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Karpova D, Bräuninger S, Wiercinska E, Krämer A, Stock B, Graff J, Martin H, Wach A, Escot C, Douglas G, Romagnoli B, Chevalier E, Dembowski K, Hooftman L, Bonig H. Mobilization of hematopoietic stem cells with the novel CXCR4 antagonist POL6326 (balixafortide) in healthy volunteers-results of a dose escalation trial. J Transl Med 2017; 15:2. [PMID: 28049490 PMCID: PMC5209880 DOI: 10.1186/s12967-016-1107-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/08/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Certain disadvantages of the standard hematopoietic stem and progenitor cell (HSPC) mobilizing agent G-CSF fuel the quest for alternatives. We herein report results of a Phase I dose escalation trial comparing mobilization with a peptidic CXCR4 antagonist POL6326 (balixafortide) vs. G-CSF. METHODS Healthy male volunteer donors with a documented average mobilization response to G-CSF received, following ≥6 weeks wash-out, a 1-2 h infusion of 500-2500 µg/kg of balixafortide. Safety, tolerability, pharmacokinetics and pharmacodynamics were assessed. RESULTS Balixafortide was well tolerated and rated favorably over G-CSF by subjects. At all doses tested balixafortide mobilized HSPC. In the dose range between 1500 and 2500 µg/kg mobilization was similar, reaching 38.2 ± 2.8 CD34 + cells/µL (mean ± SEM). Balixafortide caused mixed leukocytosis in the mid-20 K/µL range. B-lymphocytosis was more pronounced, whereas neutrophilia and monocytosis were markedly less accentuated with balixafortide compared to G-CSF. At the 24 h time point, leukocytes had largely normalized. CONCLUSIONS Balixafortide is safe, well tolerated, and induces efficient mobilization of HSPCs in healthy male volunteers. Based on experience with current apheresis technology, the observed mobilization at doses ≥1500 µg/kg of balixafortide is predicted to yield in a single apheresis a standard dose of 4× 10E6 CD34+ cells/kg from most individuals donating for an approximately weight-matched recipient. Exploration of alternative dosing regimens may provide even higher mobilization responses. Trial Registration European Medicines Agency (EudraCT-Nr. 2011-003316-23) and clinicaltrials.gov (NCT01841476).
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Affiliation(s)
- Darja Karpova
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
- Department of Internal Medicine, Division of Oncology, Section of Stem Cell Biology, Washington University Medical School, St. Louis, MO, USA
| | - Susanne Bräuninger
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Eliza Wiercinska
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Ariane Krämer
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Belinda Stock
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Jochen Graff
- Clinical Trial Center Rhein-Main (KSRM), Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University, Frankfurt, Germany
| | - Hans Martin
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | | | | | | | | | | | | | | | - Halvard Bonig
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany.
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstr. 1, 60528, Frankfurt, Germany.
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.
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Stoecklein NH, Fischer JC, Niederacher D, Terstappen LWMM. Challenges for CTC-based liquid biopsies: low CTC frequency and diagnostic leukapheresis as a potential solution. Expert Rev Mol Diagn 2015; 16:147-64. [DOI: 10.1586/14737159.2016.1123095] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Choi S, Rajan SS, Trivedi MV. The incidence of tumor cell contamination of peripheral blood stem cells: a meta-analysis to evaluate the impact of mobilization regimens and the influence on outcomes in breast cancer patients. Acta Haematol 2013; 131:133-40. [PMID: 24192756 DOI: 10.1159/000353478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/31/2013] [Indexed: 01/12/2023]
Abstract
Tumor cell contamination (TCC) of peripheral blood stem cells (PBSCs) is a major risk in the autologous PBSC transplant setting. However, the effect of different mobilization regimens (cytokines only versus cytokines + chemotherapy) on TCC of PBSCs and its impact on treatment outcomes have not been systematically reviewed. In the present meta-analysis, we aimed to investigate this effect in breast cancer patients since multiple studies have been conducted in this setting. We systematically searched MEDLINE and Cochrane Library up to May 2012. Seventeen studies (1,819 patients) were assessed. There was no significant difference in the incidence of TCC of PBSCs between the two mobilization regimens. When the analysis was restricted to granulocyte colony-stimulating factor as a cytokine, this difference was again not significant. We also found that TCC of PBSCs was associated with a higher annual recurrence rate in these patients. This suggests that there may be a significant risk for reinfusion of tumor cell-positive PBSCs, and whether it can increase the risk of disease recurrence needs to be determined. This study also raises important questions regarding the causes of TCC of PBSCs. These issues should be investigated systematically in PBSC transplant patients.
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Affiliation(s)
- Sora Choi
- University of Houston College of Pharmacy, Houston, Tex., USA
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Gutensohn K, Magens MM, Kuehnl P, Zeller W. TRANSPLANTATION AND CELLULAR ENGINEERING: Increasing the economic efficacy of peripheral blood progenitor cell collections by monitoring peripheral blood CD34+ concentrations. Transfusion 2009; 50:656-62. [DOI: 10.1111/j.1537-2995.2009.02466.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kröger N, Renges H, Sonnenberg S, Krüger W, Gutensohn K, Dielschneider T, Cortes-Dericks L, Zander AR. Stem cell mobilisation with 16 microg/kg vs 10 microg/kg of G-CSF for allogeneic transplantation in healthy donors. Bone Marrow Transplant 2002; 29:727-30. [PMID: 12040468 DOI: 10.1038/sj.bmt.1703509] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Accepted: 02/14/2002] [Indexed: 11/09/2022]
Abstract
We compared two doses of recombinant human granulocyte-stimulating factor (G-CSF) for stem cell mobilisation in 90 healthy donors for allogeneic stem cell transplantation in a retrospective analysis. Group I (n = 46) received 10 microg/kg G-CSF (filgrastim) given as 5 microg/kg twice daily, and group II (n = 44) received 16 microg/kg, given as 8 microg/kg twice daily with a 12-h interval. The groups were well-balanced for age and body-weight. G-CSF application was performed on an out-patient basis, and leukapheresis was started in all donors on day 5. The most frequent side-effects of G-CSF were grade I/II, bone pain, headache and fatigue in both groups, whereas grade III of bone pain, headache and fatigue occurred in the 2 x 8 microg/kg group only. One serious non-fatal event with non-traumatic spleen rupture occurred in the 2 x 5 microg/kg group. The CD34(+)cell count in the first apheresis of all donors was 5.1 x 10(6)/kg donor weight (range, 1.5-19.3). The CD34(+) cell harvest was higher in the 2 x 8 microg/kg group than in the 2 x 5 microg/kg group (7.1 x 10(6)/kg vs 4.9 x 10(6)/kg; P = 0.09). The target of collecting >5.0 x 10(6) CD34(+) cells/kg donor weight with one apheresis procedure was achieved in 45% of group I and in 61% of group II, respectively. Administering G-CSF at a dosage of 8 microg/kg twice daily leads to a higher CD34(+) cell yield than a dosage of 2 x 5 microg/kg, but is associated with increased toxicity and higher cost.
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Affiliation(s)
- N Kröger
- Department of Bone Marrow Transplantation, University of Hamburg, Germany
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Tögel F, Datta C, Badbaran A, Kröger N, Renges H, Gieseking F, Jänicke F, Zander AR, Krüger W. Urokinase-like plasminogen activator receptor expression on disseminated breast cancer cells. JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 2001; 10:141-5. [PMID: 11276367 DOI: 10.1089/152581601750098390] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disseminated tumor cells are detected frequently in bone marrow, peripheral blood, and cytokine-mobilized peripheral blood cell products of women undergoing high-dose therapy for breast cancer. Several attempts were made to purge autografts from contaminating cancer cells; however, the biological and clinical impact of these contaminations has not been clarified so far. Expression of distinct phenotypes is a surrogate marker for metastatic behavior of cancer cells. The expression of the urokinase-like plasminogen activator receptor seems to be a factor of high importance. It is not expressed by normal mammary tissue. Disseminated cancer cells from marrow, blood, and stem cell products have been investigated by double-stain technique for urokinase-like plasminogen activator receptor (uPA-R) expressing cytokeratin-positive cells. uPA-R(+)/CK(+) cells could be found in all qualities of samples; however, significantly less in G-CSF-mobilized peripheral blood stem cells compared to samples of other provenance (p = 0.02). It can be concluded that epithelial cells of malignant phenotype occur in blood, marrow, and autografts of breast cancer patients. Populations of disseminated tumor cells are phenotypically heterogeneous. Reduced uPA-R expression on cancer cells from leukapheresis samples might suggest a less aggressive nature of these cells compared to disseminated cells found in bone marrow. Furthermore, the data suggest that the phenotype of tumor cell contamination in leukapheresis products differs significantly from those of disseminated cancer cells in bone marrow or blood.
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Affiliation(s)
- F Tögel
- Bone Marrow Transplantation Centre, University-Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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