1
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Okubo M, Furuta Y, Nakamura Y, Osawa T, Tada N, Sawada T, Yamatoya K, Sekiguchi Y, Araki Y, Miyake K, Noguchi M, Komatsu N, Ohsaka A. Threshold for optimal administration of plerixafor in autologous peripheral blood stem cell collections through CD34+ cell monitoring based on the experience from two Japanese university hospitals. Ther Apher Dial 2020; 25:687-696. [PMID: 33325621 DOI: 10.1111/1744-9987.13614] [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: 03/31/2020] [Revised: 11/19/2020] [Accepted: 12/13/2020] [Indexed: 12/01/2022]
Abstract
Plerixafor was introduced to Japan in 2017 as a stem cell mobilization enhancement reagent, but the threshold for its use remains unclear. In this study, we assessed 57 patients treated with plerixafor (33 patients with multiple myeloma (MM) and 24 with malignant lymphoma (ML) and 152 patients without plerixafor administration. When CD34+ cell pre-counts were between 5.5 and 20 cells/μL in MM or 6 and 21 cells/μL in ML, the CD34+ cell count increased significantly, attaining the highest yield in response to plerixafor (achievement rate by one leukapheresis is 93.3% and 91.7% in MM and ML, at P < .001 and P = .012, respectively). In case the CD34+ cell pre-count was less than 5.5 cells/μL, an increase of at least 7 cells/μL from baseline by plerixafor was the necessary condition to achieve successful collection through a two-time leukapheresis. Monitoring CD34+ cell numbers might improve the collection efficiency and reduce the cost.
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Affiliation(s)
- Mitsuo Okubo
- Department of Transfusion Service, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Furuta
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan
| | - Yuki Nakamura
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan
| | - Toshiya Osawa
- Department of Transfusion Service, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoki Tada
- Department of Transfusion Service, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tomohiro Sawada
- Department of Clinical Laboratory Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kenji Yamatoya
- Institute for Environmental & Gender-specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Yasunobu Sekiguchi
- Department of Hematology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yoshihiko Araki
- Institute for Environmental & Gender-specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Kazunori Miyake
- Department of Clinical Laboratory Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masaaki Noguchi
- Department of Hematology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University Hospital, Tokyo, Japan
| | - Akimichi Ohsaka
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan
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2
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Factors that predict delayed platelet recovery after autologous stem cell transplantation for lymphoma or myeloma. Ann Hematol 2020; 99:2893-2901. [PMID: 32572522 DOI: 10.1007/s00277-020-04112-4] [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: 12/11/2019] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
The amount of infused CD34+ cells has been reported to be the strongest predictor of platelet recovery after autologous stem cell transplantation (ASCT). However, the timing of platelet recovery varies widely among patients even after the infusion of similar amounts of CD34+ cells. Therefore, we retrospectively assessed 99 patients who underwent their first ASCT for lymphoma or myeloma at our center. Thirteen patients (13%) did not achieve platelet engraftment, defined as a platelet count of at least 2.0 × 104/μL without transfusion, at day 28 after transplantation, whereas 58 of 60 patients (97%) who received at least 2.0 × 106/kg CD34+ cells achieved platelet engraftment within 28 days. Multivariate analysis identified the following significant risk factors for delayed platelet recovery: hemoglobin level and platelet count before stem cell harvest, body temperature of > 39 °C within 5 days after ASCT, and infusion of a small amount (< 2.0 × 106/kg) of CD34+ cells. In a subgroup analysis of 39 patients infused with < 2.0 × 106/kg CD34+ cells, a need for repeated apheresis for stem cell harvest and a body temperature of > 39 °C within 5 days after ASCT were identified as independent factors for delayed platelet recovery. In summary, platelet recovery following ASCT was affected by insufficient hematopoietic recovery at stem cell harvest, a need for repeated apheresis, and high fever early after ASCT, particularly when the amount of infused stem cells was insufficient.
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3
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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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4
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Kriegsmann K, Wuchter P. Mobilization and Collection of Peripheral Blood Stem Cells in Adults: Focus on Timing and Benchmarking. Methods Mol Biol 2019; 2017:41-58. [PMID: 31197767 DOI: 10.1007/978-1-4939-9574-5_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral blood stem cells (PBSCs) are preferentially used as a hematopoietic stem cell source for autologous blood stem cell transplantation (ABSCT) upon high-dose chemotherapy (HDT) in a variety of hemato-oncologic diseases. As a prerequisite, hematopoietic stem cells have to be mobilized into the peripheral blood (PB) and collected by leukapheresis (LP). Despite continuous improvements, e.g., the introduction of plerixafor, current challenges are the further optimization regarding the leukapheresis procedure, preventing collection failures, as well as benchmarking and harmonization of mobilization approaches between institutions.This chapter summarizes the current PBSC mobilization and collection approaches and is focusing on timely orchestration of mobilization therapy, granulocyte colony-stimulating factor (G-CSF) application, and peripheral blood (PB) CD34+ cell assessment. Moreover, strategies for prediction and performance assessment of the PBSC collection yield are discussed.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Medicine V (Hematology, Oncology, Rheumatology), Heidelberg University, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany.
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5
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Kriegsmann K, Schmitt A, Kriegsmann M, Bruckner T, Anyanwu A, Witzens-Harig M, Müller-Tidow C, Klein S, Wuchter P. Orchestration of Chemomobilization and G-CSF Administration for Successful Hematopoietic Stem Cell Collection. Biol Blood Marrow Transplant 2018; 24:1281-1288. [PMID: 29353110 DOI: 10.1016/j.bbmt.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
Successful collection of peripheral blood stem cells (PBSCs) depends on the optimal orchestration of mobilization chemotherapy, granulocyte colony stimulating factor (G-CSF) application, and CD34+ cell number assessment in the peripheral blood (PB). However, determining the optimal timing in accordance to the applied chemomobilization regimen can be challenging. Although most centers apply their own local timing schedules, a reliable timetable including the currently most often used mobilization regimens is lacking. We present a comprehensive analysis of the timing modalities for 11 of the most commonly used chemomobilization regimens. A retrospective analysis was performed on the clinical and PBSC collection parameters (including duration of G-CSF application, time point of CD34+ assessment, PB CD34+ cell count, number of leukapheresis [LP] sessions, processed blood volume, and CD34+ collection results) of 91 representatively selected patients who had undergone stem cell mobilization at 2 collection centers. Six to 10 patients were analyzed per regimen with a variety of diagnoses, including multiple myeloma, malignant lymphoma, and sarcoma. No collection failures (<2 × 106 CD34+ cells/kg body weight) were observed. All analyzed patients successfully reached their individual collection goal in adherence to the given schedule of chemotherapy, application of G-CSF, measurement of CD34+ cells, and subsequent LP. The presented data on the timing of chemomobilization, G-CSF application, and stem cell collection may be helpful in clinical decision making and contribute to a more transparent and predictable treatment process.
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Affiliation(s)
| | - Anita Schmitt
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics, Heidelberg University, Heidelberg, Germany
| | - Adamma Anyanwu
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | | | | | - Stefan Klein
- Department of Medicine III, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.
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6
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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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7
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Greil C, Kiote-Schmidt C, Fink G, Ihorst G, Hildenbeutel S, Bosse R, Duyster J, Engelhardt M, Wäsch R. Successful peripheral blood stem cell mobilization with a cost-efficient single fixed-dose plerixafor schedule in poor mobilizers. Leuk Lymphoma 2017; 58:1849-1858. [DOI: 10.1080/10428194.2016.1271946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Christine Greil
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Chrissoula Kiote-Schmidt
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Geertje Fink
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffi Hildenbeutel
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roland Bosse
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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8
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Chabannon C, Bijou F, Miclea JM, Milpied N, Grouin JM, Mohty M. A nationwide survey of the use of plerixafor in patients with lymphoid malignancies who mobilize poorly demonstrates the predominant use of the "on-demand" scheme of administration at French autologous hematopoietic stem cell transplant programs. Transfusion 2015; 55:2149-57. [PMID: 25968564 DOI: 10.1111/trf.13141] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/05/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND High-dose chemotherapy supported with autologous stem cell transplantation is a standard therapeutic option for a subset of patients with lymphoid malignancies. Cell procurement is nowadays done almost exclusively through cytapheresis, after mobilization of hematopoietic stem and progenitor cells (HSPCs) from the marrow to peripheral blood (PB). The egress of HSPCs out of hematopoietic niches occurs in various physiologic or nonhomeostatic situations; pharmacologic approaches include the administration of acutely myelosuppressive agents or hematopoietic growth factors such as recombinant human granulocyte-colony-stimulating factor (rHuG-CSF). The introduction of plerixafor, a first-of-its-class molecule that reversibly inhibits the interaction between the chemokine CXCL-12 (also known as SDF-1) and its receptor CXCR-4, has offered new opportunities for the so-called "poor mobilizers" who achieve insufficient mobilization and/or collection with conventional approaches. STUDY DESIGN AND METHODS Because of the lack of consensus on a definition for poor mobilizers and the relatively high cost of plerixafor, French competent authorities have mandated a postmarketing survey on its use in routine practice. RESULTS AND CONCLUSION We report here the results of this nationwide survey that confirms the clinical efficacy of plerixafor, even in the subset of patients who barely increased PB CD34+ cell count in response to rHuG-CSF-containing mobilization regimen. Furthermore, analysis of this registry showed that despite heterogeneity in medical practices, the early-"on-demand" or "preemptive"-introduction of plerixafor was widely used and did not result in an excess of prescriptions, beyond its expected use at the time when marketing authorization was granted.
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Affiliation(s)
- Christian Chabannon
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer.,Université d'Aix-Marseille.,Inserm CBT 1409, Centre d'Investigations Cliniques en Biothérapie, Marseille, France
| | - Fontanet Bijou
- Etablissement Français du Sang Aquitaine.,CNRS UMR 5164, CIRID, "Composantes Innées de la Réponse Immunitaire et de la Différenciation,", Bordeaux, France
| | - Jean-Michel Miclea
- Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Noel Milpied
- Centre Hospitalier et Universitaire de Bordeaux, Bordeaux, France
| | - Jean-Marie Grouin
- Inserm U657 "Pharmaco-Épidémiologie et Évaluation de l'Impact des Produits de Santé sur les Populations",Université de Rouen, Rouen, France
| | - Mohamad Mohty
- Hôpital Saint Antoine, Assistance Publique des Hôpitaux de Paris (AP-HP).,Université Pierre et Marie Curie (UPMC).,INSERM, UMRs 938, Centre de Recherches Saint-Antoine, Paris, France
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