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Najima Y, Maeda T, Kamiyama Y, Nakao S, Ozaki Y, Nishio H, Tsuchihashi K, Ichihara E, Miumra Y, Endo M, Maruyama D, Yoshinami T, Susumu N, Takekuma M, Motohashi T, Ito M, Baba E, Ochi N, Kubo T, Uchino K, Kimura T, Tamura S, Nishimoto H, Kato Y, Sato A, Takano T, Yano S. Effectiveness and safety of granulocyte colony-stimulating factor priming regimen for acute myeloid leukemia: A systematic review and meta-analysis of the Clinical Practice Guideline for the use of G-CSF 2022 from the Japan Society of Clinical Oncology. Int J Clin Oncol 2024; 29:899-910. [PMID: 38755516 DOI: 10.1007/s10147-023-02461-4] [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: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND The outcomes of relapsed or refractory acute myeloid leukemia (AML) remain poor. Although the concomitant use of granulocyte colony-stimulating factor (G-CSF) and anti-chemotherapeutic agents has been investigated to improve the antileukemic effect on AML, its usefulness remains controversial. This study aimed to investigate the effects of G-CSF priming as a remission induction therapy or salvage chemotherapy. METHODS We performed a thorough literature search for studies related to the priming effect of G-CSF using PubMed, Ichushi-Web, and the Cochrane Library. A qualitative analysis of the pooled data was performed, and risk ratios (RRs) with confidence intervals (CIs) were calculated and summarized. RESULTS Two reviewers independently extracted and accessed the 278 records identified during the initial screening, and 62 full-text articles were assessed for eligibility in second screening. Eleven studies were included in the qualitative analysis and 10 in the meta-analysis. A systematic review revealed that priming with G-CSF did not correlate with an improvement in response rate and overall survival (OS). The result of the meta-analysis revealed the tendency for lower relapse rate in the G-CSF priming groups without inter-study heterogeneity [RR, 0.91 (95% CI 0.82-1.01), p = 0.08; I2 = 4%, p = 0.35]. In specific populations, including patients with intermediate cytogenetic risk and those receiving high-dose cytarabine, the G-CSF priming regimen prolonged OS. CONCLUSIONS G-CSF priming in combination with intensive remission induction treatment is not universally effective in patients with AML. Further studies are required to identify the patient cohort for which G-CSF priming is recommended.
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Affiliation(s)
- Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-8-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan.
| | - Tomoya Maeda
- Department of Hemato-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yutaro Kamiyama
- Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Nakao
- Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yukinori Ozaki
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroshi Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - Eiki Ichihara
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Yuji Miumra
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tetsuhiro Yoshinami
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Nobuyuki Susumu
- Department of Obstetrics and Gynecology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Takashi Motohashi
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Mamoru Ito
- Department of Hematology, Oncology and Cardiovascular Medicine, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuaki Ochi
- Department of General Internal Medicine 4, Kawasaki Medical School, Okayama, Japan
| | - Toshio Kubo
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Keita Uchino
- Department of Medical Oncology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Hitomi Nishimoto
- Department of Nursing, Okayama University Hospital, Okayama, Japan
| | - Yasuhisa Kato
- Department of Drug Information, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, Kanagawa, Japan
| | - Atsushi Sato
- Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Toshimi Takano
- Department of Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shingo Yano
- Department of Clinical Oncology/Hematology, The Jikei University School of Medicine, Tokyo, Japan
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Farahzadi R, Valipour B, Montazersaheb S, Fathi E. Targeting the stem cell niche micro-environment as therapeutic strategies in aging. Front Cell Dev Biol 2023; 11:1162136. [PMID: 37274742 PMCID: PMC10235764 DOI: 10.3389/fcell.2023.1162136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Adult stem cells (ASCs) reside throughout the body and support various tissue. Owing to their self-renewal capacity and differentiation potential, ASCs have the potential to be used in regenerative medicine. Their survival, quiescence, and activation are influenced by specific signals within their microenvironment or niche. In better words, the stem cell function is significantly influenced by various extrinsic signals derived from the niche. The stem cell niche is a complex and dynamic network surrounding stem cells that plays a crucial role in maintaining stemness. Studies on stem cell niche have suggested that aged niche contributes to the decline in stem cell function. Notably, functional loss of stem cells is highly associated with aging and age-related disorders. The stem cell niche is comprised of complex interactions between multiple cell types. Over the years, essential aspects of the stem cell niche have been revealed, including cell-cell contact, extracellular matrix interaction, soluble signaling factors, and biochemical and biophysical signals. Any alteration in the stem cell niche causes cell damage and affects the regenerative properties of the stem cells. A pristine stem cell niche might be essential for the proper functioning of stem cells and the maintenance of tissue homeostasis. In this regard, niche-targeted interventions may alleviate problems associated with aging in stem cell behavior. The purpose of this perspective is to discuss recent findings in the field of stem cell aging, heterogeneity of stem cell niches, and impact of age-related changes on stem cell behavior. We further focused on how the niche affects stem cells in homeostasis, aging, and the progression of malignant diseases. Finally, we detail the therapeutic strategies for tissue repair, with a particular emphasis on aging.
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Affiliation(s)
- Raheleh Farahzadi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnaz Valipour
- Department of Anatomical Sciences, Sarab Faculty of Medical Sciences, Sarab, Iran
| | - Soheila Montazersaheb
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ezzatollah Fathi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
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Pınar İE, Özkocaman V, Özkalemkaş F, Durgut H, Dakiki B, Ersal T, Gürsoy V, Yalçın C, Orhan B, Candar Ö, Ali R. Is split-dose better than single-dose? Results of Turkish Stem Cell Coordination Center (TURKOK) donors in the era of rising biosimilar G-CSF. J Clin Apher 2022; 37:430-437. [PMID: 35689647 DOI: 10.1002/jca.21995] [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: 03/15/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Turkish Stem Cell Coordination Center (TURKOK) carries out the procurement process of unrelated allogeneic hematopoietic stem cells in Turkey. This study aims to compare the efficacy of both once-daily and divided-dose G-CSF administration and the original and biosimilar G-CSF use and the frequency and severity of adverse events in TURKOK donors. METHOD The study was conducted retrospectively with 142 healthy TURKOK donors. For PBSC mobilization, two different subcutaneous G-CSF programs were used as 10 μ/kg/day single-dose and 5 μ/kg/12 h. Neupogen (Amgen, Puerto Rico) and Tevagrastim (Teva, Kfar Saba, Israel) were used as G-CSF. All donors started apheresis on the fifth day, and all side effects were recorded during the procedure. RESULTS Stem cell yield was similar between single-dose and divided-doses based on donor weight, favoring the split-dose based on recipient weight (P = .506 and P = .023, respectively). Both G-CSF posologies were comparable if the target CD34+ cell yield was ≥4 × 106 /kg. CD34+ cell yield was equivalent when evaluated against recipient weight, significantly favoring Tevagrastim vs Neupogen by donor weight (P = .740 and P = .021, respectively). Side effects, duration of pain, and need for analgesia favor Tevagratim over Neupogen. CONCLUSION Split-dose may be recommended for cases where the need for large numbers of CD34+ cells to be harvested is anticipated due to significant cell yield relative to recipient weight. However, sufficient hematopoietic stem cells can be collected with both posology. Tevagrastim is non-inferiority effective to Neupogen. Side effects during administration are both low-grade and temporary.
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Affiliation(s)
- İbrahim Ethem Pınar
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Vildan Özkocaman
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fahir Özkalemkaş
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Himmet Durgut
- Republic of Turkey Ministry of Health, Turkish Stem Cell Coordination Center, Ankara, Turkey
| | - Bahar Dakiki
- Department of Internal Medicine, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tuba Ersal
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Vildan Gürsoy
- Department of Internal Medicine, Division of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Cumali Yalçın
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Bedrettin Orhan
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ömer Candar
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Rıdvan Ali
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
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Heyn J, Bräuninger S, Dimova-Dobreva M, Mathieson N, Koptelova N, Kolpakova A, Seidl C, Reinhardt P, Tsamadou C, Schrezenmeier H, Nakov R, Seifried E, Bonig H. Superior physical and mental health of healthy volunteers before and five years after mobilized stem cell donation. J Transl Med 2022; 20:121. [PMID: 35287672 PMCID: PMC8919626 DOI: 10.1186/s12967-022-03322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safety, tolerability and efficacy of granulocyte colony-stimulating factor (G-CSF) for mobilization of hematopoietic stem and progenitor cells (HSPCs) from healthy donors have been conclusively demonstrated. This explicitly includes, albeit for smaller cohorts and shorter observation periods, biosimilar G-CSFs. HSPC donation is non-remunerated, its sole reward being “warm glow”, hence harm to donors must be avoided with maximal certitude. To ascertain, therefore, long-term physical and mental health effects of HSPC donation, a cohort of G-CSF mobilized donors was followed longitudinally.
Methods
We enrolled 245 healthy volunteers in this bi-centric long-term surveillance study. 244 healthy volunteers began mobilization with twice-daily Sandoz biosimilar filgrastim and 242 underwent apheresis after G-CSF mobilization. Physical and mental health were followed up over a period of 5-years using the validated SF-12 health questionnaire.
Results
Baseline physical and mental health of HSPC donors was markedly better than in a healthy reference population matched for ethnicity, sex and age. Physical, but not mental health was sharply diminished at the time of apheresis, likely due to side effects of biosimilar G-CSF, however had returned to pre-apheresis values by the next follow-up appointment after 6 months. Physical and mental health slightly deteriorated over time with kinetics reflecting the known effects of aging. Hence, superior physical and mental health compared to the general healthy non-donor population was maintained over time.
Conclusions
HSPC donors are of better overall physical and mental health than the average healthy non-donor. Superior well-being is maintained over time, supporting the favorable risk–benefit assessment of volunteer HSPC donation.
Trial registration National Clinical Trial NCT01766934
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Kurki P, Kang HN, Ekman N, Knezevic I, Weise M, Wolff-Holz E. Regulatory Evaluation of Biosimilars: Refinement of Principles Based on the Scientific Evidence and Clinical Experience. BioDrugs 2022; 36:359-371. [PMID: 35596890 PMCID: PMC9148871 DOI: 10.1007/s40259-022-00533-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 01/13/2023]
Abstract
The World Health Organization (WHO) guidelines on evaluation of similar biotherapeutic products (SBPs; also called biosimilars) were adopted by the WHO Expert Committee on Biological Standardization (ECBS) in 2009. In 2019, the ECBS considered that a more tailored and potentially reduced clinical data package may be acceptable in cases where this was clearly supported by the available scientific evidence. The goal of this publication is to review the current clinical experience and scientific evidence and to provide an expert perspective for updating the WHO guidelines to provide more flexibility and clarity. As the first step, the relevant guidelines by other regulatory bodies were reviewed in order to identify issues that might help with updating the WHO guidelines. Next, a literature search was conducted for information on the long-term efficacy, safety, and immunogenicity of biosimilars to identify possible long-term problems. Finally, a search for articles concerning the role of clinical studies in the benefit-risk evaluation of biosimilars was conducted. The analysis of other guidelines suggested that the WHO guidelines may need more emphasis on the importance of the state-of-the-art physicochemical and structural comparability exercise and in vitro functional testing. The use of "foreign" reference product will also need clarifications. The value of in vivo toxicological tests in the development of biosimilars is questionable, and the non-clinical part needs revisions accordingly. The concepts of "totality of evidence," "stepwise development," and "residual uncertainty" were applied in the evaluation of the clinical sections of the guideline. The review of long-term safety and efficacy demonstrated the robustness of the current biosimilar development concept. The analysis of the roles of different development phases suggested that the large efficacy, safety, and immunogenicity studies are, in most cases, redundant. The residual uncertainty of safety, immunogenicity, and efficacy of biosimilars that has shaped the current regulatory guidelines is now substantially reduced. This will allow the re-evaluation of the non-clinical and clinical requirements of the current WHO main guideline. The shift of the relative impact of the development phases towards physico-chemical and in vitro functional testing will provide a relief to the manufacturers and new challenges to the regulators.
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Affiliation(s)
- Pekka Kurki
- University of Helsinki, Lukupolku 19, 00680 Helsinki, Finland
| | - Hye-Na Kang
- World Health Organization, Geneva, Switzerland
| | | | | | - Martina Weise
- Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
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Husian S, Jeyaraman P, Gupta SK, Rai R, Pathak S, Dayal N, Naithani R. Innovator Filgrastim versus Generic Filgrastim in Hematopoietic Stem Cell Transplantation Mobilization. South Asian J Cancer 2021; 10:172-174. [PMID: 34938680 PMCID: PMC8687862 DOI: 10.1055/s-0041-1729446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Methods
This is a retrospective study. G-CSF was administered in the dose of 10 μg/kg subcutaneous as a single dose for 4 days. On day 5, peripheral blood stem cell (PBSC) apheresis was performed using Haemonetics MCS plus or COBE Spectra apheresis machine through a double-lumen central venous catheter. Primary outcome parameters were the total number of CD34+ HSCs/kg of recipient weight mobilized in peripheral blood and the number of days required for neutrophil and platelets engraftment, respectively.
Objective
We compared the effectiveness and safety of innovator filgrastim versus generic filgrastim in patients who underwent hematopoietic stem cell transplantation (HSCT).
Results
A total of 91 stem cell mobilizations was analyzed. There were 58 normal healthy donors for allogeneic HSCT and 33 patients for autologous HSCT. There was no statistically significant difference among groups in terms of total collected CD34+ cells value (
p
= 0.609). The mean time to neutrophil engraftment was 13.7 days in the innovator group and 13.2 days in the Grafeel group (
p
= 0.518). The mean time to platelet engraftment was 16.2 days in the innovator group and 14.8 days in the generic group (
p
= 0.435). The patient who received generic filgrastim had more febrile episodes during the course of transplantation (
p
= 0.020).
Conclusion
Generic filgrastim was found to be comparable to original filgrastim for peripheral blood stem cell mobilization in normal healthy donors for allogeneic HSCT and patients for autologous HSCT.
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Affiliation(s)
- Sadik Husian
- Department of Pharmacology, Pharmaceutical Sciences and Research University, New Delhi, India
| | - Preethi Jeyaraman
- Division of Hematology and Bone Marrow Transplant, Saket, New Delhi, India
| | - S K Gupta
- Department of Pharmacology, Pharmaceutical Sciences and Research University, New Delhi, India
| | - Reeta Rai
- Division of Transfusion Medicine, Department of Lab Medicine Transfusion Medicine, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Sangeeta Pathak
- Division of Transfusion Medicine, Department of Lab Medicine Transfusion Medicine, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Nitin Dayal
- Department of Lab Medicine, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Rahul Naithani
- Division of Hematology and Bone Marrow Transplant, Saket, New Delhi, India
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Tecchio C, Cassatella MA. Uncovering the multifaceted roles played by neutrophils in allogeneic hematopoietic stem cell transplantation. Cell Mol Immunol 2021; 18:905-918. [PMID: 33203938 PMCID: PMC8115169 DOI: 10.1038/s41423-020-00581-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a life-saving procedure used for the treatment of selected hematological malignancies, inborn errors of metabolism, and bone marrow failures. The role of neutrophils in alloHSCT has been traditionally evaluated only in the context of their ability to act as a first line of defense against infection. However, recent evidence has highlighted neutrophils as key effectors of innate and adaptive immune responses through a wide array of newly discovered functions. Accordingly, neutrophils are emerging as highly versatile cells that are able to acquire different, often opposite, functional capacities depending on the microenvironment and their differentiation status. Herein, we review the current knowledge on the multiple functions that neutrophils exhibit through the different stages of alloHSCT, from the hematopoietic stem cell (HSC) mobilization in the donor to the immunological reconstitution that occurs in the recipient following HSC infusion. We also discuss the influence exerted on neutrophils by the immunosuppressive drugs delivered in the course of alloHSCT as part of graft-versus-host disease (GVHD) prophylaxis. Finally, the potential involvement of neutrophils in alloHSCT-related complications, such as transplant-associated thrombotic microangiopathy (TA-TMA), acute and chronic GVHD, and cytomegalovirus (CMV) reactivation, is also discussed. Based on the data reviewed herein, the role played by neutrophils in alloHSCT is far greater than a simple antimicrobial role. However, much remains to be investigated in terms of the potential functions that neutrophils might exert during a highly complex procedure such as alloHSCT.
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Affiliation(s)
- Cristina Tecchio
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
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Chen J, Lazarus HM, Dahi PB, Avecilla S, Giralt SA. Getting blood out of a stone: Identification and management of patients with poor hematopoietic cell mobilization. Blood Rev 2020; 47:100771. [PMID: 33213986 DOI: 10.1016/j.blre.2020.100771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 07/15/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Hematopoietic cell transplantation (HCT) has become a primary treatment for many cancers. Nowadays, the primary source of hematopoietic cells is by leukapheresis collection of these cells from peripheral blood, after a forced egress of hematopoietic cells from marrow into blood circulation, a process known as "mobilization". In this process, mobilizing agents disrupt binding interactions between hematopoietic cells and marrow microenvironment to facilitate collection. As the first essential step of HCT, poor mobilization, i.e. failure to obtain a desired or required number of hematopoietic cell, is one of the major factors affecting engraftment or even precluding transplantation. This review summarizes the available mobilization regimens using granulocyte-colony stimulating factor (G-CSF) and plerixafor, as well as the current understanding of the factors that are associated with poor mobilization. Strategies to mobilize patients or healthy donors who failed previous mobilization are discussed. Multiple novel agents are under investigation and some of them have shown the potential to enhance the mobilization response to G-CSF and/or plerixafor. Further investigation of the risk factors including genetic factors will offer an opportunity to better understand the molecular mechanism of mobilization and help develop new therapeutic strategies for successful mobilizations.
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Affiliation(s)
- Jian Chen
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Parastoo B Dahi
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Scott Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sergio A Giralt
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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Dewi KS, Fuad AM. Improving the Expression of Human Granulocyte Colony Stimulating Factor in Escherichia coli by Reducing the GC-content and Increasing mRNA Folding Free Energy at 5'-Terminal End. Adv Pharm Bull 2020; 10:610-616. [PMID: 33072539 PMCID: PMC7539321 DOI: 10.34172/apb.2020.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/24/2019] [Accepted: 01/27/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose: Strategy for improving the production of biopharmaceutical protein continues to develop due to increasing market demand. Human granulocyte colony stimulating factor (hG-CSF) is one of biopharmaceutical proteins that has many applications, and easily produced in Escherichia coli expression system. Previous studies reported that codon usage, rare codon, mRNA folding and GC-content at 5’-terminal end were crucial for protein production in E. coli. In the present study, the effect of reducing the GC-content and increasing the mRNA folding free energy at the 5’-terminal end on the expression level of hG-CSF proteins was investigated. Methods: Synonymous codon substitutions were performed to generate mutant variants of open reading frame (ORF) with lower GC-content at 5’-terminal ends. Oligoanalyzer tool was used to calculate the GC content of eight codons sequence after ATG. Whereas, mRNA folding free energy was predicted using KineFold and RNAfold tools. The template DNA was amplified using three variant forward primers and one same reverse primer. Those DNA fragments were individually cloned into pJexpress414 expression vector and were confirmed using restriction and DNA sequencing analyses. The confirmed constructs were transformed into E. coli NiCo21(DE3) host cells and the recombinant protein was expressed using IPTG-induction. Total protein obtained were characterized using SDS-PAGE, Western blot and ImageJ software analyses. Results: The result showed that the mutant variant with lower GC-content and higher mRNA folding free energy near the translation initiation region (TIR) could produce a higher amount of hG-CSF proteins compared to the original gene sequence. Conclusion: This study emphasized the important role of the nucleotide composition immediately downstream the start codon to achieve high-yield protein product on heterologous expression in E. coli.
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Affiliation(s)
- Kartika Sari Dewi
- Research Center for Biotechnology, Indonesian Institute of Sciences, Cibinong, Bogor, Indonesia, 16911
| | - Asrul Muhamad Fuad
- Research Center for Biotechnology, Indonesian Institute of Sciences, Cibinong, Bogor, Indonesia, 16911
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11
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Parody R, Sánchez-Ortega I, Ferrá C, Guardia R, Talarn C, Encuentra M, Fort E, López D, Morgades M, Alonso E, Ortega S, Sarrá J, Gallardo D, Ribera JM, Sureda A. Mobilization of Hematopoietic Stem Cells into Peripheral Blood for Autologous Transplantation Seems Less Efficacious in Poor Mobilizers with the Use of a Biosimilar of Filgrastim and Plerixafor: A Retrospective Comparative Analysis. Oncol Ther 2020; 8:311-324. [PMID: 32700041 PMCID: PMC7683658 DOI: 10.1007/s40487-020-00115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Biosimilars of granulocyte colony-stimulating factors (G-CSF) have shown similar efficacy to originator filgrastim (Neupogen® [NEU]; Amgen Inc.) as prophylaxis in neutropenia and in the mobilization of stem cells in patients receiving combination chemotherapy with G-CSF. Methods This was a retrospective study in which the characteristics of stem cell mobilization treated with a G-CSF alone were compared in 216 patients and 56 donors. The two G-CSF compared were NEU and the biosimilar filgrastim Zarzio® (Sandoz GmbH) (referred to hereafter as BIO). Primary objectives were mobilization rate (minimum of 10 × 103/ml CD34+ on day 4 of treatment [day +4]) and use of the immunostimulant plerixafor (PLEX) in each group. Results The general characteristics of the patients receiving NEU (n = 138) and those receiving BIO (n = 78) did not differ significantly. PLEX was used in 24% of BIO patients and in 25.7% of NEU patients. The median CD34+ cell count on day +4 was significantly lower in BIO patients who needed PLEX than in those who did not (2.4 vs. 4.8 × 103/ml; p = 0.002), as was the final CD34+ cell count (2.5 vs. 3.3 × 106/kg; p 0.03). Mobilization failure rate was higher in the BIO group than in the NEU group (20 vs. 0%; p = 0.01). With respect to donors, more than one apheresis was needed in three BIO donors, one of them with PLEX. The use of BIO was the only risk factor for mobilization failure in patients who needed PLEX (hazard ratio 10.3; 95% confidence interval 1.3–77.8). Conclusion The study revealed that BIO had a lower efficacy for stem cell mobilization when the only treatment was G-CSF, especially in poor mobilizers needing PLEX.
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Affiliation(s)
- Rocío Parody
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain.
| | - Isabel Sánchez-Ortega
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Christelle Ferrá
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carme Talarn
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Maite Encuentra
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain.,Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Eduard Fort
- Pharmacy Department, Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - David López
- Pharmacy Department, Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Mireia Morgades
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institut Català d'Oncologia, L'Hospitalet, IDIBELL, Barcelona, Spain
| | - Eva Alonso
- Banc de Sang I Teixits de Catalunya, Barcelona, Spain
| | - Sandra Ortega
- Banc de Sang I Teixits de Catalunya, Barcelona, Spain
| | - Josep Sarrá
- Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Josep M Ribera
- Hematology Department, Institut Català d'Oncologia-Badalona, Hospital Universitari Germans Trias I Pujol, Josep Carreras Leukemia Research Institute,, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia, L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
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12
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Gascon P, Krendyukov A, Mathieson N, Natek M, Aapro M. Extrapolation in Practice: Lessons from 10 Years with Biosimilar Filgrastim. BioDrugs 2019; 33:635-645. [PMID: 31440986 PMCID: PMC6875156 DOI: 10.1007/s40259-019-00373-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Biosimilar filgrastim (Sandoz) was approved in Europe in 2009 and, in 2015, was the first biosimilar approved in the USA. These authorizations were based on the "totality of evidence" concept, an approach that considers data from structural and functional characterization and comparability analysis and non-clinical and clinical studies. For biosimilar filgrastim, phase III confirmatory clinical studies were performed in the most sensitive population, patients with breast cancer undergoing myelosuppressive chemotherapy. In Europe and the USA, approval was granted for all indications of the reference biologic. Hence, stem cell mobilization and severe chronic neutropenia indications were approved on the basis of extrapolation, with no clinical data available at the time of market authorization in the EU. Although extrapolation is well-accepted in biologic development and regulatory contexts, it remains a misunderstood part of the biosimilarity concept in the medical community. Since approval, more than a decade of obtained clinical experience supports the totality of evidence and reassures clinicians regarding the efficacy and safety of biosimilar filgrastim. This includes real-world data from MONITOR-GCSF, a multicenter, prospective, observational study describing treatment patterns and clinical outcomes of patients with cancer (n = 1447) receiving biosimilar filgrastim for the prophylaxis of chemotherapy-induced neutropenia in solid tumors and hematological malignancies. Evidence is also available from unrelated healthy donors and those with severe chronic neutropenia. Together, the experience from a decade of use of biosimilar filgrastim includes over 24 million patient-days of exposure, which can help reassure oncologists that extrapolation is based on strong scientific evidence and works in practice.
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Affiliation(s)
- Pere Gascon
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | | | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, 1272, Genolier, Switzerland.
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13
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Gómez‐De León A, Bugarin‐Estrada E, Colunga‐Pedraza PR, Colunga‐Pedraza JE, Salazar‐Riojas R, Valdés‐Galván M, López‐García YK, López‐Garza M, Gutiérrez‐Aguirre CH, Cantú‐Rodríguez OG, Mancías‐Guerra C, González‐Llano O, Gómez‐Almaguer D. Efficacy of three filgrastim‐intended copies for hematopoietic stem cell mobilization in healthy adult and pediatric donors in Mexico. J Clin Apher 2019; 34:537-544. [DOI: 10.1002/jca.21707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Andrés Gómez‐De León
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Emmanuel Bugarin‐Estrada
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Perla R. Colunga‐Pedraza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Julia E. Colunga‐Pedraza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Rosario Salazar‐Riojas
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Mayra Valdés‐Galván
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Yadith K. López‐García
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Mariana López‐Garza
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - César H. Gutiérrez‐Aguirre
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Olga G. Cantú‐Rodríguez
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Consuelo Mancías‐Guerra
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - Oscar González‐Llano
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
| | - David Gómez‐Almaguer
- Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Hematology DepartmentUniversidad Autónoma de Nuevo León Monterrey Nuevo León Mexico
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