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Marchesi F, Vacca M, Giannarelli D, Ipsevich F, Pandolfi A, Gumenyuk S, Renzi D, Palombi F, Pisani F, Romano A, Spadea A, Papa E, Canfora M, Pierelli L, Mengarelli A. Lenograstim 5 µg/kg is not superior to biosimilar filgrastim 10 µg/kg in lymphoma patients undergoing peripheral blood stem cell mobilization after chemotherapy: preliminary results from a prospective randomized study. Transfusion 2018; 58:1143-1148. [PMID: 29446445 DOI: 10.1111/trf.14533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/12/2018] [Accepted: 01/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Randomized trials comparing chemomobilization efficiency between lenograstim and biosimilar filgrastim are lacking. Our previous retrospective study suggested that lenograstim could be more effective than biosimilar filgrastim when used at the same conventional dosage (5 µg/kg) only in lymphoma patients undergoing peripheral blood stem cell mobilization. We planned a prospective randomized study comparing lenograstim 5 µg/kg with biosimilar filgrastim 10 µg/kg to verify the hypothesis of lenograstim superiority even at half the dosage (stress test). Herein we report data after enrolling 60% of planned patients. STUDY DESIGN AND METHODS From October 2014 to November 2017, a total of 42 of 70 planned patients with lymphoma were randomly assigned to receive lenograstim 5 µg/kg (21) or biosimilar filgrastim 10 µg/kg (21). Patients were stratified according to treatment line at the time of mobilization (1 or ≥2). Primary endpoint was the rate of achievement of the CD34+ cell collection target dose (≥ 4 × 106 /kg). An improvement by 23% was expected to validate the hypothesis of lenograstim superiority. RESULTS The two cohorts were balanced for all the baseline features. We observed an identical rate of patients able to reach the targeted CD34+ cell dose and of mobilization failures (90.4 and 4.8% in both cohorts) and a perfect equivalence in any of the secondary collection outcomes. The hypothesis of lenograstim superiority was not corroborated at interim analysis. CONCLUSION Lenograstim at conventional dosage has failed to demonstrate its superiority over biosimilar filgrastim at double the dosage at interim analysis in their first head-to-head trial.
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Affiliation(s)
| | - Michele Vacca
- Immuno-Transfusional Medicine, Leukapheresis and Cellular Therapy Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Regina Elena National Cancer Institute
| | - Francesco Ipsevich
- Immuno-Transfusional Medicine, Leukapheresis and Cellular Therapy Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Annino Pandolfi
- Immuno-Transfusional Medicine, Leukapheresis and Cellular Therapy Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | | | | | | | | | | | - Elena Papa
- Hematology and Stem Cell Transplant Unit
| | - Marco Canfora
- Biostatistics Unit, Scientific Direction, IRCCS Regina Elena National Cancer Institute, Regina Elena National Cancer Institute
| | - Luca Pierelli
- Immuno-Transfusional Medicine, Leukapheresis and Cellular Therapy Unit, S. Camillo-Forlanini Hospital, Rome, Italy
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Kuan JW, Su AT, Leong CF. Pegylated granulocyte-colony stimulating factor versus non-pegylated granulocyte-colony stimulating factor for peripheral blood stem cell mobilization: A systematic review and meta-analysis. J Clin Apher 2017; 32:517-542. [PMID: 28485020 DOI: 10.1002/jca.21550] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/11/2017] [Accepted: 04/04/2017] [Indexed: 12/15/2022]
Abstract
Granulocyte-colony stimulating factor (G-CSF) mobilizes and increases the amount of hematopoietic stem cells in peripheral blood, enabling its harvest by few apheresis procedures. The pegylated G-CSF has longer half-life and is given once only, which is more comfortable for patients, whereas the non-pegylated requires multiple daily injection because of its short half-life. We summarized results of randomized trials comparing the efficacy and safety of pegylated and non-pegylated G-CSF for peripheral blood stem cell mobilization. We searched the Cochrane CENTRAL, MEDLINE, EMBASE, and two conference proceedings. Two authors made the selection, extracted data and evaluated methodological quality using GRADE independently. We used random-effects model for meta-analysis. We found 3956 records and retrieved 47 full texts. We included eight randomized trials with a total number of 554 randomized and 532 analyzed subjects. The meta-analysis included five trials because not all trials reported the same outcomes. Pooling data from two studies shows no evidence for a difference in the successful mobilization rate (CD34+ cell ≥ 2 × 106 /kg collected) between pegfilgrastim 6 mg (early administration) and filgrastim 5 µg/kg/day (147 participants; risk ratio (RR) 0.87, 95% confidence interval (95%CI) 0.67-1.11; P = .26). Pooling data from three studies shows no difference in the incidence of adverse events between pegylated and non-pegylated G-CSF (170 participants; RR 0.86, 95%CI 0.34-2.17; P = .75). No difference found on the quantity of CD34+ cells collected, number of apheresis procedure in successful mobilization, level of peak PB CD34+ cells achieved, and day of neutrophil and platelet engraftment.
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Affiliation(s)
- Jew W Kuan
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Anselm T Su
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Chooi F Leong
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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Miller PH, Nakamichi N, Knapp DJ, Rabu G, Schultz KR, Jones DM, Couban S, Eaves CJ. Quantitation of Human Cells that Produce Neutrophils and Platelets in Vivo Obtained from Normal Donors Treated with Granulocyte Colony–Stimulating Factor and/or Plerixafor. Biol Blood Marrow Transplant 2016; 22:1945-1952. [DOI: 10.1016/j.bbmt.2016.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 01/09/2023]
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Marchesi F, Vacca M, Gumenyuk S, Pandolfi A, Renzi D, Palombi F, Pisani F, Romano A, Spadea A, Ipsevich F, Santinelli S, De Rienzo M, Papa E, Canfora M, Laurenzi L, Foddai ML, Pierelli L, Mengarelli A. Biosimilar filgrastim (Zarzio®) vs. lenograstim (Myelostim®) for peripheral blood stem cell mobilization in adult patients with lymphoma and myeloma: a single center experience. Leuk Lymphoma 2015; 57:489-492. [DOI: 10.3109/10428194.2015.1063147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Marchesi F, Pimpinelli F, Dessanti ML, Gumenyuk S, Palombi F, Pisani F, Romano A, Spadea A, Maschio M, Ensoli F, Mengarelli A. Evaluation of risk of symptomatic cytomegalovirus reactivation in myeloma patients treated with tandem autologous stem cell transplantation and novel agents: a single-institution study. Transpl Infect Dis 2014; 16:1032-8. [PMID: 25369809 DOI: 10.1111/tid.12309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/18/2014] [Accepted: 08/23/2014] [Indexed: 01/12/2023]
Abstract
The introduction of proteasome inhibitors and/or immunomodulators in the treatment of myeloma has led to an increase in viral infections, particularly in the Herpesviridae family. Previous studies about the risk of cytomegalovirus (CMV) reactivation after autologous stem cell transplantation (ASCT) have examined the clinical outcome after the first ASCT; however, only 1 study to date has investigated the risk of CMV reactivation after a second transplantation. To address this issue, we performed a retrospective chart review on 78 consecutive myeloma patients (median age 56 years) who underwent a tandem non-CD34(+) selected ASCT after induction treatment with either conventional chemotherapy (n = 42) or with novel agents (n = 36), respectively. All subjects had been mobilized and conditioned with cyclophosphamide plus granulocyte colony-stimulating factor and melphalan alone, respectively. CMV DNA load in the blood has been determined by polymerase chain reaction in the case of a clinical suspicion of CMV reactivation; therefore, routine monitoring was not performed. Considering the outcome of both the first and the second transplantations, we observed a total of 13 episodes of symptomatic CMV reactivation (13/156, 8%), in 12 subjects (12/78, 15%), all successfully treated. Eight subjects experienced a CMV reactivation after the first ASCT (8/78, 10%); however, only 1 of them (1/8, 12%) experienced a CMV reactivation after the second transplantation. Conversely, 4 CMV reactivations (6%) were observed after the second transplantation in the group of 70 patients who did not experience a CMV reactivation after the first ASCT. No statistically significant difference was observed between first and second ASCT (8/78, 10% vs. 5/78, 6%; P = 0.767). Univariate analysis showed that a pre-transplant treatment with novel agents was the only baseline factor significantly associated with the occurrence of post-ASCT CMV symptomatic reactivation after the first transplant (odds ratio [OR]: 9.897; 95% confidence interval [CI]: 1.154-84.840; P = 0.021) but not after the second transplant (OR: 5.125; 95% CI: 0.546-48.119; P = 0.115). No end-organ disease or primary infection was documented. Our data suggest that second transplantation does not increase the risk of CMV reactivation in our patient population, when compared with the first one, and confirm the role of a pre-transplant treatment with novel agents as a risk factor for CMV symptomatic reactivation.
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Affiliation(s)
- F Marchesi
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Rome, Italy
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Mohty M, Hübel K, Kröger N, Aljurf M, Apperley J, Basak GW, Bazarbachi A, Douglas K, Gabriel I, Garderet L, Geraldes C, Jaksic O, Kattan MW, Koristek Z, Lanza F, Lemoli RM, Mendeleeva L, Mikala G, Mikhailova N, Nagler A, Schouten HC, Selleslag D, Suciu S, Sureda A, Worel N, Wuchter P, Chabannon C, Duarte RF. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014; 49:865-72. [PMID: 24686988 DOI: 10.1038/bmt.2014.39] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 12/16/2022]
Abstract
Autologous haematopoietic SCT with PBSCs is regularly used to restore BM function in patients with multiple myeloma or lymphoma after myeloablative chemotherapy. Twenty-eight experts from the European Group for Blood and Marrow Transplantation developed a position statement on the best approaches to mobilising PBSCs and on possibilities of optimising graft yields in patients who mobilise poorly. Choosing the appropriate mobilisation regimen, based on patients' disease stage and condition, and optimising the apheresis protocol can improve mobilisation outcomes. Several factors may influence mobilisation outcomes, including older age, a more advanced disease stage, the type of prior chemotherapy (e.g., fludarabine or melphalan), prior irradiation or a higher number of prior treatment lines. The most robust predictive factor for poor PBSC collection is the CD34(+) cell count in PB before apheresis. Determination of the CD34(+) cell count in PB before apheresis helps to identify patients at risk of poor PBSC collection and allows pre-emptive intervention to rescue mobilisation in these patients. Such a proactive approach might help to overcome deficiencies in stem cell mobilisation and offers a rationale for the use of novel mobilisation agents.
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Affiliation(s)
- M Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - K Hübel
- University Hospital Cologne, Cologne, Germany
| | - N Kröger
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabi
| | | | - G W Basak
- The Medical University of Warsaw, Warsaw, Poland
| | | | - K Douglas
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - L Garderet
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - C Geraldes
- University Hospital Coimbra, Coimbra, Portugal
| | - O Jaksic
- University Hospital Dubrava, Zagreb, Croatia
| | - M W Kattan
- Quantitative Health Sciences Cleveland Clinic, Cleveland, OH, USA
| | - Z Koristek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - F Lanza
- Cremona Hospital, Cremona, Italy
| | | | - L Mendeleeva
- National Research Centre for Haematology, Moscow, Russia
| | - G Mikala
- St Istvan and St Laszlo Hospital, Budapest, Hungary
| | - N Mikhailova
- Institute of Children Haematology and Transplantation n.a. R Gorbacheva, St Petersburg State Pavlov Medical University, St Petersburg, Russia
| | - A Nagler
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - H C Schouten
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Selleslag
- Department of Haematology, AZ Sint-Jan, Brugge-Oostende, Belgium
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | - A Sureda
- Addenbrooke's Hospital, Cambridge, UK
| | - N Worel
- Medical University Vienna, Vienna, Austria
| | - P Wuchter
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - C Chabannon
- Institut Paoli-Calmettes and Inserm CBT-510, Marseille, France
| | - R F Duarte
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Marchesi F, Mengarelli A, Giannotti F, Tendas A, Anaclerico B, Porrini R, Picardi A, Cerchiara E, Dentamaro T, Chierichini A, Romeo A, Cudillo L, Montefusco E, Tirindelli MC, De Fabritiis P, Annino L, Petti MC, Monarca B, Arcese W, Avvisati G. High incidence of post-transplant cytomegalovirus reactivations in myeloma patients undergoing autologous stem cell transplantation after treatment with bortezomib-based regimens: a survey from the Rome transplant network. Transpl Infect Dis 2013; 16:158-64. [PMID: 24215479 DOI: 10.1111/tid.12162] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/19/2013] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
Abstract
The incidence of cytomegalovirus (CMV) reactivations in patients with multiple myeloma (MM) receiving autologous stem cell transplantation (ASCT) is relatively low. However, the recent increased use of novel agents, such as bortezomib and/or immunomodulators, before transplant, has led to an increasing incidence of Herpesviridae family virus infections. The aim of the study was to establish the incidence of post-engraftment symptomatic CMV reactivations in MM patients receiving ASCT, and to compare this incidence with that of patients treated with novel agents or with conventional chemotherapy before transplant. The study was a survey of 80 consecutive patients who underwent ASCT after treatment with novel agents (Group A). These patients were compared with a cohort of 89 patients treated with VAD regimen (vincristine, doxorubicin, and dexamethasone) before ASCT (Group B). Overall, 7 patients (4.1%) received an antiviral treatment for a symptomatic CMV reactivation and 1 died. The incidence of CMV reactivations was significantly higher in Group A than in Group B (7.5% vs. 1.1%; P = 0.048). When compared with Group B, the CMV reactivations observed in Group A were significantly more frequent in patients who received bortezomib, whether or not associated with immunomodulators (9.4% vs. 1.1%; P = 0.019), but not in those treated with immunomodulators only (3.7% vs. 1.1%; P = 0.396). These results suggest that MM patients treated with bortezomib-based regimens are at higher risk of developing a symptomatic CMV reactivation after ASCT.
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Affiliation(s)
- F Marchesi
- Hematology Unit, Campus Bio-Medico University Hospital, Rome, Italy
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Single-dose pegylated-filgrastim versus daily filgrastim after high-dose chemotherapy and autologous stem cell transplantation for lymphoid malignancies: delayed platelets recovery? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:561-2. [PMID: 22395357 DOI: 10.2450/2012.0148-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/19/2011] [Indexed: 11/21/2022]
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