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Callera AF, Rosa ES, Callera F. Intermediate-dose cytarabine plus G-CSF as mobilization regimen for newly diagnosed multiple myeloma and heavily pre-treated patients with hematological and non-hematological malignancies. Transfus Apher Sci 2019; 58:318-322. [PMID: 30961974 DOI: 10.1016/j.transci.2019.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 02/24/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Intermediate-dose cytarabine plus G-CSF has recently emerged as safe and effective mobilization regimen for heavily pre-treated patients with lymphoid malignancies. We prospectively tested this regimen in patients referred to our center in order to collect enough stem cells for hematopoietic rescue in autologous transplantation (auto-HSCT). STUDY DESIGN AND METHODS cytarabine (1.6 g/m2) plus G-CSF (outpatient administration) was performed in 81 consecutive patients who underwent auto-HSCT. For analyses purposes patients were divided into Group A, consisted of 48 patients with newly diagnosed multiple myeloma (MM) and Group B with 33 heavily pre-treated patients (13 Hodgkin´s lymphoma, 7 non-Hodgkin´s lymphoma, 7 MM, 4 germ cell tumor, 2 non-promyelocytic acute myeloid leukemia). RESULTS In the Group A, circulating CD34+ cells/μL was significantly higher, 90% started stem cell harvest on day 14, 98% collected ≥5.0 × 106 CD34+cells/kg and a single apheresis was sufficient in 92% of the cases. In the Group B, 85% started leukapheresis on day 14, 88% collected ≥2.0 × 106 CD34+cells/kg which was achieved with a single apheresis in 82% of the cases; a higher proportion of the patients (63.6% versus 33.3%) required platelet transfusions. Both groups exhibited few adverse events and the time to neutrophil and platelet recovery was similar between groups. CONCLUSION Intermediate-dose cytarabine plus G-CSF mobilization is effective even for heavily pre-treated patients. The outpatient administration of G-CSF, the reliable prediction of the day to begin harvesting, the optimal CD34+ cell yield obtained with a single apheresis and the fewer occurrences of adverse events denoted the benefits of this regimen.
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Affiliation(s)
- Alexandra Fernandes Callera
- Centro de Hematologia do Vale, Rua Euclides Miragaia 700, Sala 75 - Centro, São José dos Campos, São Paulo 12245-820, Brazil
| | - Evandro Secchi Rosa
- Centro de Hematologia do Vale, Rua Euclides Miragaia 700, Sala 75 - Centro, São José dos Campos, São Paulo 12245-820, Brazil
| | - Fernando Callera
- Centro de Hematologia do Vale, Rua Euclides Miragaia 700, Sala 75 - Centro, São José dos Campos, São Paulo 12245-820, Brazil.
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2
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Mueller BU, Seipel K, Bacher U, Pabst T. Autologous Transplantation for Older Adults with AML. Cancers (Basel) 2018; 10:cancers10090340. [PMID: 30235847 PMCID: PMC6162649 DOI: 10.3390/cancers10090340] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
While the majority of patients with acute myeloid leukemia (AML) are above the age of 65 years at diagnosis, the outcome of older AML patients remains disappointing. Even if standard intensive chemotherapy induces morphologic complete remission (CR1), relapses in older AML patients are common leading to poor long-term survival outcomes. Since autologous hematopoietic stem cell transplantation (HCT) offers distinct anti-leukemic effectiveness while avoiding graft-versus-host disease associated with allogeneic transplantation, it represents an option for consolidation treatment in selected older AML patients. However, prospective studies in older AML patients assessing the benefit of autologous HCT compared to chemotherapy consolidation or allogeneic transplantation are lacking. Consequently, clinicians face the dilemma that there is considerable ambiguity on the most appropriate consolidation treatment for older AML patients in CR1. This review highlights the possible role of autologous HCT for consolidation in older AML patients reaching CR1 after induction treatment.
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Affiliation(s)
- Beatrice U Mueller
- Department of BioMedical Research, University of Bern, 3010 Berne, Switzerland.
| | - Katja Seipel
- Department of BioMedical Research, University of Bern, 3010 Berne, Switzerland.
| | - Ulrike Bacher
- Department of Hematology, University of Bern, 3010 Berne, Switzerland.
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3010 Berne, Switzerland.
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3
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Blum V, Heini AD, Novak U, Taleghani BM, Baerlocher GM, Leibundgut K, Seipel K, Banz Y, Bargetzi M, Pabst T. Hematopoietic stem cell remobilization with vinorelbine and filgrastim in AML. Bone Marrow Transplant 2017; 52:786-788. [PMID: 28194031 DOI: 10.1038/bmt.2017.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- V Blum
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - A D Heini
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - U Novak
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - B M Taleghani
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - G M Baerlocher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.,Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - K Leibundgut
- Department of Pediatric Hemato-Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - K Seipel
- Department of Clinical Research, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Y Banz
- Institute of Pathology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - M Bargetzi
- Department of Hematology, Kantonsspital, Aarau, Switzerland
| | - T Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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4
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A single center's experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation. Bone Marrow Transplant 2017; 52:561-566. [PMID: 28067870 PMCID: PMC5382040 DOI: 10.1038/bmt.2016.304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
In an otherwise eligible patient with relapsed lymphoma, inadequate mobilization of peripheral blood stem cells is a limiting factor to proceeding with an autologous hematopoietic cell transplantation (auto-HCT). Multiple strategies have been used to mobilize an adequate number of hematopoietic stem cells (HSCs) with no obvious front-line strategy. We report a single institutional experience mobilizing HSCs using four different approaches in lymphoma patients. We prospectively collected mobilization outcomes on patients planning to undergo auto-HCT at Ohio State University. We report results of first mobilization attempt for all relapsed or refractory lymphoma patients between 2008–2014. We identified 255 lymphoma patients who underwent mobilization for planned auto-HCT. The 255 lymphoma patients underwent the following front line mobilization strategies: 95 (37%) GCSF alone, 38 (15%) chemomobilization (GCSF+chemotherapy), 97 (38%) preemptive day 4 plerixafor, and 25 (10%) rescue day 5 plerixafor. As expected, there were significant differences between cohorts including age, comorbid indices, histology, and amount of prior chemotherapy. After controlling for differences between groups, the odds of collecting 2×106/kg HSCs on the first day of collection and 5×106/kg HSCs in total was highest in the cohort undergoing chemomobilization. In conclusion, our experience highlights the effectiveness of chemomobilization.
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5
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Duarte FB, Prado BDPA, Vieira GMM, Costa LJ. Mobilization of hematopoietic progenitor cells for autologous transportation: consensus recommendations. Rev Assoc Med Bras (1992) 2016; 62 Suppl 1:10-15. [PMID: 27982316 DOI: 10.1590/1806-9282.62.suppl1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Selected patients with certain hematological malignancies and solid tumors have the potential to achieve long-term survival with autologous hematopoietic progenitor cell transplant. The collection of these cells in peripheral blood avoids multiple bone marrow aspirations, results in faster engraftment and allows treatment of patients with infection, fibrosis, or bone marrow hypocellularity. However, for the procedure to be successful, it is essential to mobilize a sufficient number of progenitor cells from the bone marrow into the blood circulation. Therefore, a group of Brazilian experts met in order to develop recommendations for mobilization strategies adapted to the reality of the Brazilian national health system, which could help minimize the risk of failure, reduce toxicity and improve the allocation of financial resources.
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Affiliation(s)
- Fernando Barroso Duarte
- Service of Hematology and Hematopoietic Cell Transplantation, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Brazil
| | | | | | - Luciano J Costa
- Department of Bone Marrow Transplantation and Cell Therapy Program, Department of Medicine and UAB-CCC, Birmingham, AL, USA
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6
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Voegeli M, Rondeau S, Berardi Vilei S, Lerch E, Wannesson L, Pabst T, Rentschler J, Bargetzi M, Jost L, Ketterer N, Bischof Delaloye A, Ghielmini M. Y 90 -Ibritumomab tiuxetan (Y 90 -IT) and high-dose melphalan as conditioning regimen before autologous stem cell transplantation for elderly patients with lymphoma in relapse or resistant to chemotherapy: a feasibility trial (SAKK 37/05). Hematol Oncol 2016; 35:576-583. [PMID: 27677906 DOI: 10.1002/hon.2348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/24/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
Standard conditioning regimens for autologous stem cell transplantation (ASCT) are often not tolerated by elderly patients, on one hand. Single high-dose melphalan, on the other hand, has been shown to be safe and active as a pretransplant preparative regimen in elderly patients. Y90 -Ibritumomab tiuxetan (Y90 -IT) is well tolerated and feasible in the transplantation setting. We therefore investigated the combination of high-dose melphalan and Y90 -IT as a conditioning regimen for patients ≥65 years of age. Patients with relapsed or resistant CD20-positive lymphoma in remission after salvage chemotherapy could be enrolled. High-dose therapy consisted of standard dose Y90 -IT (0.4-mCi/kg body weight) followed by melphalan at escalating doses (100, 140, 170 and 200 mg/m2 ) and ASCT. The primary objective was to identify the maximum tolerated dose; secondary end points were complete response (CR) rate 100 days after transplantation and toxicity. Twenty patients (median age 72 years) were included. No DLT occurred at any dose level. Thirteen patients completed the treatment, 11 were evaluable for response. Seven patients did not complete treatment because of mobilization failure (n = 3), progressive disease (n = 2), worsening of cardiac function (n = 1), and grade 3 dyspnea (n = 1). Seven patients achieved a CR/complete remission/unconfirmed (CRu) and 2 had stable disease. Five out of 7 responding patients were still alive more than 3 years after transplantation. The 2 patients with SD had a long-term survival of 3 and 5 years, respectively. Nonhematological grade 3 or higher treatment related adverse events (AEs) were infection (n = 6), including 2 cases of febrile neutropenia, diarrhea (n = 3), mucositis, anorexia, viral hepatitis, hypokalemia, dehydration, and multiorgan failure (n = 1 for each). The combination of Y90 -IT and high-dose melphalan is feasible before ASCT for elderly patients, with promising activity and manageable toxicity.
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Affiliation(s)
| | | | | | - Erika Lerch
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Luciano Wannesson
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | - Jochen Rentschler
- Universitätsspital Basel, Basel, Switzerland.,Ortenau Klinikum Offenburg, Offenburg, Germany
| | | | - Lorenz Jost
- Kantonsspital Bruderholz, Bruderholz, Switzerland
| | - Nicolas Ketterer
- CHUV, Lausanne, Switzerland.,Hirslanden Lausanne SA, Lausanne, Switzerland
| | | | - Michele Ghielmini
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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7
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Carneiro-Silva FA, Brunetta DM, Kaufman J, Leitão JPV, Barroso KSN, Barbosa SAT, Carlos LMDB, Barroso-Duarte F. Successful hematopoietic stem cell mobilization with vinorelbine and filgrastim in germ cell tumor. Clin Exp Med 2016; 17:417-418. [PMID: 27165295 DOI: 10.1007/s10238-016-0425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/27/2016] [Indexed: 11/24/2022]
Abstract
Germ cell tumor (GCT) is the most frequent cancer in young men and is highly curable. Almost 80 % of patients with the disease in an advanced stage achieve a reliable response to cisplatin combination chemotherapy. For relapsing or refractory disease, autologous hematopoietic stem cell transplantation (HSCT) is an effective therapy. The two most used mobilization strategies for HSC collection are filgrastim alone or filgrastim after chemotherapy (chemomobilization). HSC collection with filgrastim mobilization can be difficult, especially in highly treated patients. While the addition of chemotherapy improves mobilization and reduces the number of apheresis sessions, it can increase morbidity rate as well. We describe a case of a 45-year-old male with classical seminoma who was submitted to orchiectomy. Two months after, he presented progression of the tumor. He received four cycles of cisplatin, etoposide and bleomycin, with residual retroperitoneal mass and cervical lymphadenopathy. Further, he was submitted to three more cycles of cisplatin, ifosfamide and paclitaxel. Thereupon, he showed partial response. At that moment, autologous HSC transplantation was considered. In the first mobilization, filgrastim alone was used without success in harvesting. The second mobilization consisted of vinorelbine at day 1 (35 mg/m2) and filgrastim (16 µg/kg) started at day 5. The peak of CD34+ cells in peripheral blood was 32.6 × 106 cells/L on day 8, with 4.73 × 106 cells/kg CD34+ collected on days 8 and 9. The benefits of this scheme include: (a) outpatient administration, (b) fewer doses of filgrastim, (c) minimal risk of febrile neutropenia and (d) reliable prediction of collection day. For these reasons, we conclude that vinorelbine chemomobilization is a great option for GCT, particularly in patients with high risk of mobilization failure. Furthermore, it requires less resource usage, hospitalizations and transfusions than conventional chemomobilization.
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Affiliation(s)
- Fabiana Aguiar Carneiro-Silva
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil.
| | - Denise Menezes Brunetta
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil.,Center of Hematology and Hemotherapy of Ceara, HEMOCE, Fortaleza, CE, Brazil
| | - Jacques Kaufman
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil
| | - João Paulo Vasconcelos Leitão
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil
| | - Karine Sampaio Nunes Barroso
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil
| | | | | | - Fernando Barroso-Duarte
- Hematology Division, Walter Cantidio University Hospital, Federal University of Ceara, Rua Capitão Francisco Pedro, 1290. Rodolfo Teofilo, Fortaleza, CE, 60.430-270, Brazil
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8
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Mueller BU, Keller S, Seipel K, Mansouri Taleghani B, Rauch D, Betticher D, Egger T, Pabst T. Stem cell mobilization chemotherapy with gemcitabine is effective and safe in myeloma patients with bortezomib-induced neurotoxicity. Leuk Lymphoma 2015; 57:1122-9. [DOI: 10.3109/10428194.2015.1079315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Keller S, Seipel K, Novak U, Mueller BU, Taleghani BM, Leibundgut K, Pabst T. Neurotoxicity of stem cell mobilization chemotherapy with vinorelbine in myeloma patients after bortezomib treatment. Leuk Res 2015; 39:786-92. [DOI: 10.1016/j.leukres.2015.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/13/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022]
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10
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Berger MD, Branger G, Klaeser B, Taleghani BM, Novak U, Banz Y, Mueller BU, Pabst T. Zevalin and BEAM (Z-BEAM) versus rituximab and BEAM (R-BEAM) conditioning chemotherapy prior to autologous stem cell transplantation in patients with mantle cell lymphoma. Hematol Oncol 2015; 34:133-9. [PMID: 25689832 DOI: 10.1002/hon.2197] [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: 10/09/2014] [Revised: 01/17/2015] [Accepted: 01/21/2015] [Indexed: 11/06/2022]
Abstract
Early relapse is common in patients with mantle cell lymphoma (MCL) highlighting the unmet need for further improvement of therapeutic options for these patients. CD20 inhibition combined with induction chemotherapy as well as consolidation with high-dose chemotherapy (HDCT) is increasingly considered cornerstones within current therapy algorithms of MCL whereas the role of radioimmunotherapy is unclear. This retrospective single center study compared 46 consecutive MCL patients receiving HDCT in first or second remission. Thirty-five patients had rituximab and BEAM (R-BEAM), and 11 patients received ibritumomab tiuxetan (Zevalin®), an Yttrium-90 labeled CD20 targeting antibody, prior to BEAM (Z-BEAM) followed by autologous stem cell transplantation (ASCT). We observed that the 5-year overall survival (OS) in the R-BEAM and Z-BEAM groups was 55% and 71% (p = 0.288), and the 4-year progression free survival (PFS) was 32% and 41%, respectively (p = 0.300). There were no treatment related deaths in both groups, and we observed no differences in toxicities, infection rates or engraftment. Our data suggest that the Z-BEAM conditioning regimen followed by ASCT is well tolerated, but was not associated with significantly improved survival compared to R-BEAM. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin D Berger
- Department of Medical Oncology, University Hospital, Berne, Switzerland
| | - Giacomo Branger
- Department of Medical Oncology, University Hospital, Berne, Switzerland
| | - Bernd Klaeser
- Department of Nuclear Medicine, University Hospital, Berne, Switzerland
| | | | - Urban Novak
- Department of Medical Oncology, University Hospital, Berne, Switzerland
| | - Yara Banz
- Institute of Pathology, University of Berne, Berne, Switzerland
| | - Beatrice U Mueller
- Department of Clinical Research, University of Berne, Berne, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, University Hospital, Berne, Switzerland
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11
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Samaras P, Pfrommer S, Seifert B, Petrausch U, Mischo A, Schmidt A, Schanz U, Nair G, Bargetzi M, Taverna C, Stupp R, Stenner-Liewen F, Renner C. Efficacy of vinorelbine plus granulocyte colony-stimulation factor for CD34+ hematopoietic progenitor cell mobilization in patients with multiple myeloma. Biol Blood Marrow Transplant 2014; 21:74-80. [PMID: 25278456 DOI: 10.1016/j.bbmt.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/19/2014] [Indexed: 01/08/2023]
Abstract
We aimed to assess the efficacy of vinorelbine plus granulocyte colony-stimulating factor (G-CSF) for chemo-mobilization of CD34(+) hematopoietic progenitor cells (HPC) in patients with multiple myeloma and to identify adverse risk factors for successful mobilization. Vinorelbine 35 mg/m(2) was administered intravenously on day 1 in an outpatient setting. Filgrastim 5 μg/kg body weight (BW) was given twice daily subcutaneously from day 4 until the end of the collection procedure. Leukapheresis was scheduled to start on day 8 and be performed for a maximum of 3 consecutive days until at least 4 × 10(6) CD34(+) cells per kg BW were collected. Overall, 223 patients were mobilized and 221 (99%) patients proceeded to leukapheresis. Three (1.5%) patients required an unscheduled hospitalization after chemo-mobilization because of neutropenic fever and renal failure (n = 1), severe bone pain (n = 1), and abdominal pain with constipation (n = 1). In 211 (95%) patients, the leukaphereses were started as planned at day 8, whereas in 8 (3%) patients the procedure was postponed to day 9 and in 2 (1%) patients to day 10. In the great majority of patients (77%), the predefined amount of HPC could be collected with 1 leukapheresis. Forty-four (20%) patients needed a second leukapheresis, whereas only 6 (3%) patients required a third leukapheresis procedure. The median number of CD34(+) cells collected was 6.56 × 10(6) (range, .18 to 25.9 × 10(6)) per kg BW at the first day of leukapheresis and 7.65 × 10(6) (range, .18 to 25.9 × 10(6)) per kg BW in total. HPC collection was successful in 212 (95%) patients after a maximum of 3 leukaphereses. Patient age (P = .02) and prior exposition to lenalidomide (P < .001) were independent risk factors for a lower HPC amount collected in multiple regression analysis. Vinorelbine plus G-CSF enables a very reliable prediction of the timing of leukapheresis and results in successful HPC collection in 95% of the patients.
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Affiliation(s)
- Panagiotis Samaras
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland.
| | - Sarah Pfrommer
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Ulf Petrausch
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Axel Mischo
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Adrian Schmidt
- Medical Oncology and Hematology, Triemli City Hospital, Zurich, Switzerland
| | - Urs Schanz
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Gayathri Nair
- Department of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Mario Bargetzi
- Center of Oncology, Hematology and Transfusion Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christian Taverna
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Roger Stupp
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christoph Renner
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Holbro A, Graf L, Topalidou M, Bucher C, Passweg JR, Tsakiris DA. Cryopreserved stem cell products containing dimethyl sulfoxide lead to activation of the coagulation system without any impact on engraftment. Transfusion 2013; 54:1508-14. [PMID: 24304039 DOI: 10.1111/trf.12511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/14/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dimethyl sulfoxide (DMSO) is extensively used as a cryoprotectant in stem cell preservation. Little is known on direct hemostatic changes in recipients of hematopoietic stem cell transplantation (HSCT), immediately after DMSO administration. The objectives of the current study were to measure hemostatic changes during HSCT. STUDY DESIGN AND METHODS In this prospective analysis, changes in plasma biomarkers, platelets (PLTs), or endothelial cells (D-dimers, thrombin-antithrombin complex [TAT], microparticle activity as thrombin-generation potential [MPA], whole blood aggregation, von Willebrand factor) were measured before and immediately after HSCT. Furthermore, associations with clinical complications were recorded. RESULTS A total of 54 patients were included in the study. Mean MPA and TAT increased significantly immediately after HSCT, returning to baseline the day after the procedure (p<0.01). No significant differences in engraftment for neutrophils and PLTs were found in patients presenting a high increase of TAT or MPA compared with those presenting with a smaller increase. Patients with a high increase in TAT and MPA had received a greater number of total mononucleated cells (p<0.001) and higher transplant volumes (p=0.002). CONCLUSIONS Infusion of stem cells containing DMSO reversibly activated coagulation, measured as thrombin generation. This finding was not associated with acute adverse events and did not influence engraftment. Further studies are needed to compare variable DMSO concentrations as well as DMSO-free products, to better address the influence of DMSO on hemostasis.
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Affiliation(s)
- Andreas Holbro
- Department of Hematology and Diagnostic Hematology, University Hospital Basel, Basel, Switzerland; Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
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13
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Wood WA, Whitley J, Goyal R, Brown PM, Sharf A, Irons R, Rao KV, Essenmacher A, Serody JS, Coghill JM, Armistead PM, Sarantopoulos S, Gabriel DA, Shea TC. Effectiveness of etoposide chemomobilization in lymphoma patients undergoing auto-SCT. Bone Marrow Transplant 2012; 48:771-6. [PMID: 23165501 DOI: 10.1038/bmt.2012.216] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effectiveness of stem cell mobilization with G-CSF in lymphoma patients is suboptimal. We reviewed our institutional experience using chemomobilization with etoposide (VP-16; 375 mg/m(2) on days +1 and +2) and G-CSF (5 μg/kg twice daily from day +3 through the final day of collection) in 159 patients with lymphoma. This approach resulted in successful mobilization (>2 × 10(6) CD34+ cells collected) in 94% of patients (83% within 4 apheresis sessions). Fifty-seven percent of patients yielded at least 5 × 10(6) cells in 2 days and were defined as good mobilizers. The regimen was safe with a low rate of rehospitalization. Average costs were $14 923 for good mobilizers and $27 044 for poor mobilizers (P<0.05). Using our data, we performed a 'break-even' analysis that demonstrated that adding two doses of Plerixafor to predicted poor mobilizers at the time of first CD34+ cell count would achieve cost neutrality if the frequency of good mobilizers were to increase by 21%, while the frequency of good mobilizers would need to increase by 25% if three doses of Plerixafor were used. We conclude that chemomobilization with etoposide and G-CSF in patients with lymphoma is effective, with future opportunities for cost-neutral improvement using novel agents.
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Affiliation(s)
- W A Wood
- Bone Marrow and Stem Cell Transplantation Program, Division of Hematology and Oncology, Lineberger Comprehensive Center Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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