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Jantunen E, Turunen A, Varmavuo V, Partanen A. Impact of plerixafor use in the mobilization of blood grafts for autologous hematopoietic cell transplantation. Transfusion 2024; 64:742-750. [PMID: 38407504 DOI: 10.1111/trf.17755] [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: 12/02/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/27/2024]
Abstract
Plerixafor (PLER), a reversible antagonist of the CXC chemokine receptor type 4, has been in clinical use for mobilization of blood grafts for autologous hematopoietic cell transplantation (AHCT) for about 15 years. Initially PLER was investigated in placebo-controlled trials with the granulocyte colony-stimulating factor (G-CSF) filgrastim. It has also been used in combination with chemotherapy plus G-CSF in patients who had failed a previous mobilization attempt or appeared to mobilize poorly with current mobilization (preemptive use). This review summarizes what is known regarding addition of PLER to standard mobilization regimens. PLER increases mobilization of CD34+ cells, decreases the number of apheresis sessions needed to achieve collection targets and increases the proportion of patients who can proceed to AHCT. It appears also to increase the amount of various lymphocyte subsets in the grafts collected. In general, hematologic recovery after AHCT has been comparable to patients mobilized without PLER, although slower platelet recovery has been observed in some studies of patients who mobilize poorly. In phase III studies, long-term outcome has been comparable to patients mobilized without PLER. This also appears to be the case in patients receiving plerixafor for poor or suboptimal mobilization of CD34+ cells. In practice, PLER is safe and has not been shown to increase tumor cell mobilization.
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Affiliation(s)
- Esa Jantunen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Antti Turunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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2
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Kriegsmann K, Bittrich M, Sauer S, Tietze-Stolley C, Movassaghi K, Grube M, Vucinic V, Wehler D, Burchert A, Schmidt-Hieber M, Rank A, Dürk HA, Metzner B, Kimmich C, Hentrich M, Kunz C, Hartmann F, Khandanpour C, de Wit M, Holtick U, Kiehl M, Stoltefuß A, Kiani A, Naumann R, Scholz CW, Tischler HJ, Görner M, Brand F, Ehmer M, Kröger N. Mobilization and Hematopoietic Stem Cell Collection in Poor Mobilizing Patients with Lymphoma: Final Results of the German OPTIMOB Study. Transfus Med Hemother 2023; 50:403-416. [PMID: 37899991 PMCID: PMC10601601 DOI: 10.1159/000531936] [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] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Successful mobilization and collection of peripheral hematopoietic stem cells (HSCs) are necessary for lymphoma patients eligible for myeloablative chemotherapy with subsequent autologous stem cell transplantation (ASCT). Albeit G-CSF alone or combined with chemotherapy is well-established methods for HSC mobilization, up to 40% of the patients fail to mobilize (poor mobilizer, PM). Plerixafor (PLX) is commonly used in PM patients resulting in increased migration of HSCs into peripheral blood and thus improves the collection outcome. Methods The prospective, multicenter, open-label, non-interventional OPTIMOB study assessed mobilization and collection parameter of patients with lymphoma or multiple myeloma to get deep insights in the treatment of those patients in clinical routine focusing on PM patients. PM was defined as follows: (1) no achievement of ≥20 CD34+ progenitor cells/µL before first apheresis, (2) PLX administration at any time point during the observational period, (3) reduction of the initially planned CD34+ progenitor cell yield as necessity due to failed mobilization or HSC collection, and (4) no performance of apheresis due to low CD34+ progenitor level. Primary objective of the study was to assess mobilization success by the proportion of PM patients achieving >2 × 106 CD34+ progenitor cells/kg body weight on the first day of apheresis. Here, the data of the lymphoma cohort are presented. Results Out of 238 patients with lymphoma documented in the study, 32% were classified as PM. 87% of them received PLX. Demographic data revealed no obvious differences between PM and good mobilizing (GM) patients. All patients were treated highly individualized prior to mobilization. Majority of all PM patients were able to undergo apheresis (95%) and reached their individual requested CD34+ progenitor cell target (72%). 57% of the PM patients achieved >2.0 × 106 CD34+ progenitor cells/kg body weight on day 1 of apheresis and nearby 70% of them underwent ASCT. Median time to engraftment was similar in PM and GM patients of the lymphoma cohort. Conclusions Majority of PM patients with lymphoma were successfully mobilized and underwent ASCT. Most of them received PLX during the study.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Laborarztpraxis, Laborarztpraxis Rhein-Main MVZ GbR, Limbach Gruppe SE, Frankfurt, Germany
| | - Max Bittrich
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carola Tietze-Stolley
- Department of Hematology and Oncology, Stem Cell Facility, University Hospital Charité, Berlin, Germany
| | - Kamran Movassaghi
- Department of Hematology and Oncology, Stem Cell Facility, University Hospital Charité, Berlin, Germany
| | - Matthias Grube
- Department of Hematology and Internistic Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Vladan Vucinic
- Klinik und Poliklinik für Hämatologie, Zelltherapie und Hämostaseologie, University Hospital Leipzig, Leipzig, Germany
| | - Daniela Wehler
- Klinik und Poliklinik für Innere Medizin III, University Hospital of Mainz, Mainz, Germany
| | - Andreas Burchert
- Klinik für Hämatologie, Onkologie und Immunologie, University Hospital of Gießen and Marburg (UKGM), Marburg, Germany
| | - Martin Schmidt-Hieber
- 2. Medizinische Klinik für Hämatologie, Onkologie, Pneumologie und Nephrologie, Carl-Thiem Hospital Cottbus gGmbH, Cottbus, Germany
| | - Andreas Rank
- 2. Medizinische Klinik – Hämatologie, Internistische Onkologie und Hämostaseologie, University Hospital of Augsburg, Augsburg, Germany
| | - Heinz A. Dürk
- Klinik für Hämatologie und Onkologie, St. Barbara Hospital Hamm-Heessen, Hamm, Germany
| | - Bernd Metzner
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie, University Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Christoph Kimmich
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie, University Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Marcus Hentrich
- Abteilung für Innere Medizin III –Hämatologie und Onkologie, Rotkreuzklinikum München, Munich, Germany
| | - Christian Kunz
- Innere Medizin I, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
| | - Frank Hartmann
- Klinik für Onkologie und Hämatologie, Hospital Lippe-Lemgo, Lemgo, Germany
| | - Cyrus Khandanpour
- Medizinische Klinik A, University Hospital Münster, Münster, Germany
- Klinik für Hämatologie und Onkologie, University Hospital Schleswig-Holstein (Campus Lübeck) and University of Lübeck, Lübeck, Germany
| | - Maike de Wit
- Klinik für Innere Medizin – Hämatologie, Onkologie und Palliativmedizin, Vivantes Hospital Neukölln, Berlin, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michael Kiehl
- Medizinische Klinik I, Hospital Frankfurt (Oder), Frankfurt/Oder, Germany
| | - Andrea Stoltefuß
- Klinik für Innere Medizin II, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Alexander Kiani
- Department of Hematology and Oncology, Klinikum Bayreuth, Bayreuth, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Ralph Naumann
- Klinik für Hämatologie, Medizinische Onkologie und Palliativmedizin, St. Marien-Krankenhaus Marien Gesellschaft Siegen gGmbH, Siegen, Germany
| | - Christian W. Scholz
- Klinik für Innere Medizin – Hämatologie und Onkologie, Vivantes Hospital Am Urban, Berlin, Germany
| | - Hans-Joachim Tischler
- Universitätsklinik für Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Hospital Minden, Mühlenkreiskliniken, Minden, Germany
| | - Martin Görner
- Klinik für Hämatologie, Onkologie, Palliativmedizin und Stammzelltherapie, Hospital Bielefeld-Mitte, Bielefeld, Germany
| | | | - Martin Ehmer
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Nicolaus Kröger
- Interdisziplinäre Klinik und Poliklinik für Stammzelltransplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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3
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Wei X, Wei Y. Stem cell mobilization in multiple myeloma: challenges, strategies, and current developments. Ann Hematol 2023; 102:995-1009. [PMID: 36949293 PMCID: PMC10102143 DOI: 10.1007/s00277-023-05170-0] [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: 12/06/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
Among hematological malignancies, multiple myeloma (MM) represents the leading indication of autologous hematopoietic stem cell transplantation (auto-HCT). Auto-HCT is predominantly performed with peripheral blood stem cells (PBSCs), and the mobilization and collection of PBSCs are essential steps for auto-HCT. Despite the improved success of conventional methods with the incorporation of novel agents for PBSC mobilization in MM, mobilization failure is still a concern. The current review comprehensively summarizes various mobilization strategies for mobilizing PBSCs in MM patients and the evolution of these strategies over time. Moreover, existing evidence substantiates that the mobilization regimen used may be an important determinant of graft content. However, limited data are available on the effects of graft characteristics in patient outcomes other than hematopoietic engraftment. In this review, we discussed the effect of graft characteristics on clinical outcomes, mobilization failure, factors predictive of poor mobilization, and potential mobilization regimens for such patients.
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Affiliation(s)
- Xiaolei Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China
| | - Yongqiang Wei
- Department of Hematology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, China.
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Miyamoto‐Nagai Y, Mimura N, Tsukada N, Aotsuka N, Ri M, Katsuoka Y, Wakayama T, Suzuki R, Harazaki Y, Matsumoto M, Kumagai K, Miyake T, Ozaki S, Shono K, Tanaka H, Shimura A, Kuroda Y, Sunami K, Suzuki K, Yamashita T, Shimizu K, Murakami H, Abe M, Nakaseko C, Sakaida E. Outcomes of poor peripheral blood stem cell mobilizers with multiple myeloma at the first mobilization: A multicenter retrospective study in Japan. EJHAEM 2022; 3:838-848. [PMID: 36051061 PMCID: PMC9422024 DOI: 10.1002/jha2.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
Autologous stem cell transplantation (ASCT) remains an important therapeutic strategy for multiple myeloma; however, a proportion of patients fail to mobilize a sufficient number of peripheral blood stem cells (PBSCs) to proceed to ASCT. In the present study, we aimed to clarify the characteristics and outcomes of poor mobilizers. Clinical data on poorly mobilized patients who underwent PBSC harvest for almost 10 years were retrospectively collected from 44 institutions in the Japanese Society of Myeloma (JSM). Poor mobilizers were defined as patients with less than 2 × 106/kg of CD34+ cells harvested at the first mobilization. The proportion of poor mobilization was 15.1%. A sufficient dataset including overall survival (OS) was evaluable in 258 poor mobilizers. Overall, 92 out of 258 (35.7%) poor mobilizers did not subsequently undergo ASCT, mainly due to an insufficient number of PBSCs. Median OS from apheresis was longer for poor mobilizers who underwent ASCT than for those who did not (86.0 vs. 61.9 mon., p = 0.02). OS from the diagnosis of poor mobilizers who underwent ASCT in our cohort was similar to those who underwent ASCT in the JSM database (3y OS rate, 86.8% vs. 85.9%). In this cohort, one‐third of poor mobilizers who did not undergo ASCT had relatively poor survival. In contrast, the OS improved in poor mobilizers who underwent ASCT. However, the OS of extremely poor mobilizers was short irrespective of ASCT.
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Affiliation(s)
| | - Naoya Mimura
- Department of Hematology Chiba University Hospital Chiba Japan
- Department of Transfusion Medicine and Cell Therapy Chiba University Hospital Chiba Japan
| | - Nobuhiro Tsukada
- Division of Hematology Japanese Red Cross Medical Center Tokyo Japan
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology Japanese Red Cross Narita Hospital Narita Japan
| | - Masaki Ri
- Department of Hematology and Oncology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Yuna Katsuoka
- Department of Hematology National Hospital Organization Sendai Medical Center Sendai Japan
| | - Toshio Wakayama
- Department of Hematology and Oncology Shimane Prefectural Central Hospital Izumo Japan
| | - Rikio Suzuki
- Department of Hematology and Oncology, Department of Medicine Tokai University School of Medicine Isehara Japan
| | | | - Morio Matsumoto
- Department of Hematology National Hospital Organization Shibukawa Medical Center Shibukawa Japan
| | - Kyoya Kumagai
- Division of Hematology‐Oncology Chiba Cancer Center Chiba Japan
| | - Takaaki Miyake
- Department of Oncology and Hematology Shimane University Hospital Izumo Japan
| | - Shuji Ozaki
- Department of Hematology Tokushima Prefectural Central Hospital Tokushima Japan
| | - Katsuhiro Shono
- Department of Hematology Chiba Aoba Municipal Hospital Chiba Japan
| | - Hiroaki Tanaka
- Department of Hematology Asahi General Hospital Asahi Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yoshiaki Kuroda
- Department of Hematology National Hospital Organization Hiroshimanishi Medical Center Otake Japan
| | - Kazutaka Sunami
- Department of Hematology National Hospital Organization Okayama Medical Center Okayama Japan
| | - Kazuhito Suzuki
- Department Clinical Oncology and Hematology The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Takeshi Yamashita
- Department of Internal Medicine Keiju Kanazawa Hospital Ishikawa Japan
| | - Kazuyuki Shimizu
- Department of Hematology/Oncology Higashi Nagoya National Hospital Nagoya Japan
| | - Hirokazu Murakami
- Faculty of Medical Technology and Clinical Engineering Gunma University of Health and Welfare Maebashi Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism Tokushima University Graduate School Tokushima Japan
| | - Chiaki Nakaseko
- Department of Hematology International University of Health and Welfare School of Medicine Narita Japan
| | - Emiko Sakaida
- Department of Hematology Chiba University Hospital Chiba Japan
- Department of Transfusion Medicine and Cell Therapy Chiba University Hospital Chiba Japan
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5
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Corbingi A, Metafuni E, Di Salvatore M, Putzulu R, Chiusolo P, Schinzari G, Massini G, Rossi E, Zini G, Cassano A, Sica S, Piccirillo N. Successful "on-demand" plerixafor for autologous peripheral blood stem-cells transplantation for relapsed/refractory germ cell tumors. J Clin Apher 2021; 37:65-69. [PMID: 34822725 PMCID: PMC9298771 DOI: 10.1002/jca.21952] [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: 09/01/2021] [Revised: 10/18/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Background Germ cell tumors represent, among solid cancers, a potentially curable disease even if up to 20% to 30% of patients (pts) relapse after first‐line treatment especially considering intermediate and poor prognosis groups. In this scenario, patients are candidates for high‐dose chemotherapy and autologous stem‐cells transplantation as second‐line treatment even though stem‐cells mobilization potential can be affected by several cycles and regimens of chemotherapy. To date, plerixafor is authorized in poor mobilizer adult pts diagnosed with lymphoma or multiple myeloma and in pediatric solid tumors or lymphoma. Therefore, the use of plerixafor in adult pts with relapsing/refractory GCT is still off label. Materials and methods In our study, we describe mobilization and collection of peripheral blood stem cells for 10 pts with germ cell tumors. Six patients underwent plerixafor administration since classified as poor mobilizers based on WBC count (>5.000/μL) and CD34+ cell count (<15/μL) the day before apheresis procedure. Results On the first day of apheresis, plerixafor administration in poor mobilizers made possible a remarkable boost of CD34+ cells in such a way to overlap that of good mobilizers' (32/μL vs 35/μL, respectively, P > .05). Conclusion Therefore, in our experience, plerixafor made a good fraction of poor mobilizer patients eligible for mobilization and collection and able to undergo the predicted autologous stem‐cells transplantation; thus, the lack of access to the use of plerixafor in this setting of patients risks jeopardizing an effective treatment, especially in case of poor prognosis.
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Affiliation(s)
- Andrea Corbingi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | | | - Rossana Putzulu
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppina Massini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gina Zini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Cassano
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Piccirillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Bilgin YM. Use of Plerixafor for Stem Cell Mobilization in the Setting of Autologous and Allogeneic Stem Cell Transplantations: An Update. J Blood Med 2021; 12:403-412. [PMID: 34104027 PMCID: PMC8180285 DOI: 10.2147/jbm.s307520] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Mobilization failure is an important issue in stem cell transplantations. Stem cells are yielded from the peripheral blood via apheresis. Granulocyte colony-stimulating factor (G-CSF) is the most commonly used mobilization agent among patients and donors. G-CSF is administered subcutaneously for multiple days. However, patients with mobilization failure cannot receive autologous stem cell transplantation and, therefore, cannot be treated adequately. The incidence rate of mobilization failure among patients is about 6–23%. Plerixafor is a molecule that inhibits the binding of chemokine receptor-4 with stromal-cell-derived factor-1, thereby resulting in the release of CD34+ cells in the peripheral blood. Currently, plerixafor is used in patients with mobilization failure with G-CSF and is administered subcutaneously. Several studies conducted on different clinical settings have shown that plerixafor is effective and well tolerated by patients. However, more studies should be conducted to explore the optimal approach for plerixafor in patients with mobilization failure. The incidence of mobilization failure among donors is lower. However, plerixafor is not approved among donors with mobilization failure. Moreover, several clinical studies in donors have shown a beneficial effect of plerixafor. In addition, the adverse events of plerixafor are mild and transient, which can overcome the adverse events due to G-CSF. This review assessed the current role and effects of plerixafor in stem cell mobilization for autologous and allogeneic stem cell transplantations.
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Affiliation(s)
- Yavuz M Bilgin
- Department of Internal Medicine/Hematology, Admiraal de Ruijter Hospital, Goes, the Netherlands
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7
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Gupta GK, Perreault S, Seropian SE, Tormey CA, Hendrickson JE. Optimization of repeat plerixafor dosing for autologous peripheral blood stem-cell collection. Transfus Apher Sci 2021; 60:103069. [PMID: 33546988 DOI: 10.1016/j.transci.2021.103069] [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: 11/25/2020] [Revised: 12/24/2020] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Peripheral CD34+ cells may be mobilized using filgrastim alone or in combination with chemotherapy. The addition of plerixafor can be efficacious, though guidelines for repeat dosing are lacking. MATERIAL AND METHODS This quality improvement project was initiated to generate guidelines for repeat plerixafor dosing after retrospective evaluation of data in adult patients undergoing autologous peripheral blood stem cell mobilization and collection. RESULTS Analysis included 195 patients: 119 (61 %) with multiple myeloma and 76 (39 %) with lymphoma. Patients given at least one dose of plerixafor (n = 109) were further divided: Group 1) (A) goal of 3 × 10E6/kg and day 1 peripheral blood CD34+ count < 30 × 10E6/L, vs (B) ≥ 30 × 10 E6/L; Group 2) (A) goal of 6 × 10E6/kg and day 1 peripheral blood CD34+ count < 50 × 10E6/L or < 50 % of collection goal after day 1, vs (B) ≥ 50 % of collection goal after day 1. Ninety five percent of cases in Group 1B and 88 % of cases in Group 2B did not receive additional plerixafor doses and all of them achieved their collection goals. In contrast, those in Groups 1A and 2A required additional plerixafor dosing and some mobilizations/collections were futile. CONCLUSION Based on these data, with consideration of collection goal, peripheral blood CD34+ count, and CD34+ cell bag count on collection day 1, we have generated institutional guidelines for collection initiation and repeat plerixafor dosing. Long term, we predict these guidelines will optimize pharmacy, apheresis, and stem cell processing resources while improving the patient experience.
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Affiliation(s)
- Gaurav K Gupta
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Sarah Perreault
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | - Stuart E Seropian
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT, USA
| | | | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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8
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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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9
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Milone G, Conticello C, Leotta S, Michieli MG, Martino M, Marco ALD, Spadaro A, Cupri A, Condorelli A, Milone GA, Markovic U, Sciortino R, Schininà G, Moschetti G, Villari L, Saccardi R. Plerixafor on-demand in association with low-dose cyclophosphamide and G-CSF in the mobilization of patients with multiple myeloma: High effectiveness, low toxicity, and affordable cost. Leuk Res Rep 2020; 14:100227. [PMID: 33204611 PMCID: PMC7649636 DOI: 10.1016/j.lrr.2020.100227] [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: 09/15/2020] [Revised: 10/10/2020] [Accepted: 10/25/2020] [Indexed: 11/18/2022] Open
Abstract
In CD34 mobilization of Multiple Myeloma patients, Cyclophosphamide at the dose of 4 gr/m2 is usually administered. A lower dose of Cyclophosphamide (1.5–2.0 gr/m2) has a lower mobilizing effect and, for this reason, this dose is not widely used in CD34+ cells mobilization. The use of Plerixafor on demand, however, could have changed these conclusions. We hypothesized that when used in conjunction with on-demand Plerixafor, low lose CTX is more advantageous than the higher dose. The results of this prospective trial support, indeed, the view that low dose Cyclophosphamide in association to on-demand PLX allows the reaching efficacy and low toxicity.
In CD34+ cells mobilization of patients with multiple myeloma (MM), the use of Cyclophosphamide (CTX) at a dose of 2 g/m2 has low efficacy although also lower toxicity. The suboptimal mobilizing effect of low-dose CTX, however, may be overcome by plerixafor (PLX) on demand. We conducted a prospective multicenter study in 138 patients with MM to evaluate CTX 2 g/m2 in association with granulocyte-colony stimulating factor (G-CSF) and on-demand PLX. We compared results with a historical group of MM patients (n = 138) mobilized using CTX at a dose of 4 g/m2. CD34+ cells greater than 2 × 106/kg in max three aphereses were harvested in 98.6% of patients in the on-demand PLX study group while in 84.0% in the historical group, (p = 0.0001). In the on-demand-PLX study group, a successful harvest greater than 5 × 106/kg in max three aphereses was observed in 85.5% of patients versus 62.3% of patients in the historical control group, (p=0.0001). In the on-demand-PLX study group, 4.3% (6/138) of patients had febrile complications. Salvage mobilization in the on-demand PLX study group was 1.4%. In conclusions, on-demand PLX + CTX 2 g/m2 + G-CSF 10 μg/kg has higher efficacy and lower toxicity compared with CTX 4 g/m2 + G-CSF. An analysis of costs is presented.
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Affiliation(s)
- Giuseppe Milone
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Concetta Conticello
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Salvatore Leotta
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | | | - Massimo Martino
- Centro Unico Regionale per il Trapianto di Midollo, Grande Ospedale Metropolitano BMM, Reggio Calabria, Italy
| | - Anna Lia Di Marco
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Andrea Spadaro
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Alessandra Cupri
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Annalisa Condorelli
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Giulio Antonio Milone
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Uros Markovic
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Roberta Sciortino
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Giovanni Schininà
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | | | - Loredana Villari
- Division of Hematology and Program for Hematopoietic Transplantation, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy.,Department of Pathology, Azienda Ospedaliera Policlinico Vittorio Emanuele Catania, Italy
| | - Riccardo Saccardi
- SODc Terapie Cellulari e Medicina Trasfusionale, Azienda Ospedaliera Careggi, Firenze, Italy.,GITMO Gruppo Italiano Trapianto di Midollo Osseo
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10
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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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11
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Partanen A, Turunen A, Valtola J, Vasala K, Ågren L, Penttilä K, Pyörälä M, Kuittinen T, Mäntymaa P, Pelkonen J, Jantunen E, Varmavuo V. A prospective comparison of pegfilgrastim and lipegfilgrastim combined with chemotherapy in the mobilization of
CD34
+
cells in
NHL
patients. J Clin Apher 2020; 35:255-263. [DOI: 10.1002/jca.21785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Anu Partanen
- Department of Medicine Kuopio University Hospital Kuopio Finland
| | - Antti Turunen
- Department of Medicine Kuopio University Hospital Kuopio Finland
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Jaakko Valtola
- Department of Medicine Kuopio University Hospital Kuopio Finland
| | - Kaija Vasala
- Department of Oncology Central Hospital of Central Finland Jyväskylä Finland
| | - Lasse Ågren
- Siunsote‐Department of Medicine Hospital District of North Karelia Joensuu Finland
| | - Karri Penttilä
- Department of Medicine Central Hospital of Savonlinna Savonlinna Finland
- The Finnish Medicines Agency Kuopio Finland
| | - Marja Pyörälä
- Department of Medicine Kuopio University Hospital Kuopio Finland
| | - Taru Kuittinen
- Department of Medicine Kuopio University Hospital Kuopio Finland
| | | | - Jukka Pelkonen
- Eastern Finland Laboratory Centre Kuopio Finland
- Department of Clinical Microbiology University of Eastern Finland Kuopio Finland
| | - Esa Jantunen
- Department of Medicine Kuopio University Hospital Kuopio Finland
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Siunsote‐Department of Medicine Hospital District of North Karelia Joensuu Finland
| | - Ville Varmavuo
- Department of Medicine Kymenlaakso Central Hospital Kotka Finland
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12
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Hematopoietic Stem and Progenitor Cell (HSPC) Mobilization Responses to Different Exercise Intensities in Young and Older Adults. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-019-00050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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13
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Shah EE, Young RP, Wong SW, Damon LE, Wolf JL, Shah ND, Leavitt AD, Loeffler P, Martin TG. Impact of Plerixafor Use at Different Peripheral Blood CD34 + Thresholds on Autologous Stem Cell Collection in Patients with Multiple Myeloma. Biol Blood Marrow Transplant 2019; 26:876-883. [PMID: 31785375 DOI: 10.1016/j.bbmt.2019.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/22/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
Patients with multiple myeloma (MM) scheduled for autologous stem cell transplantation must undergo autologous stem cell mobilization; unfortunately, however, many do not obtain an adequate collection yield. Despite the availability of plerixafor, its widespread and uniform use is limited by its cost, and consequently, many institutions have adopted various risk-adapted algorithms. We report our mobilization experience as we have modified our plerixafor algorithm to a more liberal one, with the expectation of greater collection efficiency and mobilization success with higher plerixafor use. A total of 344 mobilization attempts were analyzed over 3 time periods and using 3 different peripheral blood CD34+ cell counts to guide plerixafor use: <15/µL (n = 66), <20/µL (n = 130), and <40/µL (n = 148). The primary endpoints were evaluation of changes in mean plerixafor utilization and apheresis days and assessment of the impact on overall mobilization costs. Secondary endpoints were a description of the impact of lenalidomide use on mobilization and evaluation of the rate of mobilization failure. We found that mean plerixafor use increased from 1.32 to 1.65 to 1.74 doses per mobilization (P = .026) and the mean days of apheresis decreased from 2.15 to 2.17 to 1.89 days per mobilization for the <15/µL, <20/µL, and <40/µL cohorts, respectively (P = .011). The combined cost of plerixafor and apheresis procedures at a threshold of 40/µL is close to that at a threshold of 15/µL, while saving 26 apheresis days per 100 patients. In general, there were low rates of mobilization failure across all thresholds. Patients who received more than 6 cycles of lenalidomide demonstrated impaired mobilization and required more apheresis sessions (P < .013) and greater plerixafor use (P < .001) to achieve target stem cell yields. Overall, using plerixafor in patients with MM, with a day 4 pCD34 count of <40/µL is a reasonable and cost-effective strategy to optimize apheresis utilization.
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Affiliation(s)
- Eshana E Shah
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Rebecca P Young
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Sandy W Wong
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California
| | - Lloyd E Damon
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California
| | - Jeffrey L Wolf
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California
| | - Nina D Shah
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California
| | - Andrew D Leavitt
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California; Department of Laboratory Medicine, University of California, San Francisco, California
| | - Paula Loeffler
- Department of Nursing, UCSF Health, University of California, San Francisco, California
| | - Thomas G Martin
- Department of Medicine, Division of Hematology/Oncology/Blood and Marrow Transplant, University of California, San Francisco, California.
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14
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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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15
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Allen ES, Conry-Cantilena C. Mobilization and collection of cells in the hematologic compartment for cellular therapies: Stem cell collection with G-CSF/plerixafor, collecting lymphocytes/monocytes. Semin Hematol 2019; 56:248-256. [PMID: 31836031 DOI: 10.1053/j.seminhematol.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
An essential and influential first step in all cellular therapies is collecting donor or patient cells. In hematopoietic progenitor cell transplantation, autologous or allogeneic hematopoietic progenitor cells (HPCs) are collected from either the bone marrow or the peripheral blood. Peripheral blood collection by apheresis requires mobilization with chemotherapy, granulocyte colony stimulating factor (G-CSF), plerixafor, or a combination. The modalities of mobilization and collection each carry a unique set of risks and benefits for both the donor and the recipient. In other types of cell therapy, most notably chimeric antigen receptor T cells, lymphocytes or monocytes are collected from the peripheral blood. The risks of collecting these cells by apheresis are similar to HPCs, but less is known about the composition, timing and qualitative cell characteristics which contribute to an optimal collection. Here, we review the mobilization and collection of HPCs and the collection of lymphocytes and monocytes. Donor safety is of primary importance when collecting material for any type of cell therapy. Every aspect of mobilization and collection can be studied and potentially optimized to improve patient outcomes.
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA.
| | - Cathy Conry-Cantilena
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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16
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López-Castaño F, Manresa P, Díaz V, Arranz E, López J, Pérez M, Alda O, Hernández L. Comparison and cost analysis of three protocols for mobilization and apheresis of haematopoietic progenitor cells. J Clin Apher 2019; 34:461-467. [PMID: 30817045 DOI: 10.1002/jca.21699] [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: 07/19/2018] [Revised: 01/16/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Autologous bone marrow transplantation is a component of the malignant hemopathy therapy. The preferred mobilization and collection method is apheresis. The aim of this study is to compare three protocols analyzing the effect of plerixafor, higher dose of G-CSF and large volume leukapheresis (LVL). MATERIALS AND METHODS A retrospective cohort study including 119 patients referred for mobilization. Three protocols were compared: (a) G-CSF 10 μg/kg/day subcutaneous (sc) × 4 days mobilizing 1 to 1.5 blood volumes. (b) G-CSF 10 μg/kg/day sc × 4 days + plerixafor 0.24 mg/kg/day sc preventively or as a rescue agent mobilizing 1 to 1.5 blood volumes. (c) G-CSF 20 μg/kg/day sc × 4 days ± plerixafor 0.24 mg/kg/day sc preventively or as a rescue agent mobilizing 3 to 4 blood volumes. RESULTS The average number of days of apheresis was reduced to 1.37 with protocol 3. The average cost per patient was reduced by 67% compared with protocol 2 and increased by only 5% compared with protocol 1, reducing the failure rate to 0%. CONCLUSION Adding preemptive or rescue plerixafor (protocol 2) to G-CSF 10 μg/kg/day alone (protocol 1) did not improve the days of apheresis nor the number of CD34+ cells collected but had higher cost and failure rate. Using LVL, plerixafor and G-CSF 20 μg/kg/day (protocol 3) decreased the number of sessions to 1.37, reduced the failure rate to 0% and led to a significant increase in the number of CD34+ cells collected without toxicity and with a similar cost to protocol 1.
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Affiliation(s)
- Francisco López-Castaño
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Pablo Manresa
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Vanesa Díaz
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Eva Arranz
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Javier López
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - María Pérez
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Olga Alda
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
| | - Luis Hernández
- Department of Hematology, Hospital General Universitario de Alicante (institution where the work was performed), Alicante, Spain
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17
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Oyekunle A, Shumilov E, Kostrewa P, Burchert A, Trümper L, Wuchter P, Wulf G, Bacher U, Kröger N. Chemotherapy-Based Stem Cell Mobilization Does Not Result in Significant Paraprotein Reduction in Myeloma Patients in the Era of Novel Induction Regimens. Biol Blood Marrow Transplant 2018; 24:276-281. [PMID: 29037891 DOI: 10.1016/j.bbmt.2017.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Anthony Oyekunle
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany; Department of Internal Medicine, University of Botswana, Botswana
| | - Evgenii Shumilov
- Department of Hematology and Medical Oncology, Medical Center University of Göttingen, Germany
| | - Philippe Kostrewa
- Department of Hematology and Oncology, University Hospital Giessen and Marburg, Germany
| | - Andreas Burchert
- Department of Hematology and Oncology, University Hospital Giessen and Marburg, Germany
| | - Lorenz Trümper
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Patrick Wuchter
- Department of Internal Medicine V, University of Heidelberg, Germany; Institute of Transfusion Medicine, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, Medical Center University of Göttingen, Germany
| | - Ulrike Bacher
- Department of Hematology, Inselspital Bern, Bern, Switzerland
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany.
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18
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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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19
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Baertsch MA, Kriegsmann K, Pavel P, Bruckner T, Hundemer M, Kriegsmann M, Ho AD, Goldschmidt H, Wuchter P. Platelet Count before Peripheral Blood Stem Cell Mobilization Is Associated with the Need for Plerixafor But Not with the Collection Result. Transfus Med Hemother 2018; 45:24-31. [PMID: 29593457 PMCID: PMC5836245 DOI: 10.1159/000478911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A low platelet count before mobilization has recurrently been identified as risk factor for poor mobilization. METHODS To determine the relevance of this finding for peripheral blood stem cell (PBSC) mobilization, including pre-emptive or rescue plerixafor in the case of poor mobilization, we retrospectively analyzed all patients undergoing PBSC collection at our institution between January 2014 and December 2015 (n = 380). RESULTS In total, 99% of the patients (377/380) successfully collected a minimum of 2 × 106 CD34+ cells/kg body weight sufficient for a single transplant. Rescue or pre-emptive plerixafor was administered to 11% of the patients (42/380). No correlations between the platelet count before mobilization and the number of peripheral blood CD34+ cells or the CD34+ cell collection result were detected in the entire population or the subgroups according to diagnosis (newly diagnosed multiple myeloma, relapsed multiple myeloma, lymphoma, amyloid light-chain amyloidosis, sarcoma, or germ cell tumor). However, patients requiring pre-emptive or rescue plerixafor had a significantly lower platelet count before mobilization (217/nl vs. 245/nl; p = 0.004). CONCLUSION With the current state of the art PBSC mobilization strategies, the platelet count before mobilization was not associated with the CD34+ cell collection result but was associated with the need for pre-emptive or rescue application of plerixafor.
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Affiliation(s)
- Marc-Andrea Baertsch
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Petra Pavel
- Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics, Heidelberg University, Heidelberg, Germany
| | - Michael Hundemer
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Anthony D. Ho
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg – Hesse, Mannheim, Germany
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20
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Wang G, Chen W, Wu Y, Li Y, Leng Y, Liu A. Recombinant human thrombopoietin improves the efficacy of intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor in mobilizing peripheral blood stem cells in patients with multiple myeloma: A cohort study. Medicine (Baltimore) 2017; 96:e9302. [PMID: 29390394 PMCID: PMC5815806 DOI: 10.1097/md.0000000000009302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The combination of intermediate-dose cyclophosphamide (ID-CTX) and granulocyte colony-stimulating factor (G-CSF) fails to mobilize peripheral blood stem cells (PBSCs) in approximately 20% of treated patients with multiple myeloma (MM).In this cohort study, patients with MM underwent PBSC mobilization with either an ID-CTX plus G-CSF plus recombinant human thrombopoietin (rhTPO) regimen (72 patients; TPO group), or an ID-CTX plus G-CSF regimen (70 patients; non-TPO group).In the TPO group, the median CD34+ harvest was 5.36 × 10 per kg of body weight (0.50-22.39 × 10 per kg of body weight), with a harvest success rate of 91.7% (66/72), and an excellence rate of 55.6% (40/72). In the non-TPO group, the median CD34+ harvest was 3.30 × 10 per kg of body weight (0.20-21.14 × 10 per kg of body weight), with a harvest success rate of 75.7% (53/70), and an excellence rate of 25.7% (18/70). The median count of the CD34+ cells collected, success rate of collection, and excellence rate of collection were significantly higher in the TPO group than in the non-TPO group (P=.0001, P=.01, and P = .0001, respectively). Time to granulocyte and platelet engraftment was faster among patients in the TPO group than that in those from the non-TPO group. No platelet engraftment delay (>21 days) was observed among patients in the TPO group, while 3 patients in the non-TPO group displayed delayed platelet engraftment.Adding rhTPO to the ID-CTX chemotherapy plus G-CSF regimen improved treatment efficacy in mobilizing PBSCs for autologous hematopoietic stem cell transplantation.
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21
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Abstract
In contemporary clinical practice, almost all allogeneic transplantations and autologous transplantations now capitalize on peripheral blood stem cells (PBSCs) as opposed to bone marrow (BM) for the source of stem cells. In this context, granulocyte colony-stimulating factor (G-CSF) plays a pivotal role as the most frequently applied frontline agent for stem cell mobilization. For patients classified as high-risk, chemotherapy based mobilization regimens can be preferred as a first choice and it is notable that this also used for remobilization. Mobilization failure occurs at a rate of 10%-40% with traditional strategies and it typically leads to low-efficiency practices, resource wastage, and delayed in treatment intervention. Notably, however, several factors can impact the effectiveness of CD34+ progenitor cell mobilization, including patient age and medical history (prior chemotherapy or radiotherapy, disease and marrow infiltration at the time of mobilization). In recent years, main (yet largely ineffective) approach was to increase G-CSF dose and add SCF, but novel and promising pathways have been opened up by the synergistic impact of a reversible inhibitor of CXCR4, plerixafor, with G-CSF. The literature shows to its favorable results in upfront and failed mobilizers, and it is necessary to use plerixafor (or equivalent agents) to optimize HSC harvest in poor mobilizers. Different CXCR4 inhibitors, growth hormone, VLA4 inhibitors, and parathormone, have been cited as new agents for mobilization failure in recent years. In view of the above considerations, the purpose of this paper is to examine the mobilization of PBSC while focusing specifically on poor mobilizers.
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Affiliation(s)
- Sinem Namdaroglu
- Izmir Bozyaka Training and Research Hospital, Department of Hematology, Izmir, Turkey.
| | - Serdal Korkmaz
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey
| | - Fevzi Altuntas
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey; Yıldırım Beyazıt University, Medical Faculty, Department of Hematology, Ankara, Turkey
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22
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Sahin U, Demirer T. Current strategies for the management of autologous peripheral blood stem cell mobilization failures in patients with multiple myeloma. J Clin Apher 2017; 33:357-370. [DOI: 10.1002/jca.21591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Ugur Sahin
- Department of Hematology; Ankara University Medical School; Ankara Turkey
| | - Taner Demirer
- Department of Hematology; Ankara University Medical School; Ankara Turkey
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23
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Partanen A, Valtola J, Ropponen A, Vasala K, Penttilä K, Ågren L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Preemptive plerixafor injection added to pegfilgrastim after chemotherapy in non-Hodgkin lymphoma patients mobilizing poorly. Ann Hematol 2017; 96:1897-1906. [PMID: 28879595 DOI: 10.1007/s00277-017-3123-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 12/15/2022]
Abstract
Filgrastim is usually combined with chemotherapy to mobilize hematopoietic progenitor cells in non-Hodgkin lymphoma (NHL) patients. Limited information is available on the efficacy of a preemptive plerixafor (PLER) injection in poor mobilizers after chemotherapy and pegfilgrastim. In this prospective study, 72 patients with NHL received chemotherapy plus pegfilgrastim, and 25 hard-to-mobilize patients received also PLER. The usefulness and efficacy of our previously developed algorithm for PLER use in pegfilgrastim-containing mobilization regimen were evaluated as well as the graft cellular composition, hematological recovery, and outcome after autologous stem cell transplantation (auto-SCT) according to the PLER use. A median 3.4-fold increase in blood CD34+ cell counts was achieved after the first PLER dose. The minimum collection target was achieved in the first mobilization attempt in 66/72 patients (92%) and 68 patients (94%) proceeded to auto-SCT. An algorithm for PLER use was fulfilled in 76% of the poor mobilizers. Absolute numbers of T-lymphocytes and NK cells were significantly higher in the PLER group, whereas the number of CD34+ cells collected was significantly lower. Early neutrophil engraftment was slower in the PLER group, otherwise hematological recovery was comparable within 12 months from auto-SCT. No difference was observed in survival according to the PLER use. Chemotherapy plus pegfilgrastim combined with preemptive PLER injection is an effective and convenient approach to minimize collection failures in NHL patients intended for auto-SCT. A significant effect of PLER on the graft cellular composition was observed, but no difference in outcome after auto-SCT was detected.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland.
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland
- The Finnish Medicines Agency, Kuopio, Finland
| | - L Ågren
- Department of Medicine, North Karelia Central Hospital, Joensuu, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
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24
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Kim JS. Hematopoietic stem cell mobilization: current status and future perspective. Blood Res 2017; 52:79-81. [PMID: 28698840 PMCID: PMC5503900 DOI: 10.5045/br.2017.52.2.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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25
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Douglas KW, Gilleece M, Hayden P, Hunter H, Johnson PRE, Kallmeyer C, Malladi RK, Paneesha S, Pawson R, Quinn M, Raj K, Richardson D, Robinson S, Russell N, Snowden J, Sureda A, Tholouli E, Thomson K, Watts M, Wilson KM. UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy. J Clin Apher 2017. [PMID: 28631842 DOI: 10.1002/jca.21563] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Plerixafor is a CXC chemokine receptor (CXCR4) antagonist that mobilizes stem cells in the peripheral blood. It is indicated (in combination with granulocyte-colony stimulating factor [G-CSF]) to enhance the harvest of adequate quantities of cluster differentiation (CD) 34+ cells for autologous transplantation in patients with lymphoma or multiple myeloma whose cells mobilize poorly. Strategies for use include delayed re-mobilization after a failed mobilization attempt with G-CSF, and rescue or pre-emptive mobilization in patients in whom mobilization with G-CSF is likely to fail. Pre-emptive use has the advantage that it avoids the need to re-schedule the transplant procedure, with its attendant inconvenience, quality-of-life issues for the patient and cost of additional admissions to the transplant unit. UK experience from 2 major centers suggests that pre-emptive plerixafor is associated with an incremental drug cost of less than £2000 when averaged over all patients undergoing peripheral blood stem cell (PBSC) transplant. A CD34+ cell count of <15 µl-1 at the time of recovery after chemomobilization or after four days of G-CSF treatment, or an apheresis yield of <1 × 106 CD34+ cells/kg on the first day of apheresis, could be used to predict the need for pre-emptive plerixafor.
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Affiliation(s)
- Kenneth W Douglas
- Clinical Apheresis Unit, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Maria Gilleece
- Yorkshire Blood and Marrow Transplant Programme, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Patrick Hayden
- Haematology Department, St James's Hospital, Dublin, Ireland
| | - Hannah Hunter
- Haematology Department, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Peter R E Johnson
- Department of Haematology, Western General Hospital, Edinburgh, United Kingdom
| | - Charlotte Kallmeyer
- Department of Haematology, Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
| | - Ram K Malladi
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Shankara Paneesha
- Department of Haematology, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Rachel Pawson
- Tissue Services and Cell Banking, NHS Blood and Transplant, Bristol, United Kingdom
| | - Michael Quinn
- Department of Haematology, Belfast NHS Trust, Belfast, United Kingdom
| | - Kavita Raj
- Haematological Cancer Services, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Deborah Richardson
- Department of Haematology, University Hospital Southampton, Southampton, United Kingdom
| | - Stephen Robinson
- Bristol Haematology Unit, University Hospitals Bristol, Bristol, United Kingdom
| | - Nigel Russell
- Clinical Haematology, Nottingham University Hospital, Nottingham, United Kingdom
| | - John Snowden
- Department of Haematology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Anna Sureda
- Department of Haematology, Institut Catalá d'Oncologia, Barcelona, Spain
| | - Eleni Tholouli
- HSC Transplant Services, Department of Haematology, Central Manchester University Hospitals, Manchester, United Kingdom
| | - Kirsty Thomson
- Department of Clinical Haematology, University College Hospitals, London, United Kingdom
| | - Mike Watts
- Wolfson Cellular Therapies Unit, University College Hospitals, London, United Kingdom
| | - Keith M Wilson
- Department of Haematology, Cardiff & Vale University Health Board, Cardiff, United Kingdom
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26
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Milone G, Martino M, Leotta S, Spadaro A, Zammit V, Cupri A, Avola G, Camuglia MG, Di Marco A, Scalzulli P, Morelli M, Olivieri A, Tripepi G. Cost-effectiveness of on-demand plerixafor added to chemotherapy and granulocyte-colony stimulating factor for peripheral blood stem cell mobilization in multiple myeloma. Leuk Lymphoma 2017; 59:42-48. [DOI: 10.1080/10428194.2017.1324161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Giuseppe Milone
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Massimo Martino
- Hematology and BMT UNIT, Ospedale Bianco Melacrino Morelli, Reggio Calabria, Italy
| | - Salvatore Leotta
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Andrea Spadaro
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Valentina Zammit
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Alessandra Cupri
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Giuseppe Avola
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Annalia Di Marco
- Hematology and BMT UNIT, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Potito Scalzulli
- Hematology and BMT UNIT, Ospedale Sollievo Sofferenza, San Giovanni Rotondo, Italy
| | - Mara Morelli
- Hematology and BMT UNIT, H San Raffaele, Milano, Italy
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27
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Abstract
Peripheral blood stem cell collection is an effective approach to obtain a hematopoietic graft for stem cell transplantation. Developing hematopoietic stem/progenitor cell (HSPC) mobilization methods and collection algorithms have improved efficiency, clinical outcomes, and cost effectiveness. Differences in mobilization mechanisms may change the HSPC content harvested and result in different engraftment kinetics and complications. Patient-specific factors can affect mobilization. Incorporating these factors in collection algorithms and improving assays for evaluating mobilization further extend the ability to obtain sufficient HSPCs for hematopoietic repopulation. Technological advance and innovations in leukapheresis have improved collection efficiency and reduced adverse effects.
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Affiliation(s)
- Yen-Michael S Hsu
- Pathology and Laboratory Medicine, Transfusion Medicine and Cellular Therapy, Weill Cornell Medical College, 525 East 68th Street, Box 251, New York, NY 10065, USA.
| | - Melissa M Cushing
- Transfusion Medicine and Cellular Therapy, Weill Cornell Medical College, 525 East 68th Street, Box 251, M09, New York, NY 10065, USA.
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28
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Azar N, Ouzegdouh M, Choquet S, Leblond V. Impact of plerixafor (mozobil) on hospital efficiency: A single center experience. J Clin Apher 2017; 33:5-13. [DOI: 10.1002/jca.21551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Nabih Azar
- Hematology department; Hôpital Pitié-Salpêtrière; 47-83 Boulevard de l'Hôpital, Paris 75013 France
| | - Maya Ouzegdouh
- Hematology department; Hôpital Pitié-Salpêtrière; 47-83 Boulevard de l'Hôpital, Paris 75013 France
| | - Sylvain Choquet
- Hematology department; Hôpital Pitié-Salpêtrière; 47-83 Boulevard de l'Hôpital, Paris 75013 France
| | - Véronique Leblond
- Hematology department; Hôpital Pitié-Salpêtrière; 47-83 Boulevard de l'Hôpital, Paris 75013 France
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29
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Yosupov N, Haimov H, Juodzbalys G. Mobilization, Isolation and Characterization of Stem Cells from Peripheral Blood: a Systematic Review. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2017; 8:e1. [PMID: 28496961 PMCID: PMC5423306 DOI: 10.5037/jomr.2017.8101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 01/10/2023]
Abstract
Objectives The purpose of this article is to systematically review the methods of mobilization, isolation and characterization of stem cells from peripheral blood and to discuss their potential therapeutic applications for bone tissue regeneration. Material and Methods An electronic literature search was performed through MEDLINE (PubMed) electronic database. The search was restricted to English language articles published during the last 10 years, from January 2006 to November 2016. Results In total, 37 literature sources were reviewed, and 11 of the most relevant articles that are suitable to the criteria were selected. Articles were analysed with data on animals and humans for mobilization, isolation and characterization of stem cells from peripheral blood. From the examination of selected articles, the mobilization materials, side effects, alternatives and factors affecting the extracted amount of mesenchymal stem cells (MSC) from mobilized peripheral blood of healthy individuals, as well as characterization of mobilized MSC were reviewed in this article. Conclusions Bone tissue engineering is a potential alternative strategy in bone regeneration and bone defect repair, however, insufficiency data display in the literature on potential therapeutic applications of peripheral blood stem cells for bone tissue regeneration.
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Affiliation(s)
- Natali Yosupov
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Haim Haimov
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
| | - Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, KaunasLithuania
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30
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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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31
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Ataca Atilla P, Bakanay Ozturk SM, Demirer T. How to manage poor mobilizers for high dose chemotherapy and autologous stem cell transplantation? Transfus Apher Sci 2016; 56:190-198. [PMID: 28034547 DOI: 10.1016/j.transci.2016.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/16/2016] [Accepted: 11/26/2016] [Indexed: 12/15/2022]
Abstract
Today, peripheral blood stem cells are the preferred source of stem cells over bone marrow. Therefore, mobilization plays a crutial role in successful autologous stem cell transplantation. Poor mobilization is generally defined as failure to achieve the target level of at least 2×106 CD34+ cells/kg body weight. There are several strategies to overcome poor mobilization: 1) Larger volume Leukapheresis (LVL) 2) Re-mobilization 3) Plerixafor 4) CM+Plerixafor (P)+G-CSF and 5) Bone Marrow Harvest. In this review, the definitions of successful and poor mobilization are discussed. Management strategies for poor mobilization are defined. The recent research on new agents are included.
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Affiliation(s)
- Pinar Ataca Atilla
- Department of Hematology, Ankara University Medical School, Cebeci, 06590 Ankara, Turkey.
| | | | - Taner Demirer
- Department of Hematology, Ankara University Medical School, Cebeci, 06590 Ankara, Turkey.
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32
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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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33
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Yuan S, Wang S. How do we mobilize and collect autologous peripheral blood stem cells? Transfusion 2016; 57:13-23. [PMID: 27731496 DOI: 10.1111/trf.13868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/15/2022]
Abstract
Autologous stem cell transplantation (ASCT) with mobilized peripheral blood stem cells (PBSCs) has become a widely applied therapeutic approach for many hematologic and nonhematologic diseases. Adequate PBSC mobilization is critical to the success of ASCT. However, many factors can contribute to poor mobilization. Plerixafor is an effective yet costly adjunct agent that has been increasingly used to improve mobilization in a variety of diagnoses and clinical settings. However, to achieve both optimal cell collection yields and cost-effectiveness, the role of plerixafor in PBSC mobilization needs to be well defined in terms of triggers for initiating its use and criteria for monitoring response. As one of the largest hematopoietic transplant centers in the country, we have developed an approach to PBSC mobilization and collection that incorporates patient laboratory assessments, monitoring of the collection yields, and judicious use of plerixafor as well as various patient support and education programs. These measures have resulted in an increase in our collection success rate and a decrease in the mean number of collection days. In this article we describe our approach to autologous PBSC mobilization and collection. Pertinent reports in the literature are also reviewed and discussed.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California
| | - Shirong Wang
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California
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34
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Kouroukis CT, Varela NP, Bredeson C, Kuruvilla J, Xenocostas A. Plerixafor for autologous stem-cell mobilization and transplantation for patients in Ontario. ACTA ACUST UNITED AC 2016; 23:e409-30. [PMID: 27536190 DOI: 10.3747/co.23.3137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND High-dose chemotherapy with autologous stem-cell transplantation (asct) is an accepted part of standard therapy for patients with hematologic malignancies. Usually, stem-cell mobilization uses granulocyte colony-stimulating factor (g-csf); however, some patients are not able to be mobilized with chemotherapy and g-csf, and such patients could be at higher risk of failing mobilization. Plerixafor is a novel mobilization agent that is absorbed quickly after subcutaneous injection and, at the recommended dose of 0.24 mg/kg, provides a sustained increase in circulating CD34+ cells for 10-18 hours. The main purpose of the present report was to evaluate the most current evidence on the efficacy of plerixafor in enhancing hematopoietic stem-cell mobilization and collection before asct for patients in Ontario so as to make recommendations for clinical practice and to assist Cancer Care Ontario in decision-making with respect to this intervention. METHODS The medline and embase databases were systematically searched for evidence from January 1996 to March 2015, and the best available evidence was used to draft recommendations relevant to the efficacy of plerixafor in enhancing hematopoietic stem-cell mobilization and collection before asct. Final approval of this practice guideline report was obtained from both the Stem Cell Transplant Steering Committee and the Report Approval Panel of the Program in Evidence-Based Care. RECOMMENDATIONS These recommendations apply to adult patients considered for asct: ■ Adding plerixafor to g-csf is an option for initial mobilization in patients with non-Hodgkin lymphoma or multiple myeloma who are eligible for asct when chemotherapy cannot be used and only g-csf mobilization is available.■ For patients with a low peripheral blood CD34+ cell count (for example, <10/μL) at the time of anticipated stem-cell harvesting, or with an inadequate first-day apheresis collection, it is recommended that plerixafor be added to the mobilization regimen to maximize stem-cell collection and to prevent the need for remobilization.■ It is recommended that patients who have failed a previous mobilization attempt undergo remobilization with g-csf and plerixafor, with or without chemotherapy.
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Affiliation(s)
- C T Kouroukis
- Division of Malignant Hematology, Juravinski Cancer Centre, and Department of Oncology, McMaster University, London, ON
| | - N P Varela
- Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, London, ON
| | - C Bredeson
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, London, ON
| | - J Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, London, ON
| | - A Xenocostas
- Division of Hematology, London Health Sciences Centre, Department of Medicine, London, ON
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Varmavuo V, Silvennoinen R, Anttila P, Säily M, Sankelo M, Putkonen M, Ahonen J, Mahlamäki E, Mäntymaa P, Savolainen ER, Remes K, Jantunen E. Cost analysis of a randomized stem cell mobilization study in multiple myeloma. Ann Hematol 2016; 95:1653-9. [DOI: 10.1007/s00277-016-2772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
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36
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Jantunen E, Varmavuo V, Valtola J. Plerixafor injection: a hematopoietic stem cell mobilizer in non-Hodgkin lymphoma and multiple myeloma. Expert Rev Hematol 2016; 9:723-32. [DOI: 10.1080/17474086.2016.1208082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wu CY, Chiou TJ, Liu CY, Lin FC, Lin JS, Hung MH, Hsiao LT, Yen CC, Gau JP, Yen HJ, Hung GY, Hsu HC, Tzeng CH, Liu JH, Yu YB. Decision-tree algorithm for optimized hematopoietic progenitor cell-based predictions in peripheral blood stem cell mobilization. Transfusion 2016; 56:2042-51. [PMID: 27232662 DOI: 10.1111/trf.13666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Enumerating hematopoietic progenitor cells (HPCs) by using an automated hematology analyzer is a rapid, inexpensive, and simple method for predicting a successful harvest compared with enumerating circulating CD34+ cells. However, the optimal HPC cutoff count and the indicating factors to be considered for improved predicting have not yet been determined. STUDY DESIGN AND METHODS Between 2007 and 2012, a total of 189 consecutive patients who proceeded to peripheral blood stem cell (PBSC) harvesting were retrospectively recruited. Baseline characteristics were analyzed to identify the risk factors for a failed harvest, which were defined as less than 2 × 10(6) CD34+ cells/kg. Variables identified by multivariate logistic regression and correlation analysis for predicting a successful harvest were subjected to classification and regression tree (CART) analysis. RESULTS PBSCs were successfully harvested in 154 (81.5%) patients. An age of at least 60 years, a diagnosis of a solid tumor, at least five prior chemotherapy cycles, prior radiotherapy, and mobilization with granulocyte-colony-stimulating factor alone or high-dose cyclophosphamide were independent baseline predictors of poor mobilization. In CART analysis, patients with zero to two host risk factors and either higher HPC (≥28 × 10(6) /L) or mononuclear cell (MNC; ≥3.5 × 10(9) /L) counts were categorized as good mobilizers and their harvest success rate was 92.3%. By contrast, 30.3% of harvests were adequate in the patients with three to five host risk factors and lower HPC and MNC counts. CONCLUSION A CART algorithm incorporating host predictors and HPC and MNC counts improves predictions in a successful harvest and might reduce the necessity of monitoring peripheral CD34+ cells.
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Affiliation(s)
- Chia-Yun Wu
- Division of Hematology, Department of Medicine.,Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Hematology, Department of Medicine.,Division of Transfusion Medicine, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeong-Shi Lin
- Division of Hematology, Department of Medicine.,Division of Transfusion Medicine, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Man-Hsin Hung
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chueh-Chuan Yen
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chi Hsu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, Saint Mary's Hospital Luodong, Yilan, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jing-Hwang Liu
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Teusink A, Pinkard S, Davies S, Mueller M, Jodele S. Plerixafor is safe and efficacious for mobilization of peripheral blood stem cells in pediatric patients. Transfusion 2016; 56:1402-5. [PMID: 27079854 DOI: 10.1111/trf.13599] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chemotherapy followed by filgrastim is the most common strategy used to mobilize autologous peripheral blood stem cells (PBSCs) for high-dose chemotherapy and autologous stem cell transplantation. Unfortunately, this method does not always lead to adequate PBSC collection in heavily treated patients with relapsed malignancies or if multiple transplants are required. Plerixafor, a hematopoietic stem cell mobilizer that inhibits the CXCR4 chemokine receptor and blocks binding of its cognate ligand, stromal cell-derived factor-1α (SDF-1α), has been shown to be safe and efficacious in the mobilization of autologous PBSC in adults. Despite its use in adults, little evidence exists to support its use in children. STUDY DESIGN AND METHODS We report a retrospective review of 16 consecutive pediatric patients receiving plerixafor as part of their mobilization regimen at Cincinnati Children's Hospital Medical Center. All patients but one were given 0.24 mg/kg dose of plerixafor and the median number of plerixafor doses received was two (range, one to four doses). One patient received higher doses of plerixafor. RESULTS An adequate number of CD34+ cells were obtained in 14 of 16 patients (87.5%). The median number of CD34+ cells collected for patients who reached collection goal was 6 × 10(6) CD34+ cells/kg (range, 1.6 × 10(6) -12.4 × 10(6) /kg). No acute adverse events were noted to be attributable to plerixafor administration. CONCLUSION Our findings suggest that plerixafor use in children is safe and efficacious for the mobilization of autologous PBSCs in subjects with relapsed malignancies or requiring stem cells for multiple transplants.
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Affiliation(s)
- Ashley Teusink
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan Pinkard
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | - Stella Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mueller
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children. Stem Cells Int 2016; 2016:4078215. [PMID: 26880960 PMCID: PMC4736431 DOI: 10.1155/2016/4078215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 11/17/2022] Open
Abstract
Fifty-six aphaereses were performed in 23 pediatric patients with malignant hematological and solid tumors, following three different protocols for PBPC mobilization and distributed as follows: A: seventeen mobilized with 4 g/m2 of cyclophosphamide (CFA) and 10 μg/kg/day of granulocyte colony stimulating factor (G-CSF), B: nineteen with CFA + G-CSF, and C: twenty only with G-CSF when the WBC count exceeded 10 × 109/L. The average number of MNC/kg body weight (BW)/aphaeresis was 0.4 × 108 (0.1–1.4), 2.25 × 108 (0.56–6.28), and 1.02 × 108 (0.34–2.5) whereas the average number of CD34+ cells/kg BW/aphaeresis was 0.18 × 106/kg (0.09–0.34), 1.04 × 106 (0.19–9.3), and 0.59 × 106 (0.17–0.87) and the count of CFU/kg BW/aphaeresis was 1.11 × 105 (0.31–2.12), 1.16 × 105 (0.64–2.97), and 1.12 × 105 (0.3–6.63) in groups A, B, and C, respectively. The collection was better in group B versus group A (p = 0.007 and p = 0.05, resp.) and in group C versus group A (p = 0.08 and p = 0.05, resp.). The collection of PBPCs was more effective in the group mobilized with CFM + G-CSF when the WBC exceeded 10 × 103/μL in terms of MNC and CD34+ cells and there was no toxicity of the chemotherapy.
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Afifi S, Adel NG, Devlin S, Duck E, Vanak J, Landau H, Chung DJ, Lendvai N, Lesokhin A, Korde N, Reich L, Landgren O, Giralt S, Hassoun H. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study. Bone Marrow Transplant 2016; 51:546-52. [PMID: 26726942 DOI: 10.1038/bmt.2015.322] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/15/2015] [Accepted: 11/08/2015] [Indexed: 12/22/2022]
Abstract
Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.
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Affiliation(s)
- S Afifi
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N G Adel
- Pharmacy Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Devlin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Duck
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Vanak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Landau
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - D J Chung
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - N Lendvai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - A Lesokhin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - N Korde
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - L Reich
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - O Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - S Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - H Hassoun
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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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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Vertès AA. The potential of cytotherapeutics in hematologic reconstitution and in the treatment and prophylaxis of graft-versus-host disease. Chapter I: current practice and remaining unmet medical needs. Regen Med 2015; 10:331-43. [DOI: 10.2217/rme.15.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Hematopoietic stem cell transplantation is a life-saving treatment for inherited anemias, immunodeficiencies or hematologic malignancies. When using partially HLA-matched allografts, a major complication is graft-versus-host disease (GvHD). The ideal attributes of a transformational new GvHD treatment include improved survival, decreased corticosteroids, decreased antifungals, improved quality of life through decreased infections, reduced number of hospital stay days, reduced risks of developing chronic GvHD impact on lower GI tract and liver, prophylactic benefits and decreased GvHD relapses, but, in the case of cancer, without negatively impacting beneficial graft-versus-tumor effects. The current practice of hematopoietic stem cell transplantation, its incidence and its unmet medical needs are reviewed here and discussed.
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Affiliation(s)
- Alain A Vertès
- Sloan Fellow, London Business School, London, UK
- NxR Biotechnologies GmbH, Basel, Switzerland
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Musto P, Simeon V, Grossi A, Gay F, Bringhen S, Larocca A, Guariglia R, Pietrantuono G, Villani O, D'Arena G, Cuomo C, Musto C, Morabito F, Petrucci MT, Offidani M, Zamagni E, Tacchetti P, Conticello C, Milone G, Palumbo A, Cavo M, Boccadoro M. Predicting poor peripheral blood stem cell collection in patients with multiple myeloma receiving pre-transplant induction therapy with novel agents and mobilized with cyclophosphamide plus granulocyte-colony stimulating factor: results from a Gruppo Italiano Malattie EMatologiche dell'Adulto Multiple Myeloma Working Party study. Stem Cell Res Ther 2015; 6:64. [PMID: 25889496 PMCID: PMC4425876 DOI: 10.1186/s13287-015-0033-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 12/23/2014] [Accepted: 03/03/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A still not well defined proportion of patients with multiple myeloma (MM) and eligible for autologous stem cell transplantation (AuSCT) fails to mobilize CD34+ peripheral blood stem cells (PBSC) at all or to collect an adequate number for a safe procedure or sufficient for multiple transplants. These so-called "poor-mobilizers" are difficult to be predicted, due to marked difference across previous heterogeneous studies. METHODS We aimed to develop a method based on simple clinical parameters for predicting unsuccessful (<2×10(6)/kg) or sub-optimal (<5×10(6)/kg) collections of CD34+ PBSC in newly diagnosed MM patients eligible for AuSCT, treated with novel agents and receiving an homogeneous mobilizing therapy with cyclophosphamide and granulocyte-colony stimulating factor (G-CSF). To this purpose, 1,348 patients enrolled in five consecutive Italian clinical trials were retrospectively analysed. Age, baseline low peripheral blood cell counts, use of lenalidomide, and haematological toxicity developed during induction were taken into account as possible factors associated with poor mobilization. RESULTS Overall, 280 patients (20.8%) showed either sub-optimal (167 patients, 12.4%) or unsuccessful (113 patients, 8.4%) collections. All analysed parameters negatively influenced the procedure, but only age and haematological toxicity during induction maintained their significance at multivariate analysis. Based on ordinal logistic regression model, we constructed a risk heat-map where the four parameters were pooled and weighted according to their relevance as single or combined variables. This model was predictive for different probabilities of failure, suboptimal or optimal outcomes. CONCLUSIONS We found that about one fifth of newly diagnosed MM fails to collect an adequate number of PBSC. Our model, based on a large group of patients treated frontline with novel agents and receiving the most popular mobilizing approach currently employed in Europe, is applicable in individual subjects and may contribute to the early identification of "poor mobilizer" phenotypes.
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Affiliation(s)
- Pellegrino Musto
- Scientific Direction, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Vittorio Simeon
- Laboratory of Pre-clinical and Translational Research, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Alberto Grossi
- Haematology, Centro Oncologico Fiorentino, Florence, Italy.
| | - Francesca Gay
- Myeloma Unit, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Sara Bringhen
- Myeloma Unit, AOU Città della Salute e della Scienza, Turin, Italy.
| | | | - Roberto Guariglia
- Haematology and Stem Cell Transplantation Unit, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Giuseppe Pietrantuono
- Haematology and Stem Cell Transplantation Unit, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Oreste Villani
- Haematology and Stem Cell Transplantation Unit, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Giovanni D'Arena
- Haematology and Stem Cell Transplantation Unit, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Carmela Cuomo
- Transfusional Medicine, IRCCS, Referral Cancer Centre of Basilicata, Rionero in Vulture, PZ, Italy.
| | - Clelia Musto
- Transfusional Service, S. Carlo Hospital, Potenza, Italy.
| | | | | | | | - Elena Zamagni
- Seràgnoli Institute of Haematology, University School of Medicine, Bologna, Italy.
| | - Paola Tacchetti
- Seràgnoli Institute of Haematology, University School of Medicine, Bologna, Italy.
| | - Concetta Conticello
- Department of Clinical and Molecular Biomedicine, Section of Haematology, University of Catania, Catania, CT, Italy.
| | - Giuseppe Milone
- Hemopoietic Transplant Program, AOU Policlinico Vittorio Emanuele, Catania, Italy.
| | - Antonio Palumbo
- Myeloma Unit, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Michele Cavo
- Seràgnoli Institute of Haematology, University School of Medicine, Bologna, Italy.
| | - Mario Boccadoro
- Myeloma Unit, AOU Città della Salute e della Scienza, Turin, Italy.
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Cannas G, Thomas X. Supportive care in patients with acute leukaemia: historical perspectives. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:205-20. [PMID: 25369611 PMCID: PMC4385068 DOI: 10.2450/2014.0080-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/24/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Giovanna Cannas
- Haemovigilance Unit, Edouard Herriot Hospital and Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Xavier Thomas
- Leukaemia Unit, Haematology Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
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Gattillo S, Marktel S, Rizzo L, Malato S, Malabarba L, Coppola M, Assanelli A, Milani R, De Freitas T, Corti C, Bellio L, Ciceri F. Plerixafor on demand in ten healthy family donors as a rescue strategy to achieve an adequate graft for stem cell transplantation. Transfusion 2015; 55:1993-2000. [PMID: 25721167 DOI: 10.1111/trf.13059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND In allogeneic hematopoietic stem cell (HSC) transplantation, the collection of an appropriate number of HSCs while maintaining a high level of safety for healthy donors is fundamental. Inadequate HSC mobilization can be seen with the standard use of granulocyte-colony-stimulating (G-CSF). Plerixafor (PL) is a chemokine receptor CXC Type 4-stromal-derived factor 1 inhibitor; its HSC-mobilizing properties are synergistic with G-CSF in poor mobilizing patients. The use of PL as adjuvant or alternative to G-CSF in healthy donors has shown a good safety profile but is so far off-label. STUDY DESIGN AND METHODS We report 10 healthy HSC donors treated with PL because of insufficient response to G-CSF alone or contraindication to G-CSF. Eight donors did not mobilize enough CD34+ cells with G-CSF alone because poor mobilizers or because insufficient HSCs were harvested according to the clinical need of the patient; in two cases G-CSF administration and marrow harvest were unfeasible or contraindicated in the donor. RESULTS The use of PL for mobilization increased the number of circulating CD34+ cells by 2.8-fold and the CD34+/kg collection by 3.0-fold. Only mild adverse events were reported (bone pain or discomfort) and not univocally attributable to PL. Rate of engraftment and graft-versus-host disease were similar to those seen in recipients of grafts from G-CSF only-mobilized donors. CONCLUSION We exposed 10 allogeneic donors to mobilization with PL. PL was well tolerated in all cases and ensured procurement of an adequate graft for transplantation resulting in a normal hematopoietic engraftment.
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Affiliation(s)
- Salvatore Gattillo
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Rizzo
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Malato
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Malabarba
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milena Coppola
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Milani
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Tiago De Freitas
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bellio
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Jensen IS, Halbert RJ, Rossi G, Naoshy S, Iqbal SU, Xiao Z, McSweeney PA. A hospital budget impact model to compare stem cell mobilisation strategies: impact of primary research and direct stakeholder engagement. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Abstract
Plerixafor, a hematopoietic stem cell mobilizer, is indicated in combination with G-CSF to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma. Current evidence suggests that the addition of plerixafor with chemotherapy plus G-CSF is safe and effective in the large majority of the patients with low blood CD34(+) cell count after mobilization and/or poor yield after the first collection. Nevertheless, there are several questions strongly debated, and in this paper, we would like to identify areas of possible future use and development of the drug.
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Sauter CS, Giralt S. The prognostic impact of peripheral blood progenitor cell dose following high-dose therapy and autologous stem cell transplant for hematologic malignancies. Leuk Lymphoma 2014; 56:1619-25. [PMID: 25284496 DOI: 10.3109/10428194.2014.970544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
High-dose chemotherapy (HDT) followed by autologous peripheral blood progenitor cell transplant (PBPCT) has become a standard intervention in certain clinical settings of hematologic malignancies, particularly multiple myeloma and relapsed/refractory lymphoma. While the minimal required PBPCs infused, as defined by number of CD34 + cells, has been relatively well delineated for adequate hematopoietic recovery post-HDT, optimal PBPC dose has not been clearly defined. This is particularly relevant in the context of retrospective data suggesting improved survival outcomes with increased PBPC doses. The potential confounding of these data as they relate to disease risk is discussed within this review. Additionally, other retrospective data have suggested that enhanced quantitative lymphocyte subset reconstitution post-HDT-PBPCT may confer progression-free and overall survival advantage. These reported series herein reviewed may inform discussion of future, prospective clinical trials with the intent of defining optimal autologous PBPC dose following HDT, especially as it may relate to metrics beyond hematopoietic recovery.
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Affiliation(s)
- Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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Use of Laboratory Tests to Guide Initiation of Autologous Hematopoietic Progenitor Cell Collection by Apheresis: Results From the Multicenter Hematopoietic Progenitor Cell Collection by Apheresis Laboratory Trigger Survey. Transfus Med Rev 2014; 28:198-204. [DOI: 10.1016/j.tmrv.2014.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/25/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022]
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