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Yazal Erdem A, Özyörük D, Ok Bozkaya İ, Çakmakcı S, Emir S, Demir HA, Özgüner HM, Ergürhan İlhan İ, Özbek NY. Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures. Pediatr Transplant 2024; 28:e14751. [PMID: 38659194 DOI: 10.1111/petr.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.
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Affiliation(s)
- Arzu Yazal Erdem
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Derya Özyörük
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Selma Çakmakcı
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Suna Emir
- Department of Pediatrics, Atılım University Faculty of Medicine, Ankara, Turkey
| | - Hacı Ahmet Demir
- Department of Pediatric Hematology and Oncology, Memorial Private Hospital, Ankara, Turkey
| | - Habibe Meltem Özgüner
- Department of Histology and Embriology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - İnci Ergürhan İlhan
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Goto H, Kanamori R, Nishina S, Seto T. Plerixafor stem cell mobilization in Japanese children: A post-marketing study. Pediatr Int 2022; 64:e15106. [PMID: 35396889 PMCID: PMC9323438 DOI: 10.1111/ped.15106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Plerixafor is approved in Japan for hematopoietic stem cell mobilization prior to autologous transplant, but limited data are available on the use in children. This study evaluates the safety and effectiveness of plerixafor in Japanese children aged <15 years. METHODS A multicenter, post-marketing surveillance study was conducted in Japan to evaluate the safety and effectiveness of plerixafor in routine clinical practice. This subgroup analysis examined the safety and effectiveness of plerixafor administered as a once-daily, subcutaneous injection in children aged <15 years. The primary effectiveness outcome was the proportion of patients with 2 × 106 cells CD34+ cells/kg collected via apheresis within 4 days. RESULTS Eighteen patients with solid tumors were included in this analysis; (median age 6.0 years, range, 1-13 years). In addition to granulocyte colony-stimulating factor, all patients had received chemotherapy immediately prior to plerixafor administration. The mean (SD) daily dose of plerixafor was 0.24 (0.01) mg/kg. Seven of the 18 patients (38.9%) developed adverse drug reactions (ADRs), all occurring in patients aged ≥6 years and weighing ≥16 kg. The most common ADRs were pyrexia (n = 4), vomiting (n = 3), nausea (n = 2), and abdominal pain (n = 2). Twelve patients (66.7%) achieved a CD34+ cell count ≥2 × 106 cells/kg within 4 days after the start of plerixafor administration. CONCLUSIONS The results provide an encouraging sign that plerixafor 0.24 mg/kg may be safe and effective in pediatric patients in routine clinical practice in Japan, but further research in larger studies is needed.
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Affiliation(s)
- Hiroaki Goto
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Rie Kanamori
- Sanofi Genzyme Medical, Oncology Medical, Sanofi K.K., Tokyo, Japan
| | - Satoshi Nishina
- Medical Affairs, Post-Authorization Regulatory Studies, Sanofi K.K., Tokyo, Japan
| | - Takashi Seto
- Medical Affairs, Post-Authorization Regulatory Studies, Sanofi K.K., Tokyo, Japan
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Koo J, Teusink-Cross A, Davies SM, Jodele S, Dandoy CE. Single-center results reporting improved hematopoietic stem cell mobilization success in pediatric and young adult patients with solid tumors and lymphoma. Pediatr Blood Cancer 2021; 68:e29319. [PMID: 34490994 DOI: 10.1002/pbc.29319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HSCT) is an established treatment for pediatric and young adult patients with solid tumors and lymphomas. Plerixafor is a CXC chemokine receptor type 4 (CXCR4) antagonist that can be used with granulocyte colony stimulating factor (G-CSF) to amplify the mobilization of hematopoietic stem cells (HSCs). METHODS We performed a retrospective analysis of 167 pediatric solid tumor and lymphoma patients from January 2010 to July 2020 in whom HSCs were mobilized using G-CSF alone or with plerixafor. RESULTS Thirteen heavily pretreated patients (33.3%) required twice-daily dosing of G-CSF compared to five patients (3.9%) in the not heavily pretreated group (p = .0005). Fourteen heavily pretreated patients (35.9%) required plerixafor compared to four patients (3.1%) in the comparison cohort (p = .0002). The number of mobilization days was similar between both cohorts, with 5 days (range 3-11 days) in the heavily pretreated group and 5 days (range 3-13 days) in the not heavily pretreated group (p = .55). The number of harvest days was 2 days (range 1-5 days) in the heavily pretreated group and 1 day (range 1-4 days) in the not heavily pretreated group (p = .0025). The final cluster of differentiation (CD)34+ /kilogram (kg) count was 9.52 × 106 /kg among heavily pretreated patients compared to 34.99 × 106 /kg CD34+ cells in the comparison group (p < .0001). Three heavily pretreated patients (7.7%) failed HSC mobilization. CONCLUSIONS Patients at the highest risk for poor HSC mobilization can be successfully treated with more frequent G-CSF dosing or G-CSF with plerixafor in a large majority of cases.
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Affiliation(s)
- Jane Koo
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley Teusink-Cross
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stella M Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Bhunia N, Abu-Arja R, Stanek JR, Mehyar LS, Shaw PJ, Kang HJ, Stein J, O'Brien TA, Roberts CH, Lee ACW, Loeb DM, Ozkaynak MF, Dalal JD, Strahlendorf C, Goyal RK, Shenoy SS, Rangarajan HG. A multicenter report on the safety and efficacy of plerixafor based stem cell mobilization in children with malignant disorders. Transfusion 2021; 61:894-902. [PMID: 33475172 DOI: 10.1111/trf.16260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pleraxifor for peripheral blood stem cell (PBSC) mobilization in children with malignancies is often given following failure of standard mobilization (SM) rather than as a primary mobilizing agent. STUDY DESIGN AND METHODS In this retrospective multicenter study, we report the safety of plerixafor-based PBSC mobilization in children with malignancies and compare outcomes between patients who received plerixafor upfront with SM (Group A) with those who received plerixafor following failure of SM (Group B). In the latter pleraxifor was given either following a low peripheral blood (PB) CD34 (<20 cells/cu.mm) (Group B1) or as a second collection process due to an unsuccessful yield (CD34 + < 2 × 106 /kg) (Group B2) following failed SM and first apheresis attempts. RESULTS The study cohort (n = 47) with a median age of 8 (range 0.6-21) year, comprised 19 (40%) Group A and 28 (60%) Group B patients (B1 = 12 and B2 = 16). Pleraxifor mobilization was successful in 87.2% of patients, similar between Groups A and B (84.2% vs 89.2%) and resulted in a median 4-fold increase in PB CD34. Median number of apheresis attempts was 2 in Groups A and B1 but 4 in Group B2. In Group B2, median total CD34+ yield post-plerixafor was 9-fold higher than after SM (P = .0013). Mild to moderate transient adverse events affected 8.5% of patients. Among patients who proceeded to autologous transplant (n = 39), all but one engrafted. CONCLUSION Plerixafor-based PBSC collection was safe and effective in our cohort and supports consideration as a primary mobilizing agent in children with malignancies.
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Affiliation(s)
- Nabanita Bhunia
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rolla Abu-Arja
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph R Stanek
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lubna S Mehyar
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Peter J Shaw
- Department of Oncology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, Seoul National University Children's Hospital, Seoul, Korea
| | - Jerry Stein
- Hemato-Oncology Department, Schneider Children's Medical Center of Israel, Petach Tivka, Israel
| | - Tracey A O'Brien
- Centre for Children's Cancer, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Catherine H Roberts
- Massey Cancer Center Bone Marrow Transplant, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anselm Chi-Wai Lee
- Children's Hematology & Cancer Center, Mount Elizabeth Hospital, Singapore
| | - David M Loeb
- Oncology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mehmet F Ozkaynak
- Pediatric Hematology/Oncology, New York Medical College, Vallhalla, New York, USA
| | | | | | - Rakesh K Goyal
- Pediatric Hematology/Oncology, UPMC, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shalini S Shenoy
- Pediatric Hematology/Oncology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Hemalatha G Rangarajan
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Malinowska I, Romiszewski M, Smalisz K, Stelmaszczyk-Emmel A, Nasilowska-Adamska B, Krol M, Urbanowska E, Brozyna A, Baginska-Dembowska B. Plerixafor combined with G-CSF for stem cell mobilization in children qualified for autologous transplantation- single center experience. Transfus Apher Sci 2021; 60:103077. [PMID: 33583716 DOI: 10.1016/j.transci.2021.103077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Failure of autologous peripheral blood CD34+ stem cells collection can adversely affect the treatment modality for patients with hematological and nonhematological malignant diseases where high dose chemotherapy followed by hematopoietic stem cell transplantation has become part of their treatment. Plerixafor in conjunction with G-CSF is approved for clinical use as a mobilization agent. The clinical efficacy of Plerixafor in CD34+ cells collection was analyzed in our institution. A total of 13 patients aged 1-15,5 years received Plerixafor in combination with G-CSF: 7 with neuroblastoma, 2 with Ewing's sarcoma and single patients with Hodgkin's lymphoma, germ cell tumor, retinoblastoma and Wilms tumor. Twelve patients (923%) achieved CD34+ cell counts of ≥ 20 × 106/L after 1-7 doses of Plerixafor. The average 9,9 - fold increase in number of CD34+ cells were achieved following the first dose and 429 - fold after second dose of plerixafor. Among the 13 patients, 12 yielded the minimum required cell collection of 2 × 106/kg within an average of 2 doses of Plerixafor. The mean number of apheresis days was 1.75. The median total number of collected CD34+ cells was 982 × 106/kg. Plerixafor enables rapid and effective mobilization, and collection of sufficient number of CD34+ cells.
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Affiliation(s)
- Iwona Malinowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Michal Romiszewski
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Katarzyna Smalisz
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Anna Stelmaszczyk-Emmel
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Barbara Nasilowska-Adamska
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland Indiry Gandhi str. 14, 02-776 Warsaw, Poland.
| | - Malgorzata Krol
- Stem Cell Bank, Central Clinical Hospital Warsaw Medical University, Poland, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Elzbieta Urbanowska
- Stem Cell Bank, Central Clinical Hospital Warsaw Medical University, Poland, Zwirki i Wigury str. 63A, 02- 091 Warsaw, Poland.
| | - Agnieszka Brozyna
- Department of Pediatrics Oncology, Children's Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
| | - Bozenna Baginska-Dembowska
- Department of Pediatrics Oncology, Children's Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
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The Successful Sequential Use of Plerixafor and Eltrombopag For Hematopoietic Cell Transplantation in a Child With High-risk Neuroblastoma. J Pediatr Hematol Oncol 2020; 42:e680-e682. [PMID: 31306338 DOI: 10.1097/mph.0000000000001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High-dose chemotherapy with autologous hematopoietic stem cell transplantation improves event-free survival in patients with high-risk neuroblastoma. However, in heavily pretreated patients, poor marrow function can be an obstacle in the successful proceeding of therapy. Priming with plerixafor plus filgrastim is an option for effective mobilization and collection of stem cells. In addition, thrombopoietin agonist eltrombopag can improve the outcome of posttransplantation thrombocytopenia and poor graft function in the posttransplant setting. We describe a case of a child with high-risk neuroblastoma, for whom plerixafor and eltrombopag were used as an effective and safe supportive therapy.
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Bitan M, Eshel R, Sadot E, Friedman S, Pinhasov A, Levin D, Dvir R, Manisterski M, Berger-Achituv S, Rosenfeld-Keidar H, Elhasid R. Combined plerixafor and granulocyte colony-stimulating factor for harvesting high-dose hematopoietic stem cells: Possible niche for plerixafor use in pediatric patients. Pediatr Transplant 2016; 20:565-71. [PMID: 26991903 DOI: 10.1111/petr.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2016] [Indexed: 01/05/2023]
Abstract
PB is a source of HSC, especially for autologous HCT in solid tumors. However, there is a risk of failing to achieve the target number of SC after mobilization with growth factors alone in patients who were heavily pretreated with chemotherapy or those in need for tandem transplants. SC were harvested from seven pediatric patients with solid tumors who were in need of autologous HCT following combination GCSF and plerixafor. Six of them received plerixafor after failing to achieve enough SC with GCSF only, while the seventh patient received the combined protocol upfront. All seven patients achieved the target number of SC according to their treatment protocol. There were no adverse events. All patients underwent autologous HCT using the harvested HSC and achieved full engraftment. A protocol for harvesting autologous HCT using GCSF and plerixafor is feasible and safe in children with solid tumors who had been heavily pretreated with chemotherapy or needed tandem transplants.
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Affiliation(s)
- Menachem Bitan
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rinat Eshel
- Hematology & BMT Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efraim Sadot
- Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shirley Friedman
- Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviva Pinhasov
- Hematology & BMT Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dror Levin
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rina Dvir
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Manisterski
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Berger-Achituv
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Rosenfeld-Keidar
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronit Elhasid
- Pediatric Hematology/Oncology & BMT Department, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Teusink A, Pinkard S, Davies S, Mueller M, Jodele S. Plerixafor is safe and efficacious for mobilization of peripheral blood stem cells in pediatric patients. Transfusion 2016; 56:1402-5. [PMID: 27079854 DOI: 10.1111/trf.13599] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chemotherapy followed by filgrastim is the most common strategy used to mobilize autologous peripheral blood stem cells (PBSCs) for high-dose chemotherapy and autologous stem cell transplantation. Unfortunately, this method does not always lead to adequate PBSC collection in heavily treated patients with relapsed malignancies or if multiple transplants are required. Plerixafor, a hematopoietic stem cell mobilizer that inhibits the CXCR4 chemokine receptor and blocks binding of its cognate ligand, stromal cell-derived factor-1α (SDF-1α), has been shown to be safe and efficacious in the mobilization of autologous PBSC in adults. Despite its use in adults, little evidence exists to support its use in children. STUDY DESIGN AND METHODS We report a retrospective review of 16 consecutive pediatric patients receiving plerixafor as part of their mobilization regimen at Cincinnati Children's Hospital Medical Center. All patients but one were given 0.24 mg/kg dose of plerixafor and the median number of plerixafor doses received was two (range, one to four doses). One patient received higher doses of plerixafor. RESULTS An adequate number of CD34+ cells were obtained in 14 of 16 patients (87.5%). The median number of CD34+ cells collected for patients who reached collection goal was 6 × 10(6) CD34+ cells/kg (range, 1.6 × 10(6) -12.4 × 10(6) /kg). No acute adverse events were noted to be attributable to plerixafor administration. CONCLUSION Our findings suggest that plerixafor use in children is safe and efficacious for the mobilization of autologous PBSCs in subjects with relapsed malignancies or requiring stem cells for multiple transplants.
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Affiliation(s)
- Ashley Teusink
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan Pinkard
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | - Stella Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mueller
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children. Stem Cells Int 2016; 2016:4078215. [PMID: 26880960 PMCID: PMC4736431 DOI: 10.1155/2016/4078215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022] Open
Abstract
Fifty-six aphaereses were performed in 23 pediatric patients with malignant hematological and solid tumors, following three different protocols for PBPC mobilization and distributed as follows: A: seventeen mobilized with 4 g/m2 of cyclophosphamide (CFA) and 10 μg/kg/day of granulocyte colony stimulating factor (G-CSF), B: nineteen with CFA + G-CSF, and C: twenty only with G-CSF when the WBC count exceeded 10 × 109/L. The average number of MNC/kg body weight (BW)/aphaeresis was 0.4 × 108 (0.1–1.4), 2.25 × 108 (0.56–6.28), and 1.02 × 108 (0.34–2.5) whereas the average number of CD34+ cells/kg BW/aphaeresis was 0.18 × 106/kg (0.09–0.34), 1.04 × 106 (0.19–9.3), and 0.59 × 106 (0.17–0.87) and the count of CFU/kg BW/aphaeresis was 1.11 × 105 (0.31–2.12), 1.16 × 105 (0.64–2.97), and 1.12 × 105 (0.3–6.63) in groups A, B, and C, respectively. The collection was better in group B versus group A (p = 0.007 and p = 0.05, resp.) and in group C versus group A (p = 0.08 and p = 0.05, resp.). The collection of PBPCs was more effective in the group mobilized with CFM + G-CSF when the WBC exceeded 10 × 103/μL in terms of MNC and CD34+ cells and there was no toxicity of the chemotherapy.
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Karakukcu M, Unal E. Stem cell mobilization and collection from pediatric patients and healthy children. Transfus Apher Sci 2015; 53:17-22. [PMID: 26116046 DOI: 10.1016/j.transci.2015.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Today, hematopoietic stem cell transplantation (HSCT) is a standard treatment for a variety of conditions in children, including certain malignancies, hemoglobinopathies, bone marrow failure syndromes, immunodeficiency and inborn metabolic disease. Two fundamentally different types of HSCT are categorized by the source of the stem cells. The first, autologous HSCT represents infusion of patient's own hematopoietic stem cells (HSCs) obtained from the patient; the second, allogeneic HSCT refers to the infusion of HSCs obtained from a donor via bone marrow harvest or apheresis. Bone marrow has been the typical source for HSCs for pediatric donors. Bone marrow harvest is a safe procedure mainly related to mild and transient side effects. Recently, a dramatically increased use of mobilized peripheral blood stem cells (PBSCs) in the autologous as well as allogeneic setting has been seen worldwide. There are limited data comparing mobilization regimens; also mobilization practices vary widely in children. The most commonly used approach includes granulocyte colony stimulating factor (G-CSF) at 10 mg/kg/day as a single daily dose for 4 days before the day of leukapheresis. G-CSF induced pain was less reported in children compared to adult donors. For the collection, there are several technical problems, derived from the size of the patient or donor, which must be considered before and during the apheresis. Vascular access, extracorporeal circuit volume, blood flow rates are the main limiting factors for PBSC collection in small children. Most children younger than 12 years require central vascular access for apheresis; line placement may require either general anesthesia or conscious sedation and many of the complications arise from the central venous catheter. In this review, we discuss that the ethical considerations and some principals regarding children serving as stem cell donors and the commonest sources of HSCs are presented in children, together with a discussion of how to collect and process these cells.
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Affiliation(s)
- Musa Karakukcu
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey.
| | - Ekrem Unal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey
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Efficacy of plerixafor in children with malignant tumors failing to mobilize a sufficient number of hematopoietic progenitors with G-CSF. Bone Marrow Transplant 2015; 50:1089-91. [DOI: 10.1038/bmt.2015.71] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/17/2015] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
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