, China
| | - Qunyi Guo
- Department of Hematology, Taizhou Hospital of Zhejiang, Wenzhou Medical College, Taizhou, Zhejiang, China
| | - Weiguo Zhu
- Department of Hematology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Weiying Feng
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Li Huang
- Department of Hematology, Jinhua People's Hospital, Jinhua, Zhejiang, China
| | - Lihong Shou
- Department of Hematology, The Central Hospital of Huzhou City, Huzhou, Zhejiang, China
| | - Dong Chen
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Xuhui Liu
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Shuangyue Li
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Xiaohong Du
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Min Yang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Wenjuan Yu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Chao Hu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Huafeng Wang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Yangjin Jin
- Department of Hematology, The Central Hospital of Lishui City, Lishui, Zhejiang, China
| | - Jian Shen
- Department of Hematology, Taizhou Hospital of Zhejiang, Wenzhou Medical College, Taizhou, Zhejiang, China
| | - Pan Hong
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Renzhi Pei
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Ying Lu
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
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Lee CY, Yu TY, Lin FL, Hung GY, Hou MH, Ho CY, Liu CY, Chiou TJ, Yen HJ. Peripheral blood stem cell harvesting in young children weighing less than 15 kg. Cytotherapy 2024:S1465-3249(24)00709-6. [PMID: 38795116 DOI: 10.1016/j.jcyt.2024.05.008] [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: 08/23/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/27/2024]
Abstract
Autologous peripheral blood stem cell (PBSC) transplantation is crucial in pediatric cancer treatment, and tandem transplantation is beneficial in certain malignancies. Collecting PBSCs in small children with low body weight is challenging. We retrospectively analyzed data of pediatric cancer patients weighing <15 kg who underwent autologous PBSC harvesting in our hospital. Collections were performed in the pediatric intensive care unit over 2 or 3 consecutive days, to harvest sufficient stem cells (goal ≥2 × 106 CD34+ cells/kg per apheresate). From April 2006 to August 2021, we performed 129 collections after 50 mobilizations in 40 patients, with a median age of 1.9 (range, 0.6-5.6) years and a body weight of 11.0 (range, 6.6-14.7) kg. The median CD34+ cells in each apheresate were 4.2 (range, 0.01-40.13) × 106/kg. 78% and 56% of mobilizations achieved sufficient cell dose for single or tandem transplantation, respectively, without additional aliquoting. The preapheresis hematopoietic progenitor cell (HPC) count was highly correlated with the CD34+ cell yield in the apheresate (r = 0.555, P < 0.001). Granulocyte colony-stimulating factor alone was not effective for mobilization in children ≥2 years of age, even without radiation exposure. By combining the preapheresis HPC count ≥20/μL and the 3 significant host factors, including age <2 years, no radiation exposure and use of chemotherapy, the prediction rate of goal achievement was increased (area under the curve 0.787).
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Affiliation(s)
- Chih-Ying Lee
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ting-Yen Yu
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fen-Lan Lin
- Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ming-Hsin Hou
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Yin Ho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.; Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan..
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Cismaru CA, Tomuleasa C, Jurj A, Chira S, Isachekcu E, Cismaru G, Gherman LM, Gulei D, Munteanu R, Berindan Neagoe I. Synergistic Effect of Human Chorionic Gonadotropin and Granulocyte Colony Stimulating Factor in the Mobilization of HSPCs Improves Overall Survival After PBSCT in a Preclinical Murine Model. Are We Far Enough for Therapy? Stem Cell Rev Rep 2024; 20:206-217. [PMID: 37922107 DOI: 10.1007/s12015-023-10648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
Strategies to improve hematopoietic stem and progenitor cell (HSPC) mobilization from the bone marrow can have a pivotal role in addressing iatrogenic bone-marrow insufficiency from chemo(radio)therapy and overcoming peripheral blood stem cell transplantation (PBSCT) limitations such as insufficient mobilization. Granulocyte-colony stimulating factor (G-CSF) represents the standard mobilization strategy for HSPC and has done so for more than three decades since its FDA approval. Its association with non-G-CSF agents is often employed for difficult HSPC mobilization. However, obtaining a synergistic effect between the two classes is limited by different timing and mechanisms of action. Based on our previous in vitro results, we tested the mobilization potential of human chorionic gonadotropin (HCG), alone and in combination with G-CSF in vivo in a murine study. Our results show an improved mobilization capability of the combination, which seems to act synergistically in stimulating hematopoiesis. With the current understanding of the dynamics of HSPCs and their origins in more primitive cells related to the germline, new strategies to employ the mobilization of hematopoietic progenitors using chorionic gonadotropins could soon become clinical practice.
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Affiliation(s)
- Cosmin Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, P.O. 400393, Cluj-Napoca, Romania.
| | - Ciprian Tomuleasa
- MEDFUTURE - The Research Center for Advanced Medicine "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ancuta Jurj
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, P.O. 400393, Cluj-Napoca, Romania
| | - Sergiu Chira
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, P.O. 400393, Cluj-Napoca, Romania
| | - Ekaterina Isachekcu
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, P.O. 400393, Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luciana Madalina Gherman
- Laboratory Animal Facility - Centre for Experimental Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Gulei
- MEDFUTURE - The Research Center for Advanced Medicine "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Raluca Munteanu
- MEDFUTURE - The Research Center for Advanced Medicine "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, P.O. 400393, Cluj-Napoca, Romania
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Teipel R, Rieprecht S, Trautmann-Grill K, Röllig C, Klötzer C, Zimmer K, Rathaj G, Bach E, Brückner M, Heyn S, Wang SY, Jentzsch M, Schwind S, Kretschmann T, Egger-Heidrich K, Remane Y, Franke GN, von Bonin M, Bornhäuser M, Platzbecker U, Hölig K, Merz M, Vučinić V. Steady-state versus chemotherapy-based hematopoietic cell mobilization after anti-CD38-based induction therapy in newly diagnosed multiple myeloma. Transfusion 2023; 63:2131-2139. [PMID: 37850414 DOI: 10.1111/trf.17566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The incorporation of anti-CD38 monoclonal antibodies (mAb) in induction regimens of newly diagnosed transplant-eligible multiple myeloma (MM) patients has been established as a new standard. However, the optimal strategy of stem cell mobilization in this context is not yet clear. STUDY DESIGN AND METHODS From May 2020 till September 2022, we retrospectively reviewed patients receiving anti-CD38 mAb-based induction therapy followed by stem cell mobilization either in a steady-state protocol (SSM) using 10 μg/kg granulocyte colony-stimulating factor (G-CSF) for 5 days or in a chemotherapy-based protocol (CM) using 1-4 g/m2 cyclophosphamide and G-CSF. RESULTS Overall, 85 patients (median age 61 years) were included in the analysis. In total, 90 mobilization attempts were performed, 42 with SSM and 48 with CM. There was no significant difference in the median concentration of CD34+ cells in peripheral blood (PB) prior to apheresis between SSM and CM (61/μL vs. 55.4/μL; p = .60). Cumulative CD34+ yields did not differ between the groups with median of 6.68 and 6.75 × 106 /kg body weight, respectively (p = .35). The target yield (≥4 × 106 CD34+ cells/kg body weight) was reached in 88% (CM) and 86% (SSM), with a high proportion even after a single apheresis session (76% vs. 75%). Plerixafor was found to be more frequently used in SSM (52%) than in CM (23%; p < .01). A total of 83 patients underwent autologous transplantation and all were engrafted. CONCLUSIONS Stem cell collection in patients undergoing anti-CD38-based induction therapy is feasible with either CM or SSM, although SSM more frequently requires plerixafor.
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Affiliation(s)
- Raphael Teipel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Susanne Rieprecht
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
- Pharmacy, University Leipzig Medical Center, Leipzig, Germany
| | | | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christina Klötzer
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Kristin Zimmer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Grit Rathaj
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Enrica Bach
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Mandy Brückner
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Simone Heyn
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Song-Yau Wang
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Madlen Jentzsch
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | | | - Theresa Kretschmann
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Yvonne Remane
- Pharmacy, University Leipzig Medical Center, Leipzig, Germany
| | - Georg-Nikolaus Franke
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Malte von Bonin
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- National Center for Tumor Disease (NCT), Dresden, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Kristina Hölig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maximilian Merz
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Vladan Vučinić
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
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Antelo ML, Altuna A, Gimeno JJ, Ferreiro JJ, Amunárriz C, Mateos JJ, Zalba S, Alkorta A, Rifón J, Arroyo JL, Uresandi A, Moreno JA, Nájera MJ, Pinzón S, García A, Vallejo JC. Engraftment after autologous hematopoietic stem cell transplantation in patients mobilized with Plerixafor: A retrospective, multicenter study of a large series of patients. Transfus Apher Sci 2021; 60:103130. [PMID: 33840626 DOI: 10.1016/j.transci.2021.103130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
Plerixafor (PLX) appears to effectively enhance hematopoietic stem-cell mobilization prior to autologous hematopoietic stem cell transplantation (auto-HCT). However, the quality of engraftment following auto-HCT has been little explored. Here, engraftment following auto-HCT was assessed in patients mobilized with PLX through a retrospective, multicenter study of 285 consecutive patients. Information on early and 100-day post-transplant engraftment was gathered from the 245 patients that underwent auto-HCT. The median number of PLX days to reach the stem cell collection goal (≥2 × 106 CD34+ cells/kg) was 1 (range 1-4) and the median PLX administration time before apheresis was 11 h (range 1-18). The median number of apheresis sessions to achieve the collection goal was 2 (range 1-5) and the mean number of CD34+ cells collected was 2.95 × 106/kg (range 0-30.5). PLX administration was safe, with only 2 mild and transient gastrointestinal adverse events reported. The median time to achieve an absolute neutrophil count (ANC) >500/μL was 11 days (range 3-31) and the median time to platelet recovery >20 × 103/μL was 13 days (range 5-69). At 100 days after auto-HCT, the platelet count was 137 × 109/L (range 7-340), the ANC was 2.3 × 109/L (range 0.1-13.0), and the hemoglobin concentration was 123 g/L (range 79-165). PLX use allowed auto-HCT to be performed in a high percentage of poorly mobilized patients, resulting in optimal medium-term engraftment in the majority of patients in whom mobilization failed, in this case mainly due to suboptimal peripheral blood CD34+ cell concentration on day +4 or low CD34+ cell yield on apheresis.
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Affiliation(s)
- M Luisa Antelo
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Ane Altuna
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - J José Gimeno
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Javier Ferreiro
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - Cristina Amunárriz
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - J José Mateos
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - Saioa Zalba
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Aitziber Alkorta
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - José Rifón
- Servicio de Hematología, Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain.
| | - J Luis Arroyo
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Amaia Uresandi
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - J Antonio Moreno
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M Josefa Nájera
- Servicio de Hematología, Hospital San Pedro, Logroño, Spain.
| | - Sergio Pinzón
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Alejandro García
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Carlos Vallejo
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
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7
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Marumo A, Yamaguchi H, Hirakawa T, Inai K, Onai D, Omori I, Yamanaka S, Fujiwara Y, Sakaguchi M, Wakita S, Okamoto M, Yui S, Inokuchi K. Presence of Promyelocytes in Peripheral Blood as a Novel Predictor of Optimal Timing for Single-Step Peripheral Blood Stem Cell Collection. J NIPPON MED SCH 2021; 88:45-53. [PMID: 32238739 DOI: 10.1272/jnms.jnms.2021_88-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because peripheral blood stem cell (PBSC) collection places a burden on the patient and should ideally be completed in a single procedure, a convenient clinical predictive factor is needed. METHODS This retrospective study included 72 patients who underwent autologous PBSC collection. A median volume of 3.9 × 106 CD34-positive cells/kg (range: 0.3-47.4 × 106 cells/kg) was collected on the first day. We defined failure as inability to collect 2.0 × 106 cells/kg on the first day. PBSC collection was classified as failed (n = 25, 34.7%) and successful (n = 47, 65.3%), and patient clinical characteristics were analyzed. RESULTS The success group had significantly more cases in which a differential white blood cell count in peripheral blood on the day of PBSC collection detected promyelocytes (n = 34 [72.3%] vs. n = 11 [44.0%] in the failure group; P = 0.008). Sixty-two patients underwent autologous PBSC transplantation (median number of transplanted cells, 5.6 × 106/μL; range: 1.60-47.4 × 106 cells/μL). Among transplanted patients, the success and failure groups did not significantly differ in relation to the interval until neutrophil, platelet, or red blood cell engraftment. CONCLUSION The presence of promyelocytes in peripheral blood may be a useful indicator of the optimal timing for single-step PBSC collection.
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Affiliation(s)
| | | | | | - Kazuki Inai
- Department of Hematology, Nippon Medical School
| | - Daishi Onai
- Department of Hematology, Nippon Medical School
| | - Ikuko Omori
- Department of Hematology, Nippon Medical School
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Chen H, Liu KY. [Advances in mobilization of autologous hematopoietic stem cells]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:884-888. [PMID: 31775496 PMCID: PMC7364975 DOI: 10.3760/cma.j.issn.0253-2727.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- H Chen
- Peking University People's Hospital, Peking University Institution of Hematology, National Clinical Reserarch Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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9
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Tolomelli G, Mancuso K, Tacchetti P, Patriarca F, Galli M, Pantani L, Zannetti B, Motta MR, Rizzi S, Dan E, Sinigaglia B, Giudice V, Olmo A, Arpinati M, Chirumbolo G, Fanin R, Lewis RE, Paris L, Bonifazi F, Cavo M, Curti A, Lemoli RM. The timing of plerixafor addition to G-Csf and chemotherapy affects immunological recovery after autologous stem cell transplant in multiple myeloma. Bone Marrow Transplant 2019; 55:946-954. [DOI: 10.1038/s41409-019-0756-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 09/25/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
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10
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De Clercq E. Mozobil® (Plerixafor, AMD3100), 10 years after its approval by the US Food and Drug Administration. Antivir Chem Chemother 2019; 27:2040206619829382. [PMID: 30776910 PMCID: PMC6379795 DOI: 10.1177/2040206619829382] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AMD3100 (plerixafor, Mozobil®) was first identified as an anti-HIV agent
specifically active against the T4-lymphotropic HIV strains, as it selectively
blocked the CXCR4 receptor. Through interference with the interaction of CXCR4
with its natural ligand, SDF-1 (also named CXCL12), it also mobilized the
CD34+stem cells from the bone marrow into the peripheral blood
stream. In December 2008, AMD3100 was formally approved by the US FDA for
autologous transplantation in patients with Non-Hodgkin’s Lymphoma or multiple
myeloma. It may be beneficially used in various other malignant diseases as well
as hereditary immunological disorders such as WHIM syndrome, and
physiopathological processes such as hepatopulmonary syndrome.
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11
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Abstract
Mobilization failure is a major concern in patients undergoing hematopoietic cell transplantation, especially in an autologous setting, as almost all donor harvests can be accomplished with granulocyte-colony stimulating factor (G-CSF) alone. Poor mobilizers, defined as those with a peripheral blood CD34+ cell count ≤20 cells/μl after mobilization preceding apheresis is a significant risk factor for mobilization failure. We recommend preemptive plerixafor plus G-CSF (filgrastim, 10 μg/kg daily) as a first mobilization strategy, which yields sufficient peripheral blood progenitor cells (PBPCs) in almost all patients and avoids otherwise unnecessary remobilization. Preemptive plerixafor is administered in patients with a day-4 peripheral blood CD34+ count <15, depending on the disease and the target PBPC amount. Cyclophosphamide is reserved for patients who fail the first PBPC collection. We recommend second mobilization for patients who could not achieve a sufficient PBPC amount with the first mobilization. In these patients, a second attempt with plerixafor plus G-CSF or mobilization with plerixafor in combination with cyclophosphamide and G-CSF is recommended. Increased dose and/or twice daily administration of G-CSF can be considered.
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Affiliation(s)
- Kanji Miyazaki
- Department of Hematology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Kenshi Suzuki
- Department of Hematology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
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12
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Olivieri J, Attolico I, Nuccorini R, Pascale SP, Chiarucci M, Poiani M, Corradini P, Farina L, Gaidano G, Nassi L, Sica S, Piccirillo N, Pioltelli PE, Martino M, Moscato T, Pini M, Zallio F, Ciceri F, Marktel S, Mengarelli A, Musto P, Capria S, Merli F, Codeluppi K, Mele G, Lanza F, Specchia G, Pastore D, Milone G, Saraceni F, Di Nardo E, Perseghin P, Olivieri A. Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score. Bone Marrow Transplant 2018; 53:461-473. [PMID: 29330395 DOI: 10.1038/s41409-017-0051-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/26/2023]
Abstract
Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure.
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Affiliation(s)
- Jacopo Olivieri
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy.,UOC Medicina Interna ed Ematologia, ASUR-AV3, Civitanova Marche, Italy
| | | | | | | | - Martina Chiarucci
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | - Monica Poiani
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Corradini
- Dipartimento di Ematologia e Oncoematologia pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lucia Farina
- Dipartimento di Ematologia e Oncoematologia pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Luca Nassi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Simona Sica
- UOC Ematologia, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Roma, Italy
| | - Nicola Piccirillo
- UOC Ematologia, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Roma, Italy
| | | | - Massimo Martino
- Hematology and Stem Cell Transplant, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Tiziana Moscato
- Hematology and Stem Cell Transplant, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Massimo Pini
- Ematologia, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesco Zallio
- Ematologia, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milano, Italy
| | - Sarah Marktel
- Ospedale San Raffaele, Haematology and BMT, Milano, Italy
| | | | - Pellegrino Musto
- IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | | | | | | | - Giuseppe Mele
- UOC di Ematologia e Unità Trapianti, Osp. Antonio Perrino, Brindisi, Italy
| | - Francesco Lanza
- Hematology and Stem Cell Transplant, Ravenna Hospital, Ravenna, Italy
| | - Giorgina Specchia
- UO Ematologia con Trapianto, AOU Policlinico Consorziale, Bari, Italy
| | - Domenico Pastore
- UO Ematologia con Trapianto, AOU Policlinico Consorziale, Bari, Italy
| | - Giuseppe Milone
- Dipartimento di Ematologia, Unità Trapianto di Midollo Osseo, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Elvira Di Nardo
- Dipartimento di matematica "G. Peano", Università di Torino, Torino, Italy
| | | | - Attilio Olivieri
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy.
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13
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Abstract
In contemporary clinical practice, almost all allogeneic transplantations and autologous transplantations now capitalize on peripheral blood stem cells (PBSCs) as opposed to bone marrow (BM) for the source of stem cells. In this context, granulocyte colony-stimulating factor (G-CSF) plays a pivotal role as the most frequently applied frontline agent for stem cell mobilization. For patients classified as high-risk, chemotherapy based mobilization regimens can be preferred as a first choice and it is notable that this also used for remobilization. Mobilization failure occurs at a rate of 10%-40% with traditional strategies and it typically leads to low-efficiency practices, resource wastage, and delayed in treatment intervention. Notably, however, several factors can impact the effectiveness of CD34+ progenitor cell mobilization, including patient age and medical history (prior chemotherapy or radiotherapy, disease and marrow infiltration at the time of mobilization). In recent years, main (yet largely ineffective) approach was to increase G-CSF dose and add SCF, but novel and promising pathways have been opened up by the synergistic impact of a reversible inhibitor of CXCR4, plerixafor, with G-CSF. The literature shows to its favorable results in upfront and failed mobilizers, and it is necessary to use plerixafor (or equivalent agents) to optimize HSC harvest in poor mobilizers. Different CXCR4 inhibitors, growth hormone, VLA4 inhibitors, and parathormone, have been cited as new agents for mobilization failure in recent years. In view of the above considerations, the purpose of this paper is to examine the mobilization of PBSC while focusing specifically on poor mobilizers.
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Affiliation(s)
- Sinem Namdaroglu
- Izmir Bozyaka Training and Research Hospital, Department of Hematology, Izmir, Turkey.
| | - Serdal Korkmaz
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey
| | - Fevzi Altuntas
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey; Yıldırım Beyazıt University, Medical Faculty, Department of Hematology, Ankara, Turkey
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14
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Sahin U, Demirer T. Current strategies for the management of autologous peripheral blood stem cell mobilization failures in patients with multiple myeloma. J Clin Apher 2017; 33:357-370. [DOI: 10.1002/jca.21591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Ugur Sahin
- Department of Hematology; Ankara University Medical School; Ankara Turkey
| | - Taner Demirer
- Department of Hematology; Ankara University Medical School; Ankara Turkey
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15
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Partanen A, Valtola J, Ropponen A, Vasala K, Penttilä K, Ågren L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Preemptive plerixafor injection added to pegfilgrastim after chemotherapy in non-Hodgkin lymphoma patients mobilizing poorly. Ann Hematol 2017; 96:1897-1906. [PMID: 28879595 DOI: 10.1007/s00277-017-3123-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 12/15/2022]
Abstract
Filgrastim is usually combined with chemotherapy to mobilize hematopoietic progenitor cells in non-Hodgkin lymphoma (NHL) patients. Limited information is available on the efficacy of a preemptive plerixafor (PLER) injection in poor mobilizers after chemotherapy and pegfilgrastim. In this prospective study, 72 patients with NHL received chemotherapy plus pegfilgrastim, and 25 hard-to-mobilize patients received also PLER. The usefulness and efficacy of our previously developed algorithm for PLER use in pegfilgrastim-containing mobilization regimen were evaluated as well as the graft cellular composition, hematological recovery, and outcome after autologous stem cell transplantation (auto-SCT) according to the PLER use. A median 3.4-fold increase in blood CD34+ cell counts was achieved after the first PLER dose. The minimum collection target was achieved in the first mobilization attempt in 66/72 patients (92%) and 68 patients (94%) proceeded to auto-SCT. An algorithm for PLER use was fulfilled in 76% of the poor mobilizers. Absolute numbers of T-lymphocytes and NK cells were significantly higher in the PLER group, whereas the number of CD34+ cells collected was significantly lower. Early neutrophil engraftment was slower in the PLER group, otherwise hematological recovery was comparable within 12 months from auto-SCT. No difference was observed in survival according to the PLER use. Chemotherapy plus pegfilgrastim combined with preemptive PLER injection is an effective and convenient approach to minimize collection failures in NHL patients intended for auto-SCT. A significant effect of PLER on the graft cellular composition was observed, but no difference in outcome after auto-SCT was detected.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland.
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland
- The Finnish Medicines Agency, Kuopio, Finland
| | - L Ågren
- Department of Medicine, North Karelia Central Hospital, Joensuu, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
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16
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Milone G, Martino M, Leotta S, Spadaro A, Zammit V, Cupri A, Avola G, Camuglia MG, Di Marco A, Scalzulli P, Morelli M, Olivieri A, Tripepi G. Cost-effectiveness of on-demand plerixafor added to chemotherapy and granulocyte-colony stimulating factor for peripheral blood stem cell mobilization in multiple myeloma. Leuk Lymphoma 2017; 59:42-48. [DOI: 10.1080/10428194.2017.1324161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giuseppe Milone
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Massimo Martino
- Hematology and BMT UNIT, Ospedale Bianco Melacrino Morelli, Reggio Calabria, Italy
| | - Salvatore Leotta
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Andrea Spadaro
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Valentina Zammit
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Alessandra Cupri
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Giuseppe Avola
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Annalia Di Marco
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Potito Scalzulli
- Hematology and BMT UNIT, Ospedale Sollievo Sofferenza, San Giovanni Rotondo, Italy
| | - Mara Morelli
- Hematology and BMT UNIT, H San Raffaele, Milano, Italy
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17
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Ataca Atilla P, Bakanay Ozturk SM, Demirer T. How to manage poor mobilizers for high dose chemotherapy and autologous stem cell transplantation? Transfus Apher Sci 2016; 56:190-198. [PMID: 28034547 DOI: 10.1016/j.transci.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/16/2016] [Accepted: 11/26/2016] [Indexed: 12/15/2022]
Abstract
Today, peripheral blood stem cells are the preferred source of stem cells over bone marrow. Therefore, mobilization plays a crutial role in successful autologous stem cell transplantation. Poor mobilization is generally defined as failure to achieve the target level of at least 2×106 CD34+ cells/kg body weight. There are several strategies to overcome poor mobilization: 1) Larger volume Leukapheresis (LVL) 2) Re-mobilization 3) Plerixafor 4) CM+Plerixafor (P)+G-CSF and 5) Bone Marrow Harvest. In this review, the definitions of successful and poor mobilization are discussed. Management strategies for poor mobilization are defined. The recent research on new agents are included.
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Affiliation(s)
- Pinar Ataca Atilla
- Department of Hematology, Ankara University Medical School, Cebeci, 06590 Ankara, Turkey.
| | | | - Taner Demirer
- Department of Hematology, Ankara University Medical School, Cebeci, 06590 Ankara, Turkey.
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18
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Worel N, Fritsch G, Agis H, Böhm A, Engelich G, Leitner GC, Geissler K, Gleixner K, Kalhs P, Buxhofer-Ausch V, Keil F, Kopetzky G, Mayr V, Rabitsch W, Reisner R, Rosskopf K, Ruckser R, Zoghlami C, Zojer N, Greinix HT. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure. J Clin Apher 2016; 32:224-234. [PMID: 27578390 DOI: 10.1002/jca.21496] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 12/30/2022]
Abstract
Plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) is approved for autologous stem cell mobilization in poor mobilizing patients with multiple myeloma or malignant lymphoma. The purpose of this study was to evaluate efficacy and safety of plerixafor in an immediate rescue approach, administrated subsequently to G-CSF alone or chemotherapy and G-CSF in patients at risk for mobilization failure. Eighty-five patients mobilized with G-CSF alone or chemotherapy were included. Primary endpoint was the efficacy of the immediate rescue approach of plerixafor to achieve ≥2.0 × 106 CD34+ cells/kg for a single or ≥5 × 106 CD34+ cells/kg for a double transplantation and potential differences between G-CSF and chemotherapy-based mobilization. Secondary objectives included comparison of stem cell graft composition including CD34+ cell and lymphocyte subsets with regard to the mobilization regimen applied. No significant adverse events were recorded. A median 3.9-fold increase in CD34+ cells following plerixafor was observed, resulting in 97% patients achieving at least ≥2 × 106 CD34+ cells/kg. Significantly more differentiated granulocyte and monocyte forming myeloid progenitors were collected after chemomobilization whereas more CD19+ and natural killer cells were collected after G-CSF. Fifty-two patients underwent transplantation showing rapid and durable engraftment, irrespectively of the stem cell mobilization regimen used. The addition of plerixafor in an immediate rescue model is efficient and safe after both, G-CSF and chemomobilization and results in extremely high success rates. Whether the differences in graft composition have a clinical impact on engraftment kinetics, immunologic recovery, and graft durability have to be analysed in larger prospective studies.
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Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Fritsch
- Children?s Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Hermine Agis
- Medical Department I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Böhm
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | - Georg Engelich
- First Medical Department, Hospital Wiener Neustadt, Austria
| | - Gerda C Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Geissler
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Karoline Gleixner
- Medical Department I, Division of Haematology, Medical University of Vienna, Vienna, Austria
| | - Peter Kalhs
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | | | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Viktor Mayr
- Medical Department II, Hospital Krems, Austria
| | - Werner Rabitsch
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | - Regina Reisner
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Konrad Rosskopf
- Department of Blood Group Serology, Medical University Graz, Graz, Austria
| | - Reinhard Ruckser
- Medical Department II, Division of Oncology, Donauhospital Vienna, Vienna, Austria
| | - Claudia Zoghlami
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Niklas Zojer
- Department of Internal Medicine I, Wilhelminen Hospital, Vienna, Austria
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19
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Jantunen E, Varmavuo V, Valtola J. Plerixafor injection: a hematopoietic stem cell mobilizer in non-Hodgkin lymphoma and multiple myeloma. Expert Rev Hematol 2016; 9:723-32. [DOI: 10.1080/17474086.2016.1208082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Cooper DL, Medoff E, Patel N, Baker J, Pratt K, Foss F, Seropian SE, Perreault S, Wu Y. Autologous Stem Cell Mobilization in the Age of Plerixafor. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:411-6. [PMID: 27245311 DOI: 10.1016/j.clml.2016.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/30/2016] [Accepted: 04/26/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autologous stem cell transplantation remains important in the treatment of myeloma and relapsed lymphoma. Plerixafor has been shown to significantly enhance stem cell mobilization but is very expensive. PATIENTS AND METHODS We evaluated plerixafor use in the 3-year period after its approval in December 2008. RESULTS A total of 277 patients with myeloma and lymphoma had stem cell mobilization; 97.5% were successfully mobilized, including 41.5% who received plerixafor. Plerixafor was generally used for rescue after suboptimal granulocyte-colony stimulating factor (G-CSF) mobilization ("just in time") or for remobilization after an unsuccessful attempt with chemotherapy plus G-CSF. In addition, 10% of patients received planned G-CSF plus plerixafor because of high risk factors for inadequate collection. Rescue plerixafor was more effective in patients with myeloma than lymphoma as after 1 dose of plerixafor; 85% versus 55% collected a minimum number of stem cells (2 × 10E6 CD34 cells/kg) for 1 transplant and 51% versus 15% collected > 5 × 10E6 CD34 cells/kg. After transplantation, there were no significant differences in engraftment as a consequence of plerixafor use. Among all patients, there were less platelet transfusions in patients provided ≥ 3.5 × 10E6 CD34(+) cells/kg. CONCLUSION With the judicious use of plerixafor, nearly all patients can collect enough stem cells to proceed to transplantation. Further studies, including hematologic tolerance to posttransplantation therapy, are required to determine the cost-effectiveness of using plerixafor to convert adequate to more optimal mobilizers.
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Affiliation(s)
- Dennis L Cooper
- Section of Hematologic Malignancies, Yale Cancer Center, New Haven, CT; Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ.
| | - Erin Medoff
- Section of Hematologic Malignancies, Yale Cancer Center, New Haven, CT
| | - Natalie Patel
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Julie Baker
- Section of Hematologic Malignancies, Yale Cancer Center, New Haven, CT
| | - Kathryn Pratt
- Department of Nursing, Smilow Cancer Hospital, Yale-New Haven Children's Hospital, New Haven, CT
| | - Francine Foss
- Section of Hematologic Malignancies, Yale Cancer Center, New Haven, CT
| | - Stuart E Seropian
- Section of Hematologic Malignancies, Yale Cancer Center, New Haven, CT
| | - Sarah Perreault
- Department of Pharmacy, Smilow Cancer Hospital, Yale-New Haven Children's Hospital, New Haven, CT
| | - Yanyun Wu
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Bloodworks, Seattle, WA
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21
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Afifi S, Adel NG, Devlin S, Duck E, Vanak J, Landau H, Chung DJ, Lendvai N, Lesokhin A, Korde N, Reich L, Landgren O, Giralt S, Hassoun H. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study. Bone Marrow Transplant 2016; 51:546-52. [PMID: 26726942 DOI: 10.1038/bmt.2015.322] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 12/22/2022]
Abstract
Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.
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Affiliation(s)
- S Afifi
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N G Adel
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Duck
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Vanak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Landau
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - D J Chung
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - N Lendvai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - A Lesokhin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - N Korde
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - L Reich
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - O Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - S Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - H Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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22
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Bozdag SC, Ilhan O. Peripheral blood stem cell mobilization and collection from elderly patients and elderly healthy donor. Transfus Apher Sci 2015; 53:8-12. [DOI: 10.1016/j.transci.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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23
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Storch E, Mark T, Avecilla S, Pagan C, Rhodes J, Shore T, van Besien K, Cushing M. A novel hematopoietic progenitor cell mobilization and collection algorithm based on preemptive CD34 enumeration. Transfusion 2015; 55:2010-6. [PMID: 25808119 DOI: 10.1111/trf.13076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND The collection of autologous peripheral blood (PB) stem cells can be challenging in the subgroup of patients deemed "poor mobilizers" with granulocyte-colony-stimulating factor. Plerixafor, a CXCR-4 antagonist, is an alternative mobilizing agent, but is costly, and the optimal mobilization algorithm has yet to be determined. STUDY DESIGN AND METHODS To address the question we developed a protocol measuring PB CD34 on Day 4 of mobilization. We examined 26 patients before initiating the protocol versus 24 patients after initiation. RESULTS Significant differences (p ≤ 0.05) included fewer days of collection (1.25 days vs. 2.42 days), lower total blood volume processed (25.9 L vs. 57.2 L), lower total product volume (324 mL vs. 691 mL), lower RBC content (9 mL vs. 18 mL), and lower granulocyte percentage per collection (35% vs. 11%). There were no significant differences between the two groups in demographics, baseline platelet count, total CD34, or CD34/kg harvested. CONCLUSION Use of a protocol to assess PB CD34 1 day before collection allows for preemptive administration of plerixafor to augment mobilization. Subsequently, days of collection and processed blood volume are reduced while there is less RBC and granulocyte contamination in the collected stem cell product.
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Affiliation(s)
| | - Tomer Mark
- Department of Medicine, New York-Presbyterian Hospital, New York, New York
| | | | | | - Joanna Rhodes
- Department of Medicine, New York-Presbyterian Hospital, New York, New York
| | - Tsiporah Shore
- Department of Medicine, New York-Presbyterian Hospital, New York, New York
| | - Koen van Besien
- Department of Medicine, New York-Presbyterian Hospital, New York, New York
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24
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Civriz Bozdag S, Tekgunduz E, Altuntas F. The current status in hematopoietic stem cell mobilization. J Clin Apher 2015; 30:273-80. [PMID: 25790158 DOI: 10.1002/jca.21374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 12/12/2022]
Abstract
Hemotopoietic stem cell mobilization with cytokines alone, has still been widely accepted as the initial attempt for stem cell mobilization. Chemotherapy based mobilization can be preferred as first choice in high risk patients or for remobilization. But mobilization failure still remains to be a problem in one third of patients. Salvage mobilization strategies have been composed to give one more chance to 'poor mobilizers'. Synergistic effect of a reversible inhibitor of CXCR4, plerixafor, with G-CSF has opened a new era for these patients. Preemptive approach in predicted poor mobilizers, immediate salvage approach for patients with suboptimal mobilization or remobilization approach of plerixafor in failed mobilizers have all been demonstrated convincing results in various studies. Alternative CXCR4 inhibitors, VLA4 inhibitors, bortezomib, parathormone have also been emerged as novel agents for mobilization failure.
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Affiliation(s)
| | - Emre Tekgunduz
- Hematology Department, Ankara Oncology Training Hospital, Ankara, Turkey
| | - Fevzi Altuntas
- Hematology Department, Ankara Oncology Training Hospital, Ankara, Turkey
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25
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G-CSF plus preemptive plerixafor vs hyperfractionated CY plus G-CSF for autologous stem cell mobilization in multiple myeloma: effectiveness, safety and cost analysis. Bone Marrow Transplant 2015; 50:813-7. [PMID: 25751646 DOI: 10.1038/bmt.2015.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 12/22/2022]
Abstract
The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. We retrospectively compared our experience in hematopoietic cell mobilization in 83 MM patients using fractionated high-dose CY and G-CSF with G-CSF plus preemptive plerixafor. All patients in the CY group (n=56) received fractionated high-dose CY (5 g/m(2) divided into five doses of 1 g/m(2) every 3 h) with G-CSF. All patients in the plerixafor group (n=27) received G-CSF and plerixafor preemptively based on an established algorithm. Compared with plerixafor, CY use was associated with higher total CD34+ cell yield (7.5 × 10(6) vs 15.5 × 10(6) cells/kg, P=0.005). All patients in both groups yielded ⩾4 × 10(6) CD34+ cells/kg. Conversely, CY use was associated with high frequency of febrile neutropenia, blood and platelet transfusions need and hospitalizations. The average total cost of mobilization in Lebanon was slightly higher in the plerixafor group ($7886 vs $7536; P=0.16). Our data indicate robust stem cell mobilization in MM patients with either fractionated high-dose CY and G-CSF or G-CSF alone with preemptive plerixafor. The chemo-mobilization approach was associated with twofold stem cell yield, slightly lower cost but significantly increased toxicity.
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26
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Hequet O. Hematopoietic stem and progenitor cell harvesting: technical advances and clinical utility. J Blood Med 2015; 6:55-67. [PMID: 25733943 PMCID: PMC4340371 DOI: 10.2147/jbm.s52783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hematopoietic stem and progenitor cell (HSPC) transplantations require prior harvesting of allogeneic or autologous HSPCs. HSPCs are usually present in bone marrow (BM) during the entire life, in cord blood (CB) at birth, or in peripheral blood (PB) under particular circumstances. HSPCs were first harvested in BM and later in CB and PB, as studies showed interesting features of such grafts. All harvesting methods were in use throughout the years, except BM harvesting for HSPC autologous transplantation, which was replaced by PB harvesting. BM, CB, and PB harvesting methods have been developed, and materials and devices technically improved to increase the number of HSPCs harvested. In parallel, knowing the features of the donors or patients associated with successful numbers of HSPCs allows the adaptation of appropriate harvesting methods. Moreover, it is important to ensure the safety of donors or patients while harvesting. This review describes the methods used for harvesting based on recent studies or developments around these methods, and more particularly, the means developed to increase the numbers of HSPCs harvested in each method. It also explains briefly the influence of technical improvements in HSPC harvesting on potential changes in HSPC graft composition.
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Affiliation(s)
- Olivier Hequet
- Etablissement Français du Sang Rhône Alpes, Apheresis Unit, Centre Hospitalier Lyon Sud France, Lyon, France ; Cell Therapy Unit, Etablissement Français du Sang (EFS) Rhône-Alpes, Hospital Edouard Herriot, Lyon, France
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27
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Bilgin YM, Visser O, Beckers EAM, te Boome LCJ, Huisman C, Ypma PF, Croockewit AJ, Netelenbos T, Kramer EPA, de Greef GE. Evaluation of Dutch guideline for just-in-time addition of plerixafor to stem cell mobilization in patients who fail with granulocyte-colony-stimulating factor. Transfusion 2014; 55:1021-7. [PMID: 25641128 DOI: 10.1111/trf.12979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Plerixafor in combination with granulocyte-colony-stimulating factor (G-CSF) is approved for the use of stem cell collection in patients who fail to mobilize on G-CSF. In 2009 the Stem Cell Working Party of the Dutch-Belgian Cooperative Trial group for Hematology Oncology (HOVON) composed a guideline for the use of plerixafor. According to this guideline it is recommended to add plerixafor to G-CSF in patients with circulating CD34+ cell counts of fewer than 20 × 10(6) /L on 2 consecutive days accompanied by increasing white blood cells. STUDY DESIGN AND METHODS In this analysis we evaluated retrospectively the outcome of the use of this guideline in the Netherlands. In total 111 patients received plerixafor with a median one administration (range, one to four administrations). Of these patients 55.8% had non-Hodgkin lymphoma, 31.5% multiple myeloma, 8.1% Hodgkin lymphoma, and 4.5% nonhematologic malignancies. RESULTS In 63.9% patients sufficient numbers of CD34+ cells were collected. In patients with multiple myeloma more successful mobilizations with plerixafor were observed compared to patients with non-Hodgkin lymphoma (71.4% vs. 61.3%). In patients with circulating CD34+ cell counts of at least 2.0 × 10(6) /L before administration of plerixafor a successful mobilization was achieved in 76.5%, and in the patients with very low (0-1 × 10(6) /L) circulating CD34+ cell counts the success rate was 44.2%. CONCLUSION Application of the HOVON guideline on the just-in-time administration of plerixafor is effective for mobilization of hematopoietic stem cells in the majority of patients. Stem cell yield in patients with non-Hodgkin lymphoma was lower compared to patients with multiple myeloma. Also patients with very low circulating CD34+ cells before addition of plerixafor might benefit from this approach.
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Affiliation(s)
- Yavuz M Bilgin
- Department of Hematology, Erasmus MC, Rotterdam, the Netherlands
| | - Otto Visser
- Department of Hematology, VUMC, Amsterdam, the Netherlands
| | | | | | | | - Paula F Ypma
- Department of Hematology, HagaZiekenhuis, the Hague, the Netherlands
| | | | - Tanja Netelenbos
- Department of Immunohematology and Blood Transfusion, LUMC, Leiden, the Netherlands
| | - Ellen P A Kramer
- Department of Clinical Chemistry, Isala, Zwolle, the Netherlands
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28
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Jensen IS, Halbert RJ, Rossi G, Naoshy S, Iqbal SU, Xiao Z, McSweeney PA. A hospital budget impact model to compare stem cell mobilisation strategies: impact of primary research and direct stakeholder engagement. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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29
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Chow E, Rao KV, Wood WA, Covington D, Armistead PM, Coghill J, Serody JS, Gabriel DA, Jamieson KJ, Park YA, Raval JS, Shea TC. Effectiveness of an Algorithm-Based Approach to the Utilization of Plerixafor in Patients Undergoing Chemotherapy-Based Stem Cell Mobilization. Biol Blood Marrow Transplant 2014; 20:1064-8. [DOI: 10.1016/j.bbmt.2014.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
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30
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Rossi G, Skert C, Morello E, Almici C, Arcaini L, Basilico C, Cavalli L, Botto B, Castelli A, Pica G, Ripamonti F, Salvi F, Carella AM, Gaidano G, Levis A, Nosari A, Russo D, Vitolo U. PBSC mobilization in lymphoma patients: analysis of risk factors for collection failure and development of a predictive score based on the kinetics of circulating CD34+ cells and WBC after chemotherapy and G-CSF mobilization. Hematol Oncol 2014; 33:125-32. [PMID: 24890497 DOI: 10.1002/hon.2148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/30/2014] [Accepted: 04/15/2014] [Indexed: 11/06/2022]
Abstract
Autologous stem cell transplantation (ASCT) is a potentially curative treatment of lymphoma, but peripheral blood stem cell (PBSC) mobilization fails in some patients. PBSC mobilizing agents have recently been proved to improve the PBSC yield after a prior mobilization failure. Predictive parameters of mobilization failure allowing for a preemptive, more cost-effective use of such agents during the first mobilization attempt are still poorly defined, particularly during mobilization with chemotherapy + granulocyte colony-stimulating factor (G-CSF). We performed a retrospective analysis of a series of lymphoma patients who were candidates for ASCT, to identify factors influencing PBSC mobilization outcome. Premobilization parameters-age, histology, disease status, mobilizing protocol, and previous treatments-as well as white blood cell (WBC) and PBSC kinetics, markers potentially able to predict failure during the ongoing mobilization attempt, were analyzed in 415 consecutive mobilization procedures in 388 patients. We used chemotherapy + G-CSF in 411 (99%) of mobilization attempts and PBSC collection failed (<2 × 10(6) CD34+ PBSC/kg) in 13%. Multivariable analysis showed that only a low CD34+ PBSC count and CD34+ PBSC/WBC ratio, together with the use of nonplatinum-containing chemotherapy, independently predicted mobilization failure. Using these three parameters, we established a scoring system to predict risk of failure during mobilization ranging from 2 to 90%, thus allowing a selective use of a preemptive mobilization policy.
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Affiliation(s)
| | - Cristina Skert
- Bone Marrow Transplant Unit, Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Camillo Almici
- Stem Cell Collection Unit, Spedali Civili, Brescia, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Lara Cavalli
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Barbara Botto
- Division of Hematology, AOU San Giovanni Battista, Turin, Italy
| | - Andrea Castelli
- Division of Hematology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Gianmatteo Pica
- Division of Hematology/BMT Unit, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - Francesco Ripamonti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Flavia Salvi
- Division of Hematology, Ospedale Civile, Alessandria, Italy
| | - Angelo M Carella
- Division of Hematology/BMT Unit, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - Gianluca Gaidano
- Division of Hematology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | | | | | - Domenico Russo
- Bone Marrow Transplant Unit, Spedali Civili, University of Brescia, Brescia, Italy
| | - Umberto Vitolo
- Division of Hematology, AOU San Giovanni Battista, Turin, Italy
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31
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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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32
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Sorasio R, Bonferroni M, Grasso M, Strola G, Rapezzi D, Marenchino D, Di Marco C, Castellino C, Mattei D, Mordini N, Fiore F, Celeghini I, Borra A, Ghiglia A, Gallamini A. Peripheral Blood CD34+ Percentage at Hematological Recovery after Chemotherapy Is a Good Early Predictor of Harvest: A Single-Center Experience. Biol Blood Marrow Transplant 2014; 20:717-23. [DOI: 10.1016/j.bbmt.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/04/2014] [Indexed: 01/31/2023]
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33
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Mohty M, Hübel K, Kröger N, Aljurf M, Apperley J, Basak GW, Bazarbachi A, Douglas K, Gabriel I, Garderet L, Geraldes C, Jaksic O, Kattan MW, Koristek Z, Lanza F, Lemoli RM, Mendeleeva L, Mikala G, Mikhailova N, Nagler A, Schouten HC, Selleslag D, Suciu S, Sureda A, Worel N, Wuchter P, Chabannon C, Duarte RF. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014; 49:865-72. [PMID: 24686988 DOI: 10.1038/bmt.2014.39] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
Autologous haematopoietic SCT with PBSCs is regularly used to restore BM function in patients with multiple myeloma or lymphoma after myeloablative chemotherapy. Twenty-eight experts from the European Group for Blood and Marrow Transplantation developed a position statement on the best approaches to mobilising PBSCs and on possibilities of optimising graft yields in patients who mobilise poorly. Choosing the appropriate mobilisation regimen, based on patients' disease stage and condition, and optimising the apheresis protocol can improve mobilisation outcomes. Several factors may influence mobilisation outcomes, including older age, a more advanced disease stage, the type of prior chemotherapy (e.g., fludarabine or melphalan), prior irradiation or a higher number of prior treatment lines. The most robust predictive factor for poor PBSC collection is the CD34(+) cell count in PB before apheresis. Determination of the CD34(+) cell count in PB before apheresis helps to identify patients at risk of poor PBSC collection and allows pre-emptive intervention to rescue mobilisation in these patients. Such a proactive approach might help to overcome deficiencies in stem cell mobilisation and offers a rationale for the use of novel mobilisation agents.
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Affiliation(s)
- M Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - K Hübel
- University Hospital Cologne, Cologne, Germany
| | - N Kröger
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabi
| | | | - G W Basak
- The Medical University of Warsaw, Warsaw, Poland
| | | | - K Douglas
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - L Garderet
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - C Geraldes
- University Hospital Coimbra, Coimbra, Portugal
| | - O Jaksic
- University Hospital Dubrava, Zagreb, Croatia
| | - M W Kattan
- Quantitative Health Sciences Cleveland Clinic, Cleveland, OH, USA
| | - Z Koristek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Lanza
- Cremona Hospital, Cremona, Italy
| | | | - L Mendeleeva
- National Research Centre for Haematology, Moscow, Russia
| | - G Mikala
- St Istvan and St Laszlo Hospital, Budapest, Hungary
| | - N Mikhailova
- Institute of Children Haematology and Transplantation n.a. R Gorbacheva, St Petersburg State Pavlov Medical University, St Petersburg, Russia
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - H C Schouten
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Selleslag
- Department of Haematology, AZ Sint-Jan, Brugge-Oostende, Belgium
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | - A Sureda
- Addenbrooke's Hospital, Cambridge, UK
| | - N Worel
- Medical University Vienna, Vienna, Austria
| | - P Wuchter
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - C Chabannon
- Institut Paoli-Calmettes and Inserm CBT-510, Marseille, France
| | - R F Duarte
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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34
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Jantunen E, Varmavuo V. Plerixafor for mobilization of blood stem cells in autologous transplantation: an update. Expert Opin Biol Ther 2014; 14:851-61. [PMID: 24673120 DOI: 10.1517/14712598.2014.902927] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION About 99% of all autologous transplants are now performed with blood stem cells. G-CSF alone or combined with chemotherapy have been used to mobilize CD34(+) cells. Plerixafor is a novel drug used for mobilization purposes. AREAS COVERED We have evaluated recent data in regard to plerixafor use in predicted or proven poor mobilizers. In addition, we have looked for preemptive strategies to optimize the use of this expensive drug. Also cost-efficacy issues and effects of plerixafor on graft composition and post-transplant outcomes will be discussed. EXPERT OPINION Plerixafor added to G-CSF is superior than G-CSF alone for mobilization of CD34(+) cells. This combination is also efficient in patients who have failed a previous mobilization attempt with other methods or in patients with risk factors for poor mobilization. Addition of plerixafor to G-CSF or chemotherapy plus G-CSF mobilization in patients who appear to mobilize poorly is under active investigation and algorithms for a preemptive use of this expensive agent have been proposed. Grafts collected after plerixafor appear to contain more lymphoid cells than the grafts collected without it. Whether this affects post-transplant outcomes such as immune reconstitution and risk of relapse needs to be evaluated.
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Affiliation(s)
- Esa Jantunen
- University of Eastern Finland, Clinical Medicine , Kuopio , Finland
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35
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Targeting the molecular and cellular interactions of the bone marrow niche in immunologic disease. Curr Allergy Asthma Rep 2014; 14:402. [PMID: 24408534 DOI: 10.1007/s11882-013-0402-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent investigations have expanded our knowledge of the regulatory bone marrow (BM) niche, which is critical in maintaining and directing hematopoietic stem cell (HSC) self-renewal and differentiation. Osteoblasts, mesenchymal stem cells (MSCs), and CXCL12-abundant reticular (CAR) cells are niche components in close association with HSCs and have been more clearly defined in immune cell function and homeostasis. Importantly, cellular inhabitants of the BM niche signal through G protein-coupled surface receptors (GPCRs) for various appropriate immune functions. In this article, recent literature on BM niche inhabitants (HSCs, osteoblasts, MSCs, CAR cells) and their GPCR mechanistic interactions are reviewed for better understanding of the BM cells involved in immune development, immunologic disease, and current immune reconstitution therapies.
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36
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A plerixafor-based strategy allows adequate hematopoietic stem cell collection in poor mobilizers: results from the Canadian Special Access Program. Bone Marrow Transplant 2014; 49:751-5. [PMID: 24614838 DOI: 10.1038/bmt.2014.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/11/2014] [Accepted: 01/21/2014] [Indexed: 12/22/2022]
Abstract
Plerixafor effectively mobilizes hematopoietic stem cells (HSCs). However, most patients' cells are successfully collected using traditional strategies and there is limited cost-effectiveness data. The objectives of this study were to: (1) summarize the published reports of mobilization using a plerixafor-based strategy during compassionate access programs and (2) describe the Canadian experience with plerixafor during its availability by Health Canada's Special Access Program. A literature search identified reports of plerixafor-based mobilization during compassionate access programs. Overall, successful collection of at least 2 × 10(6) CD34+ cells/kg was achieved in ~75% of patients, and about two-thirds of patients went on to HSCT. A greater proportion of patients had successful collections when plerixafor was used in the upfront or preemptive settings. Plerixafor was made available by Health Canada's SAP from September 2008 to December 2010. In 96 of 132 (73%) patients, there was successful collection of at least 2 × 10(6) CD34+ cells/kg. Ninety-nine (75%) patients went on to receive an autologous transplant. Plerixafor-based mobilization is effective in perceived poor mobilizers. The optimal way to incorporate plerixafor into a mobilization strategy, however, remains to be determined. Centre-specific analysis of resource utilization may help to identify the most cost-effective way to implement various plerixafor-based mobilization strategies.
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Martino M, Laszlo D, Lanza F. Long-active granulocyte colony-stimulating factor for peripheral blood hematopoietic progenitor cell mobilization. Expert Opin Biol Ther 2014; 14:757-72. [DOI: 10.1517/14712598.2014.895809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Plerixafor ‘on demand’: results of a strategy based on peripheral blood CD34+ cells in lymphoma patients at first or subsequent mobilization with chemotherapy+G-CSF. Bone Marrow Transplant 2013; 49:453-5. [DOI: 10.1038/bmt.2013.193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Plerixafor and autologous stem cell transplantation: impressive result in a chemoresistant testicular cancer patient treated with high-dose chemotherapy. Anticancer Drugs 2013; 24:653-7. [PMID: 23698254 DOI: 10.1097/cad.0b013e328360cd8c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Plerixafor, a CXCR4 antagonist, induces the rapid release of hematopoietic progenitor stem cells from the bone marrow into peripheral blood; it is approved for autologous hematopoietic progenitor stem cell mobilization in multiple myeloma and non-Hodgkin's lymphoma patients. We report the case of a 34-year-old patient with metastatic testicular embryonal carcinoma who was extensively and in vain pretreated with chemotherapy and failed to mobilize an adequate number of hematopoietic progenitor stem cells following high-dose chemotherapy, with the support of granulocyte colony-stimulating factors. After a cycle of high-dose cyclophosphamide associated with granulocyte colony-stimulating factors, plerixafor was administered to the patient, with the clinical evidence of an increase in hematopoietic progenitor stem cells in the peripheral blood. The patient achieved a complete engraftment following two cycles of high-dose chemotherapy (paclitaxel, ifosfamide, carboplatin, etoposide), with the support of hematopoietic progenitor stem cells; the patient showed discrete tolerability to the treatment. At biochemical control, the β-human chorionic gonadotropin value decreased from 86 to less than 1.2 mUI/ml and total body PET-CT scan showed a complete response to chemotherapy. According to this experience, we believe that in patients with advanced germ cell cancer, it is essential to explore the possibility of the use of high-dose chemotherapy to induce a stable and permanent response; in this context, plerixafor, with the support of granulocyte colony-stimulating factors, may be an innovative option for satisfactory mobilization during high-dose chemotherapy protocols.
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Milone G, Martino M, Spadaro A, Leotta S, Di Marco A, Scalzulli P, Cupri A, Di Martina V, Schinocca E, Spina E, Tripepi G. Plerixafor on-demand combined with chemotherapy and granulocyte colony-stimulating factor: significant improvement in peripheral blood stem cells mobilization and harvest with no increase in costs. Br J Haematol 2013; 164:113-23. [PMID: 24138497 DOI: 10.1111/bjh.12606] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/28/2013] [Indexed: 12/23/2022]
Abstract
To date, no prospective study on Plerixafor 'on-demand' in combination with chemotherapy and granulocyte colony-stimulating factor (G-CSF) has been reported. We present an interim analysis of the first prospective study in which Plerixafor was administered on-demand in patients affected by multiple myeloma and lymphoma who received high dose cyclophosphamide or DHAP (dexamethasone, cytarabine, cisplatin) plus G-CSF to mobilize peripheral blood stem cells (PBSC). One hundred and two patients were evaluable for response. A cohort of 240 patients receiving the same mobilizing chemotherapy was retrospectively studied. Failure to mobilize CD34(+) cells in peripheral blood was reduced by 'on-demand' strategy compared to conventional mobilization; from 13·0 to 3·0% (P = 0·004). Failure to harvest CD34(+) cells 2 × 10(6) /kg decreased from 20·9 to 4·0% (P = 0·0001). The on-demand Plerixafor strategy also resulted in a lower rate of mobilization failure (P = 0·03) and harvest failure (P = 0·0008) when compared to a 'bias-adjusted set of controls'. Evaluation of economic costs of the two strategies showed that the overall cost of the two treatments were comparable when salvage mobilizations were taken into account. When in combination with cyclophosphamide or DHAP plus G-CSF, the 'on-demand' use of Plerixafor showed, in comparison to conventionally treated patients, a significant improvement in mobilization of PBSC with no increase in overall cost.
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Affiliation(s)
- Giuseppe Milone
- Programma di Trapianto Emopoietico, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy; Istituto Oncologico del Mediterraneo, Viagrande, Italy
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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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Langhammer S. Rationale for the design of an oncology trial using a generic targeted therapy multi‑drug regimen for NSCLC patients without treatment options (Review). Oncol Rep 2013; 30:1535-41. [PMID: 23877481 PMCID: PMC3810357 DOI: 10.3892/or.2013.2631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/05/2013] [Indexed: 01/07/2023] Open
Abstract
Despite more than 70 years of research concerning medication for cancer treatment, the disease still remains one of the leading causes of mortality worldwide. Many cancer types lead to death within a period of months to years. The original class of chemotherapeutics is not selective for tumor cells and often has limited efficacy, while treated patients suffer from adverse side‑effects. To date, the concept of tumor‑specific targeted therapy drugs has not fulfilled its expectation to provide a key for a cure. Today, many oncology trials are designed using a combination of chemotherapeutics with targeted therapy drugs. However, these approaches have limited outcomes in most cancer indications. This perspective review provides a rationale to combine targeted therapy drugs for cancer treatment based on observations of evolutionary principles of tumor development and HIV infections. In both diseases, the mechanisms of immune evasion and drug resistance can be compared to some extent. However, only for HIV is a breakthrough treatment available, which is the highly active antiretroviral therapy (HAART). The principles of HAART and recent findings from cancer research were employed to construct a hypothetical model for cancer treatment with a multi‑drug regimen of targeted therapy drugs. As an example of this hypothesis, it is proposed to combine already marketed targeted therapy drugs against VEGFRs, EGFR, CXCR4 and COX2 in an oncology trial for non‑small cell lung cancer patients without further treatment options.
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Lanza F, Lemoli RM, Olivieri A, Laszlo D, Martino M, Specchia G, Pavone V, Imola M, Pasini A, Milone G, Scortechini I, Todisco E, Guggiari E, Cascavilla N, Martinelli G, Rambaldi A, Bosi A. Factors affecting successful mobilization with plerixafor: an Italian prospective survey in 215 patients with multiple myeloma and lymphoma. Transfusion 2013; 54:331-9. [PMID: 23781769 DOI: 10.1111/trf.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/26/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although the efficacy of plerixafor in peripheral blood stem cell (PBSC) mobilization has been explored in several studies, factors associated with successful plerixafor mobilization after administration of granulocyte-colony-stimulating factor (G-CSF), with or without chemotherapy, have not been investigated. We analyzed data on PBSC mobilization from a large Italian database of lymphoma and myeloma plerixafor-treated patients. STUDY DESIGN AND METHODS Two endpoints were established to define successful mobilization: patients with at least 2 × 10(6) CD34+ cells/kg collected by three leukapheresis procedures and patients achieving a peak count of at least 20 × 10(6) CD34+ cells/L during mobilization. RESULTS Plerixafor achieved successful mobilization in both predicted (n = 64) and proven poor mobilizers (PMs; n = 143), classified according to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) criteria. Successful mobilization was independent of type of mobilization (steady state or chemotherapy); age; sex; disease; number or type of chemotherapy regimens preceding plerixafor; radiation therapy; prior treatment with melphalan, carmustine, lenalidomide, and radioimmune conjugates; and laboratory variables. Multivariate analysis identified previous fludarabine treatment and premobilization platelet count as predictors of successful mobilization. CONCLUSION This large, prospective, nationwide study confirmed plerixafor efficacy for mobilizing PBSCs when added to G-CSF with or without chemotherapy. Plerixafor can overcome negative effects of most predictors of poor mobilization to achieve satisfactory harvest both in predicted and proven PM.
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Affiliation(s)
- Francesco Lanza
- Section of Hematology and BMT Unit, Cremona Hospital, Cremona, Italy; Department of Hematology and Oncological Sciences, Institute of Hematology "L. & A. Seràgnoli", University of Bologna, Bologna, Italy; Section of Hematology, University Hospital of Ancona, "Ospedali Riuniti", Ancona, Italy; Hemato-Oncology Unit, Istituto Europeo Oncologico, Milan, Italy; Section of Hematology, Reggio Calabria Hospital, Reggio Calabria, Italy; Section of Hematology, University Hospital of Bari, Bari, Italy; Section of Hematology, Tricase Hospital, Tricase, Italy; Section the of Hematology, Rimini Hospital, Rimini, Italy; Section of Hematology, University Hospital Ferrarotto, Policlinico Vittorio Emanuele, Catania, Italy; Section of Hematology, Humanitas Hospital; BMT Unit, S. Raffaele Hospital, Milan, Italy; Section of Hematology, Hospital Casa Sollievo Sofferenza, S. Giovanni Rotondo, Italy; Section of Hematology, Bergamo Hospital, Bergamo, Italy; Section of Hematology and BMT Unit, University Hospital "Careggi", Florence, Italy
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Farina L, Spina F, Guidetti A, Longoni P, Ravagnani F, Dodero A, Montefusco V, Carlo-Stella C, Corradini P. Peripheral blood CD34+ cell monitoring after cyclophosphamide and granulocyte-colony-stimulating factor: an algorithm for the pre-emptive use of plerixafor. Leuk Lymphoma 2013; 55:331-6. [PMID: 23656194 DOI: 10.3109/10428194.2013.802783] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Plerixafor "on demand" after chemotherapy plus granulocyte-colony-stimulating factor (G-CSF) is efficient in peripheral stem cell mobilization, but the timing of administration and criteria for patient selection are under investigation. To devise an algorithm for the "on demand" use of plerixafor at the first mobilization attempt, we analyzed the kinetics of hematopoietic recovery and peripheral blood CD34+ cells in 107 patients treated with high-dose cyclophosphamide plus G-CSF. Fifty-one patients with myeloma were treated with cyclophosphamide 3-4 g/m(2) on day 0 followed by G-CSF 10 μg/kg from day + 6, and 56 patients with lymphoma received cyclophosphamide 6-7 g/m(2) followed by G-CSF 5 μg/kg from day + 1. Peripheral blood CD34+ cell monitoring was started on day + 8 in patients with myeloma and day + 10 in patients with lymphoma. The outcome of interest was a collection of ≤ 2 × 10(6) CD34+/kg. By a multivariate logistic regression model, CD34+ cell count < 10/μL at leukocyte recovery (> 1000/μL) or leukocyte count < 1000/μL after day + 12 in myeloma and day + 14 in lymphoma predicted the failure of mobilization by 2.7 and 2.8 times (p = 0.001 and p = 0.02) with a sensitivity of 89% and specificity of 88%, respectively. Plerixafor "on demand" may be considered in patients with myeloma and lymphoma with delayed hematopoietic recovery and < 10/μL CD34+ cells, as a first-line mobilization strategy.
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47
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Milone G, Tripepi G, Martino M, Ancora F, Bartolozzi B, Spadaro A, Nozzoli C, La Fauci A, Amico I, Leotta S, Poidomani M, Irrera G, Iacopino P, Saccardi R, Guidi S, Bosi A. Early measurement of CD34+ cells in peripheral blood after cyclophosphamide and granulocyte colony-stimulating factor treatment predicts later CD34+ mobilisation failure and is a possible criterion for guiding "on demand" use of plerixafor. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:94-101. [PMID: 23114516 PMCID: PMC3557479 DOI: 10.2450/2012.0004-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/22/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early identification of predictive factors of failure to mobilise CD34+ cells could enable rational use of plerixafor during first mobilisation, avoiding the need for a second mobilisation course. However, "on demand" administration of plerixafor needs to be driven by established parameters to avoid inappropriate use. MATERIALS AND METHODS To address this issue, we studied the value of the peripheral blood CD34+ count, measured early (on days +10, +11, +12 and +13), in predicting the mobilisation outcome in the ensuing days. We retrospectively collected data from three Italian centres on 233 patients affected by multiple myeloma or lymphoma who underwent a first or second attempt at mobilisation with cyclophosphamide 4 g/m(2) and granulocyte colony-stimulating factor. To assess the diagnostic value of peripheral blood white blood cell and CD34+ cell counts with respect to "mobilisation failure", we considered failed mobilisation as "disease" and the CD34+ cell count in peripheral blood, on a specific day, as a "diagnostic test". For various thresholds, we measured sensitivity, false positive rate, specificity and positive predictive value (PPV) as well as the area under the receiver-operating characteristic curves (AUC). RESULTS A CD34+ cell count <10 × 10(6)/L on day 13 had high sensitivity (1.00) and high specificity (1.00) for predicting subsequent mobilisation failure, with an AUC of 1.0. However, good prediction was also obtained using a lower threshold (CD34+ cell count: <6 × 10(6)/L) at an earlier time (day 12). The PPV of the day 13 threshold was 1.00 while that of the day 12 one was 0.87. DISCUSSION We propose that patients with <6 × 10(6)/L CD34+ cells in peripheral blood on day 12 and <10 × 10(6)/L on day 13 following mobilisation with cyclophosphamide 4 g/m(2) and granulocyte colony-stimulating factor are candidates for "on demand" use of plerixafor, making the administration of this expensive agent more efficient and avoiding its inappropriate use.
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Affiliation(s)
- Giuseppe Milone
- Bone Marrow Transplant Unit, Vittorio Emanuele Hospital, Catania, Italy.
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Successful mobilisation of peripheral blood stem cells in children using plerixafor: a case report and review of the literature. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 11:308-10. [PMID: 23114521 DOI: 10.2450/2012.0052-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 05/02/2012] [Indexed: 11/21/2022]
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Systematic Review of Randomized Controlled Trials of Hematopoietic Stem Cell Mobilization Strategies for Autologous Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant 2012; 18:1191-203. [DOI: 10.1016/j.bbmt.2012.01.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/11/2012] [Indexed: 11/20/2022]
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Shimizu N, Sakaida E, Ohwada C, Takeuchi M, Kawaguchi T, Tsukamoto S, Sakai S, Takeda Y, Sugita Y, Yokote K, Iseki T, Isose S, Kanai K, Misawa S, Kuwabara S, Nakaseko C. Mobilization of PBSCs in poor mobilizers with POEMS syndrome using G-CSF with plerixafor. Bone Marrow Transplant 2012; 47:1587-8. [DOI: 10.1038/bmt.2012.80] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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