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Turunen AS, Kuittinen O, Kuitunen H, Vasala K, Penttilä K, Harmanen M, Keskinen L, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E, Partanen A. CD34 + Cell Mobilization, Autograft Cellular Composition and Outcome in Mantle Cell Lymphoma Patients. Transfus Med Hemother 2023; 50:428-437. [PMID: 37899989 PMCID: PMC10601603 DOI: 10.1159/000531799] [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: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 10/31/2023] Open
Abstract
Backgound Autologous stem cell transplantation (ASCT) is a standard treatment in transplant-eligible mantle cell lymphoma (MCL) patients after first-line chemoimmunotherapy. Study Design and Methods This prospective multicenter study evaluated the impact of CD34+ cell mobilization and graft cellular composition analyzed by flow cytometry on hematologic recovery and outcome in 42 MCL patients. Results During CD34+ cell mobilization, a higher blood CD34+ cell count (>30 × 106/L) was associated with improved overall survival (median not reached [NR] vs. 57 months, p = 0.04). The use of plerixafor did not impact outcome. Higher number of viable cryopreserved graft CD34+ cells (>3.0 × 106/kg) was associated with faster platelet (median 11 vs. 15 days, p = 0.03) and neutrophil (median 9 vs. 10 days, p = 0.02) recovery posttransplant. Very low graft CD3+CD8+ cell count (≤10 × 106/kg) correlated with worse progression-free survival (PFS) (HR 4.136, 95% CI 1.547-11.059, p = 0.005). On the other hand, higher absolute lymphocyte count >2.5 × 109/L at 30 days after ASCT (ALC-30) was linked with better PFS (median NR vs. 99 months, p = 0.045) and overall survival (median NR in either group, p = 0.05). Conclusions Better mobilization capacity and higher graft CD3+CD8+ cell count had a positive prognostic impact in this study, in addition to earlier lymphocyte recovery (ALC-30>2.5 × 106/L). These results need to be validated in another study with a larger patient cohort.
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Affiliation(s)
| | - Outi Kuittinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Oncology, Kuopio University Hospital, Kuopio, Finland
- Cancer Centre, Oulu University Hospital, Oulu, Finland
| | | | - Kaija Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Karri Penttilä
- Department of Medicine, Savonlinna Central Hospital, Savonlinna, Finland
- Finnish Medicines Agency, Kuopio, Finland
| | - Minna Harmanen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leena Keskinen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | | | - Jukka Pelkonen
- Laboratory Centre of Eastern Finland, Kuopio, Finland
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, North Carelia Hospital District, Joensuu, Finland
| | - Anu Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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2
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Grosso D, Leiby B, Wilde L, Carabasi M, Filicko-O'Hara J, O'Hara W, Wagner JL, Mateja G, Alpdogan O, Binder A, Kasner M, Keiffer G, Klumpp T, Martinez UO, Palmisiano N, Porcu P, Gergis U, Flomenberg N. A Prospective, Randomized Trial Examining the Use of G-CSF Versus No G-CSF in Patients Post-Autologous Transplantation. Transplant Cell Ther 2022; 28:831.e1-831.e7. [PMID: 36167307 DOI: 10.1016/j.jtct.2022.09.012] [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: 06/06/2022] [Revised: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 12/24/2022]
Abstract
Contemporary, prospective data regarding the impact of granulocyte-colony stimulating factor (G-CSF) on outcomes after autologous hematopoietic stem cell transplantation (Auto-HSCT) in an era when stem cell grafts are more qualitatively robust are limited. Recent retrospective analyses have not supported a beneficial effect of post-transplantation G-CSF use on major outcomes after Auto-HSCT leading to strategies to delay or eliminate the use of G-CSF altogether in this context. To test the hypothesis that the infusion of consistently higher doses of stem cells (defined as ≥4 × 106/kg) in Auto-HSCT will obviate the need for post-transplantation G-CSF. If so, the impact of withholding G-CSF will be noninferior to the use of G-CSF in terms of length of stay (LOS). The specific objectives were to conduct a prospective, randomized clinical trial primarily examining the impact of post-transplantation G-CSF on LOS, and secondarily on engraftment, infectious complications, antibiotic usage, and incidence of engraftment syndrome after Auto-HSCT in patients receiving versus not receiving G-CSF after Auto-HSCT. Patients with multiple myeloma or non-Hodgkin lymphoma (NHL) who underwent Pegfilgrastim plus Plerixafor-primed stem cell collection followed by Auto-HSCT were randomized to the G-CSF group (receive G-CSF starting at day 3 after Auto-HSCT) or the no G-CSF group (G-CSF withheld after Auto-HSCT). Seventy patients per arm were planned to demonstrate the primary endpoint of noninferiority in LOS between the G-CSF and the no G-CSF groups. Patient outcomes in the two groups were followed up and compared after Auto-HSCT, and an interim analysis for futility was planned when accrual reached 50%.The primary finding of this study was that despite only a 2-day longer median absolute neutrophil count (ANC) recovery in the no G-CSF arm (median 11 versus 13 days; P = .001), LOS was 4 days longer in patients not treated with G-CSF (median 11 days versus 15 days; P = .001). G-CSF use was associated with more robust incremental daily increases in ANC once recovered (P = .001), fewer days of febrile neutropenia (P = .001), and fewer days on antibiotics (P = .001), potentially contributing to this disproportionate finding. Inferiority in LOS in the no G-CSF group was demonstrated on the interim analysis, and the study was closed at the half-way point. There were no significant group differences in platelet recovery, documented infections, hospital readmissions, or overall survival at 1 year. Engraftment syndrome occurred in 54.3% of patients and was not related to G-CSF use. These results suggest that the increased LOS associated with the omission of G-CSF is largely due to concerns regarding the potential for infection in patients without a stable, recovered ANC in a hospital setting. Engraftment syndrome represented a significant source of febrile neutropenia further contributing to patient safety concerns and requires strategies to decrease its incidence. Infectious complications and death were not affected by the omission of G-CSF supporting a carefully monitored outpatient approach to Auto-HSCT in which white blood cell growth factor is eliminated or given as needed for documented infection. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Dolores Grosso
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lindsay Wilde
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Carabasi
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanne Filicko-O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William O'Hara
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John L Wagner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Mateja
- Office of Clinical Research, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Onder Alpdogan
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Margaret Kasner
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gina Keiffer
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Klumpp
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ubaldo Outschoorn Martinez
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neil Palmisiano
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Pierluigi Porcu
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Usama Gergis
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neal Flomenberg
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
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3
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Ruder J, Docampo MJ, Rex J, Obahor S, Naghavian R, Müller AM, Schanz U, Jelcic I, Martin R. Dynamics of T cell repertoire renewal following autologous hematopoietic stem cell transplantation in multiple sclerosis. Sci Transl Med 2022; 14:eabq1693. [DOI: 10.1126/scitranslmed.abq1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) is a highly effective treatment of multiple sclerosis (MS). It depletes autoreactive cells and subsequently renews adaptive immune cells. The possible proinflammatory potential of surviving T cells early after aHSCT has not been studied. Here, we examined the dynamics of new and surviving T cells in 27 patients after aHSCT by multidimensional flow cytometry, T cell receptor (TCR) sequencing, specificity testing, telomere length profiling, and HLA genotyping. Early after aHSCT, naïve T cells are barely detectable, whereas effector memory (EM) T cells quickly reconstitute to pre-aHSCT values. EM CD4+T cells early after aHSCT have shorter telomeres, have higher expression of senescence and exhaustion markers, and proliferate less than those before aHSCT. We find a median TCR repertoire overlap of 26% between the early post-aHSCT EM CD4+T cells and pre-aHSCT, indicating persistence of EM CD4+T cells early after transplantation. The EM CD4+TCR repertoire overlap declines to 15% at 12 months after aHSCT, whereas the naïve TCR repertoire entirely renews. HLA-DR–associated EM CD4+T cell reactivity toward MS-related antigens decreased after aHSCT, whereas reactivity toward EBV increased. Our data show substantial survival of pre-aHSCT EM CD4+T cells early after transplantation but complete renewal of the T cell repertoire by nascent T cells later.
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Affiliation(s)
- Josefine Ruder
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - María José Docampo
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jordan Rex
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Simon Obahor
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Reza Naghavian
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Antonia M.S. Müller
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
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Siddiqui I, Shmookler A, Biller E, Hardy T, Hartage R, Losos M, Chen J. Impact of mobilization regimen on multiday collection of peripheral blood CD34+ cells by large volume leukapheresis. Transfusion 2022; 62:857-862. [PMID: 35211978 DOI: 10.1111/trf.16842] [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: 10/21/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The collection yield of hematopoietic progenitors cell (HPC) by leukapheresis is critical for a successful transplantation, which often requires multiday collections to achieve the collection goal. STUDY DESIGN AND METHODS Collection procedures of 181 patients who underwent leukapheresis for more than 1 day were reviewed. Patients were separated into six groups based on the mobilization regimen: G-CSF on day 1 (D1) and day 2 (D2) (G-G); G-CSF on D1 and G-CSF and plerixafor on D2 (G-GP); G-CSF and plerixafor on day D1 and D2 (GP-GP); G-CSF and plerixafor on D1 and G-CSF on D2 (GP-G); chemotherapy and G-CSF on D1 and D2 (GC-GC); and chemotherapy, G-CSF, and plerixafor on D1 and D2 (GCP-GCP). Patient's pre-collection CD34 count (pre-CD34) on D1 and D2 were compared in the same individual and among groups. RESULTS We found D2 pre-CD34 were significantly decreased in G-G, GP-G, and GP-GP groups and significantly increased in G-GP group (p < .001) using a repeated measures ANOVA analysis. D2 pre-CD34 remained at similar levels as D1 in GC-GC and GCP-GCP groups. A multiple regression analysis showed that the mobilization regimen was the only factor that significantly affected pre-CD34 D2/D1 ratio (p < .001). There was a significant difference in the pre-CD34 D2/D1 ratio (p < .001) among these six groups with the lowest in GP-G group (0.40 ± 0.45), and the highest in G-GP group (2.35 ± 0.36). DISCUSSION Mobilization regimen has significant impact on pre-collection CD34 count. Apheresis facilities may change mobilizing drugs accordingly to achieve a specific HPC goal.
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Affiliation(s)
- Irmeen Siddiqui
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Aaron Shmookler
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Elizabeth Biller
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Tanner Hardy
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Ramon Hartage
- Department of Pathology, Ohio State University, Columbus, Ohio, USA
| | - Michael Losos
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Jian Chen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
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5
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Development of a quantitative prediction model for peripheral blood stem cell collection yield in the plerixafor era. Cytotherapy 2021; 24:49-58. [PMID: 34654641 DOI: 10.1016/j.jcyt.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/31/2021] [Accepted: 09/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AIMS Predicting autologous peripheral blood stem cell (PBSC) collection yield before leukapheresis is important for optimizing PBSC mobilization and autologous stem cell transplantation (ASCT) for treating hematological malignancies. Although guidelines for plerixafor usage based on peripheral blood CD34+ (PB-CD34+) cell count are available, their predictive performance in the real world remains unclear. METHODS This study retrospectively analyzed 55 mobilization procedures for patients with non-Hodgkin lymphoma or multiple myeloma and developed a novel quantitative prediction model for CD34+ cell collection yield that incorporated four clinical parameters available the day before leukapheresis; namely, PB-CD34+ cell count the day before apheresis (day -1 PB-CD34+), number of prior chemotherapy regimens, disease status at apheresis and mobilization protocol. RESULTS The effects of PB-CD34+ cell counts on CD34+ cell collection yield varied widely per patient characteristics, and plerixafor usage was recommended in patients with poorly controlled disease or those with a history of heavy pre-treatments even with abundant day -1 PB-CD34+ cell count. This model suggested a more proactive use of plerixafor than that recommended by the guidelines for patients with poor pre-collection condition or those with a higher target number of CD34+ cells. Further, the authors analyzed the clinical outcomes of ASCT and found that plerixafor use for stem cell mobilization did not affect short- or long-term outcomes after ASCT. CONCLUSIONS Although external validations are necessary, the results can be beneficial for establishing more effective and safer mobilization strategies.
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6
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Antelo ML, Altuna A, Gimeno JJ, Ferreiro JJ, Amunárriz C, Mateos JJ, Zalba S, Alkorta A, Rifón J, Arroyo JL, Uresandi A, Moreno JA, Nájera MJ, Pinzón S, García A, Vallejo JC. Engraftment after autologous hematopoietic stem cell transplantation in patients mobilized with Plerixafor: A retrospective, multicenter study of a large series of patients. Transfus Apher Sci 2021; 60:103130. [PMID: 33840626 DOI: 10.1016/j.transci.2021.103130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
Plerixafor (PLX) appears to effectively enhance hematopoietic stem-cell mobilization prior to autologous hematopoietic stem cell transplantation (auto-HCT). However, the quality of engraftment following auto-HCT has been little explored. Here, engraftment following auto-HCT was assessed in patients mobilized with PLX through a retrospective, multicenter study of 285 consecutive patients. Information on early and 100-day post-transplant engraftment was gathered from the 245 patients that underwent auto-HCT. The median number of PLX days to reach the stem cell collection goal (≥2 × 106 CD34+ cells/kg) was 1 (range 1-4) and the median PLX administration time before apheresis was 11 h (range 1-18). The median number of apheresis sessions to achieve the collection goal was 2 (range 1-5) and the mean number of CD34+ cells collected was 2.95 × 106/kg (range 0-30.5). PLX administration was safe, with only 2 mild and transient gastrointestinal adverse events reported. The median time to achieve an absolute neutrophil count (ANC) >500/μL was 11 days (range 3-31) and the median time to platelet recovery >20 × 103/μL was 13 days (range 5-69). At 100 days after auto-HCT, the platelet count was 137 × 109/L (range 7-340), the ANC was 2.3 × 109/L (range 0.1-13.0), and the hemoglobin concentration was 123 g/L (range 79-165). PLX use allowed auto-HCT to be performed in a high percentage of poorly mobilized patients, resulting in optimal medium-term engraftment in the majority of patients in whom mobilization failed, in this case mainly due to suboptimal peripheral blood CD34+ cell concentration on day +4 or low CD34+ cell yield on apheresis.
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Affiliation(s)
- M Luisa Antelo
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Ane Altuna
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - J José Gimeno
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Javier Ferreiro
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - Cristina Amunárriz
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - J José Mateos
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - Saioa Zalba
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Aitziber Alkorta
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - José Rifón
- Servicio de Hematología, Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain.
| | - J Luis Arroyo
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Amaia Uresandi
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - J Antonio Moreno
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M Josefa Nájera
- Servicio de Hematología, Hospital San Pedro, Logroño, Spain.
| | - Sergio Pinzón
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Alejandro García
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Carlos Vallejo
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
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7
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Badarkhe G, Naik R. The Efficacy and Safety of Plerixafor in Hematopoietic Stem Cell Mobilization in Patients with Non-Hodgkin Lymphoma, Multiple Myeloma, and Hodgkin Lymphoma Who Failed Mobilization with Granulocyte-Colony-Stimulating Factor Alone: A Single-Center Experience. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_154_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractPlerixafor is a CXCR4 antagonist which is administered along with granulocyte-colony-stimulating factor (G-CSF) to mobilize hematopoietic stem cells in patients with Non-Hodgkin lymphoma (NHL) or multiple myeloma (MM), who failed the mobilization with G-CSF alone.This was a single-center, retrospective study of the efficacy of the plerixafor and G-CSF in 32 patients with NHL (n = 11), MM (n = 11), and Hodgkin lymphoma (HL) (n = 10) who failed mobilization with G-CSF alone.A median number of 1.21 × 106, 1.32 × 106, and 6.73 × 106 CD34 + cells were mobilized in patients with MM, NHL, and HL, respectively. Overall, 31 (96.8%) patients mobilized more than 2 × 106 CD34 + stem cells and 21 (33.75%) patients mobilized more than 5 × 106 CD34 + stem cells. All 32 (100%) patients underwent hematopoietic stem cell transplantation. There were no adverse drug events reported.This retrospective study shows that plerixafor is an effective and safe mobilization agent in patients with NHL, MM, and HL who have failed mobilization with G-CSF alone.
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8
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Shah H, Kim S, Singh P, Alavi A, Ratanatharathorn V, Ayash L, Uberti J, Deol A. Clinical outcomes of multiple myeloma patients who undergo autologous hematopoietic stem cell transplant with G-CSF or G-CSF and plerixafor mobilized grafts. Am J Hematol 2020; 95:198-204. [PMID: 31691333 DOI: 10.1002/ajh.25672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/27/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022]
Abstract
Impact of Plerixafor (P) mobilized stem cells on immune reconstitution, such as absolute lymphocyte count at day 30 (ALC30), and on long-term outcomes of Multiple Myeloma (MM) patients undergoing autologous stem cell transplant (ASCT) has not been well established. We evaluated total of 469 patients mobilized with G-CSF (G) alone, and 141 patients mobilized with G-CSF plus plerixafor (G+ P). Patients only received plerixafor if they had peripheral blood CD34+ blood count <20/μL on first planned day of collection. Primary endpoint, ALC30, was 1.3 K/μL (range, 0.1-4.5) and 1.2 K/μL (range, 0.1-5.1) for G and G + P, respectively (P =. 61). The median PFS was 2.5 years (95% CI, 2.1-3.2) and 2.8 years (95% CI, 2.0-3.3) for G and G + P, respectively (HR: 1.13; 95% CI, 0.84-1.50; P = .42). The median OS was 6.1 years (95% CI, 4.6-NR) for G group compared to 3.7 years (95% CI, 3.2-NR) for the G + P group (HR: 1.64; 95% CI, 1.12-2.40; P = .01). The median follow-up time for OS was 2.53 years (95% CI, 2.13-2.99) and 1.59 years (95% CI, 1.17-2.02) for G and G+ P group, respectively. In this large retrospective analysis of MM patients mobilized with G-CSF vs G-CSF + P, there was no significant difference in lymphocyte recovery or PFS. There was an overall survival difference in patients who were poor mobilizers and could not be mobilized with G-CSF alone.
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Affiliation(s)
- Harsh Shah
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
| | - Seongho Kim
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
| | - Paramveer Singh
- Department of Internal MedicineDetroit Medical Center Sinai Grace Hospital Detroit Michigan
| | - Asif Alavi
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
| | | | - Lois Ayash
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
| | - Joseph Uberti
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
| | - Abhinav Deol
- Department of OncologyWayne State University/Karmanos Cancer Institute Detroit Michigan
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9
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Jantunen E, Varmavuo V, Pelkonen J, Valtola J. Importance of early immune recovery after autologous hematopoietic cell transplantation in lymphoma patients. Leuk Lymphoma 2019; 60:2115-2121. [PMID: 30843749 DOI: 10.1080/10428194.2019.1581929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lymphomas constitute the second most common indication for autologous hematopoietic cell transplantation (AHCT). Graft infusion is followed by a rapid hematological recovery and slower immune recovery. The number of natural killer cells and CD3+ T lymphocytes achieve normal counts usually within a month, whereas the recovery of CD3+CD4+ T lymphocytes is much slower. Early immune recovery is usually defined as the absolute lymphocyte count (ALC) ≥0.5 × 109/L, which has been associated with improved progression-free and even overall survival. Several factors have been associated with early immune recovery, including higher infused lymphocyte and CD34+ cell doses, both of which are affected by the choice of mobilization. This review summarizes the clinical importance of early immune recovery for long-term success of AHCT in lymphomas. Factors known to affect early immune recovery are discussed and suggestions made how to improve mobilization and collection processes to optimize immune recovery and post-transplant outcomes.
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Affiliation(s)
- Esa Jantunen
- Insitute of Clinical Medicine/Internal Medicine, University of Eastern Finland , Kuopio , Finland.,Department of Medicine, Kuopio University Hospital , Kuopio , Finland.,Siunsote - North Carelia Hospital District , Joensuu , Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital , Kotka , Finland
| | - Jukka Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland , Kuopio , Finland.,Laboratory Centre of Eastern Finland, Kuopio , Kuopio , Finland
| | - Jaakko Valtola
- Department of Medicine, Kuopio University Hospital , Kuopio , Finland
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10
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Valtola J, Silvennoinen R, Ropponen A, Siitonen T, Säily M, Sankelo M, Putkonen M, Partanen A, Pyörälä M, Savolainen ER, Mäntymaa P, Pelkonen J, Jantunen E, Varmavuo V. Blood graft composition and post-transplant recovery in myeloma patients mobilized with plerixafor: a prospective multicenter study. Leuk Lymphoma 2018; 60:453-461. [PMID: 30160591 DOI: 10.1080/10428194.2018.1485911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The composition of autologous blood grafts after cryopreservation, post-transplant hematological recovery up to 1 year and immune recovery up to 6 months as well as outcome was analyzed in 87 patients with multiple myeloma (MM). The patients receiving added plerixafor due to poor mobilization (11%) were compared to those mobilized with G-CSF or cyclophosphamide (CY) plus G-CSF. The use of plerixafor was found to significantly affect the graft composition as there was a significantly higher proportion of the more primitive CD34+ cells, higher number of T and B lymphocytes as well as NK cells in the grafts of patients who received also plerixafor. The hematological recovery after auto-SCT was comparable between the groups. The recovery of CD3+CD4+ T cells was faster in plerixafor mobilized patients at 1 and 3 months post-transplant. There were no significant differences in progression-free (PFS) or overall survival (OS) according to the plerixafor use.
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Affiliation(s)
- Jaakko Valtola
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Raija Silvennoinen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.,b Division of Hematology , Comprehensive Cancer Center Helsinki University Hospital , Helsinki , Finland
| | - Antti Ropponen
- c Department of Clinical Microbiology , University of Eastern Finland , Kuopio , Finland
| | - Timo Siitonen
- d Department of Medicine , Oulu University Hospital , Oulu , Finland
| | - Marjaana Säily
- d Department of Medicine , Oulu University Hospital , Oulu , Finland
| | - Marja Sankelo
- e Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Mervi Putkonen
- f Department of Medicine , Turku University Hospital , Turku , Finland
| | - Anu Partanen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Marja Pyörälä
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Eeva-Riitta Savolainen
- g Nordlab Oulu, Medical Research Center Oulu , Oulu University Hospital University of Oulu , Oulu , Finland
| | | | - Jukka Pelkonen
- c Department of Clinical Microbiology , University of Eastern Finland , Kuopio , Finland.,h Laboratory Centre of Eastern Finland , Kuopio , Finland
| | - Esa Jantunen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.,i Institute of Clinical Medicine , University of Eastern Finland , Kuopio , Finland.,j Siunsote, Central Hospital of North Karelia , Joensuu , Finland
| | - Ville Varmavuo
- k Department of Medicine , Kymenlaakso Central Hospital , Kotka , Finland
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11
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Micallef IN, Stiff PJ, Nademanee AP, Maziarz RT, Horwitz ME, Stadtmauer EA, Kaufman JL, McCarty JM, Vargo R, Cheverton PD, Struijs M, Bolwell B, DiPersio JF. Plerixafor Plus Granulocyte Colony-Stimulating Factor for Patients with Non-Hodgkin Lymphoma and Multiple Myeloma: Long-Term Follow-Up Report. Biol Blood Marrow Transplant 2018; 24:1187-1195. [PMID: 29410180 DOI: 10.1016/j.bbmt.2018.01.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/26/2018] [Indexed: 12/22/2022]
Abstract
The purpose of this report is to analyze long-term clinical outcomes of patients exposed to plerixafor plus granulocyte colony-stimulating factor (G-CSF) for stem cell mobilization. This was a study of patients with non-Hodgkin lymphoma (NHL; n = 167) and multiple myeloma (MM; n = 163) who were enrolled in the long-term follow-up of 2 pivotal phase III studies (NCT00741325 and NCT00741780) of 240 µg/kg plerixafor plus 10 µg/kg G-CSF, or placebo plus 10 µg/kg G-CSF to mobilize and collect CD34+ cells for autologous hematopoietic stem cell transplantation. Overall survival (OS) and progression-free survival (PFS) were evaluated over a 5-year period following the first dose of plerixafor or placebo. The probability of OS was not significantly different in patients with NHL or MM treated with plerixafor or placebo (NHL: 64%; 95% confidence interval [CI], 56% to 71% versus 56%; 95% CI, 44% to 67%, respectively; MM: 64%; 95% CI, 54% to 72% versus 64%; 95% CI, 53% to 73%, respectively). In addition, there was no statistically significant difference in the probability of PFS over 5 years between treatment groups in patients with NHL (50%; 95% CI, 44% to 67% for plerixafor versus 43%; 95% CI, 31% to 54% for placebo) or those with MM (17%; 95% CI, 10% to 24% for plerixafor versus 30%; 95% CI, 21% to 40% for placebo). In this long-term follow-up study, the addition of plerixafor to G-CSF for stem cell mobilization did not affect 5-year survival in patients with NHL or patients with MM.
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Affiliation(s)
| | - Patrick J Stiff
- Division of Hematology/Oncology, Loyola University, Chicago, Illinois
| | | | - Richard T Maziarz
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Mitchell E Horwitz
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina
| | - Edward A Stadtmauer
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan L Kaufman
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - John M McCarty
- Department of Internal Medicine, Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
| | | | | | | | - Brian Bolwell
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - John F DiPersio
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
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12
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Impact of Single-Dose Plerixafor as an Adjunct to Granulocyte Colony-Stimulating Factor-Based Peripheral Blood Stem Cell Mobilization on the Graft Composition and Outcome for T Cell-Replete Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplantation Cyclophosphamide: A Comparative Study. Biol Blood Marrow Transplant 2017; 24:542-548. [PMID: 29191663 DOI: 10.1016/j.bbmt.2017.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/12/2017] [Indexed: 11/23/2022]
Abstract
We conducted a prospective study on T and natural killer (NK) cell subset composition of graft and transplant outcomes in T cell-replete haploidentical transplantation with a single dose of subcutaneous plerixafor (Px) added to granulocyte colony-stimulating factor (G-CSF)-based mobilization in allogeneic donors to collect 10 × 106/kg CD34+ hematopoietic stem cells (HSCs) at single apheresis. Twnety-six donors received G-CSF + Px and 25 G-CSF alone for mobilization. Despite significantly lower peripheral blood (PB) CD34+ HSCs on day 4 in the G-CSF + Px group (33 [range, 6-47] cells/µL versus 81 [range, 50-168] cells/µL in the G-CSF group; P = .0001), PB CD34+ HSC count (median 136 versus 139 cells/µL) on day 5 as well as that in the graft (2.7 versus 2.3 × 106/mL, P = .1) were comparable between the 2 groups. The total nucleated cell count was higher (3.4 versus 3.1 × 108/mL, P = .05), but CD4+ T cells (2.3 versus 2.7 × 107/mL, P = .09) were lower in the G-CSF group with mobilization of regulatory T cells being similar. NK cells were skewed toward the CD56+/16- subset in both groups, varying significantly from the steady-state NK subset ratio in PB. The time to engraftment, incidences of acute and chronic graft-versus-host disease, nonrelapse mortality, and overall survival were also similar. Addition of single-dose Px to G-CSF mobilization improves CD34 recovery and does not significantly alter the T and NK cell composition of the graft, including regulatory T cells, with no adverse impact on transplant outcomes.
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13
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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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14
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Yuan S, Palmer JM, Tsai NC, Dagis A, Nademanee A, Wang S. Engraftment and outcomes following autologous stem cell transplantation in Hodgkin lymphoma patients mobilized with plerixafor. Hematol Oncol 2016; 35:281-287. [DOI: 10.1002/hon.2286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 01/28/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte CA USA
| | - Joycelynne M. Palmer
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Ni-Chun Tsai
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Andrew Dagis
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Auayporn Nademanee
- Department of Hematology; City of Hope National Medical Center; Duarte CA USA
| | - Shirong Wang
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte CA USA
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15
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Valtola J, Varmavuo V, Ropponen A, Selander T, Kuittinen O, Kuitunen H, Keskinen L, Vasala K, Nousiainen T, Mäntymaa P, Pelkonen J, Jantunen E. Early immune recovery after autologous transplantation in non-Hodgkin lymphoma patients: predictive factors and clinical significance. Leuk Lymphoma 2016; 57:2025-32. [DOI: 10.3109/10428194.2015.1129537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Wang YT, Zhao XY, Zhao XS, Xu LP, Zhang XH, Wang Y, Liu KY, Chang YJ, Huang XJ. The impact of donor characteristics on the immune cell composition of mixture allografts of granulocyte-colony-stimulating factor-mobilized marrow harvests and peripheral blood harvests. Transfusion 2015; 55:2874-81. [PMID: 26261077 DOI: 10.1111/trf.13251] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association of donor characteristics with immune cell composition in allografts remains poorly understood. In this retrospective study, the effects of donor characteristics on immune cell composition in allografts were investigated. STUDY DESIGN AND METHODS The correlations of donor characteristics with the immune cell composition in mixture allografts of granulocyte-colony-stimulating factor-mobilized marrow harvests and peripheral blood harvests of 390 healthy donors (male, 240; female, 150; median age, 40 years old) were analyzed. RESULTS The median doses of CD3+ T cells, CD4+ T cells, CD8+ T cells, CD3+CD4-CD8- T cells, and monocytes in mixture allografts were 160.57 × 10(6), 89.29 × 10(6), 56.16 × 10(6), 10.87 × 10(6), and 137.94 × 10(6)/kg, respectively. Multivariate analysis showed that younger donor age was associated with a higher dose of CD3+ T cells (p = 0.006), CD3+CD8+ T cells (p < 0.001), CD3+CD4-CD8- T cells (p = 0.004), and monocytes (p = 0.014), as well as a higher ratio of CD3+CD4-CD8- T cells/CD3+ T cells (p < 0.001) in the mixture allografts. A negative association of donor weight with CD3+ T cells (p < 0.001), CD4+ T cells (p = 0.002), CD8+ T cells (p < 0.001), and CD3+CD4-CD8- T cells (p = 0.044) was observed. The count of peripheral blood lymphocyte pre-peripheral blood apheresis was correlated with the yield of CD3+ T cells (p < 0.001) and CD4+ T cells (p = 0.001). The peripheral blood monocyte count before marrow harvest predicted the monocyte dose (p = 0.002). CONCLUSION The results suggested that older and overweight donors should not be chosen. The monocyte and lymphocyte counts before harvest could predict the yield of immune cells in allografts.
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Affiliation(s)
- Yu-Tong Wang
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Xiang-Yu Zhao
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Xiao-Su Zhao
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology.,Collabrative Innovation Center of Hematology, Peking University
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology.,Collabrative Innovation Center of Hematology, Peking University.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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17
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Strobel J, Moellmer I, Zingsem J, Hauck-Dlimi B, Eckstein R, Strasser E. T-cell subsets in autologous and allogeneic peripheral blood stem cell concentrates. Vox Sang 2015; 109:375-86. [PMID: 26040970 DOI: 10.1111/vox.12289] [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: 10/20/2014] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Regulatory T cells (Tregs) and other T-cell subsets are of importance in the setting of autologous and allogeneic stem cell transplantations. We conducted a study to assess the content of peripheral blood stem cell concentrates and related apheresis parameters in the autologous and allogeneic setting. MATERIAL AND METHODS We characterized 53 donors, patients and peripheral blood stem cell concentrates (PBSC) regarding the content of CD45(+) cells, lymphocytes, CD3(+) cells, CD3(+) CD4(+) T cells, CD3(+) CD4(+) CD25(+) T cells, CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs and CD34(+) cells and calculated cell yields, recruitment factors and collection efficiency for all cell types. We compared allogeneic data with autologous data. RESULTS Autologous PBSC show significantly lower concentrations of T-cell subsets compared to allogeneic PBSC (17,112/μl CD4(+), 14,858/μl CD4(+) CD25(+) and 1579/μl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in autologous compared to 65,539/μl CD4(+), 44,208(+) /μl CD4(+) CD25(+) and 5040/μl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in allogeneic PBSC, respectively), in contrast to CD34(+) concentrations (5342/μl CD34(+) in autologous compared to 2367/μl CD34(+) in allogeneic PBSC, respectively). Accordantly, all T-cell yields are lower in the autologous setting compared to allogeneic PBSC. However, recruitment factor and collection efficiency of all cell types are higher in autologous compared to allogeneic PBSC, but not all parameters differ significantly when groups are compared. CONCLUSION T-cell subsets and especially Tregs are a substantial part of PBSC transplantation, as considerable recruitment during apheresis occurs. In large volume apheresis, the collection efficiency of Treg is comparable to that of CD34(+) cells, while recruitment factors are even higher.
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Affiliation(s)
- J Strobel
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - I Moellmer
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - J Zingsem
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - B Hauck-Dlimi
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - R Eckstein
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - E Strasser
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
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18
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Valtola J, Varmavuo V, Ropponen A, Nihtinen A, Partanen A, Vasala K, Lehtonen P, Penttilä K, Pyörälä M, Kuittinen T, Silvennoinen R, Nousiainen T, Pelkonen J, Mäntymaa P, Jantunen E. Blood graft cellular composition and posttransplant recovery in non-Hodgkin's lymphoma patients mobilized with or without plerixafor: a prospective comparison. Transfusion 2015; 55:2358-68. [DOI: 10.1111/trf.13170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Antti Ropponen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
| | - Anne Nihtinen
- Department of Medicine; Central Hospital of Northern Carelia; Joensuu Finland
| | - Anu Partanen
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
| | - Kaija Vasala
- Department of Oncology; Central Hospital of Central Finland; Jyväskylä Finland
| | - Päivi Lehtonen
- Department of Medicine; Central Hospital of South Carelia; Lappeenranta Finland
| | - Karri Penttilä
- Department of Medicine; Savonlinna Central Hospital; Savonlinna Finland
- Finnish Medicines Agency
| | | | | | | | | | - Jukka Pelkonen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
- Laboratory of Eastern Finland
| | | | - Esa Jantunen
- Department of Medicine; Kuopio University Hospital
- University of Eastern Finland/Clinical Medicine; Kuopio Finland
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19
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Saraceni F, Shem-Tov N, Olivieri A, Nagler A. Mobilized peripheral blood grafts include more than hematopoietic stem cells: the immunological perspective. Bone Marrow Transplant 2015; 50:886-91. [PMID: 25665044 DOI: 10.1038/bmt.2014.330] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 01/20/2023]
Abstract
Although stem cell mobilization has been performed for more than 20 years, little is known about the effects of mobilizing agents on apheresis composition and the impact of graft cell subsets on patients' outcome. With the increasing use of plerixafor and the inclusion of poor mobilizers in autologous transplant procedures, new parameters other than CD34(+) stem cell dose are emerging; plerixafor seems to mobilize more primitive CD34(+)/CD38(-) stem cells compared with G-CSF, but their correlation with stable hematopoietic engraftment is still obscure. Immune recovery is as crucial as hematopoietic reconstitution, and higher T and natural killer cells infused within the graft have been correlated with better outcome in autologous transplant; recent studies showed increased mobilization of immune effectors with plerixafor compared with G-CSF, but further data are needed to clarify the clinical impact of these findings. In the allogeneic setting, much evidence suggests that mobilized T-cell alloreactivity is tempered by G-CSF, probably with the mediation of dendritic cells, even though no clear correlation with GVL and GVHD has been found. Plerixafor is not approved in healthy donors yet; early data suggest it might mobilize a GVHD protective balance of immune effectors, but further studies are needed to define its role in allogeneic transplant.
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Affiliation(s)
- F Saraceni
- 1] Department of Hematology and Bone Marrow Transplantation, Ospedali Riuniti, Ancona, Italy [2] Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Shem-Tov
- Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Olivieri
- Department of Hematology and Bone Marrow Transplantation, Ospedali Riuniti, Ancona, Italy
| | - A Nagler
- Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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20
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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: 133] [Impact Index Per Article: 13.3] [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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21
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Jantunen E, Varmavuo V. Plerixafor for mobilization of blood stem cells in autologous transplantation: an update. Expert Opin Biol Ther 2014; 14:851-61. [PMID: 24673120 DOI: 10.1517/14712598.2014.902927] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION About 99% of all autologous transplants are now performed with blood stem cells. G-CSF alone or combined with chemotherapy have been used to mobilize CD34(+) cells. Plerixafor is a novel drug used for mobilization purposes. AREAS COVERED We have evaluated recent data in regard to plerixafor use in predicted or proven poor mobilizers. In addition, we have looked for preemptive strategies to optimize the use of this expensive drug. Also cost-efficacy issues and effects of plerixafor on graft composition and post-transplant outcomes will be discussed. EXPERT OPINION Plerixafor added to G-CSF is superior than G-CSF alone for mobilization of CD34(+) cells. This combination is also efficient in patients who have failed a previous mobilization attempt with other methods or in patients with risk factors for poor mobilization. Addition of plerixafor to G-CSF or chemotherapy plus G-CSF mobilization in patients who appear to mobilize poorly is under active investigation and algorithms for a preemptive use of this expensive agent have been proposed. Grafts collected after plerixafor appear to contain more lymphoid cells than the grafts collected without it. Whether this affects post-transplant outcomes such as immune reconstitution and risk of relapse needs to be evaluated.
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Affiliation(s)
- Esa Jantunen
- University of Eastern Finland, Clinical Medicine , Kuopio , Finland
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22
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Gaugler B, Arbez J, Legouill S, Tiberghien P, Moreau P, Derenne S, Saas P, Mohty M. Characterization of peripheral blood stem cell grafts mobilized by granulocyte colony-stimulating factor and plerixafor compared with granulocyte colony-stimulating factor alone. Cytotherapy 2013; 15:861-8. [PMID: 23731764 DOI: 10.1016/j.jcyt.2013.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/10/2013] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AIMS This study aimed to characterize the immune effectors contained in apheresis samples obtained from patients with grafts mobilized with plerixafor and granulocyte colony-stimulating factor (G-CSF) (P+G) compared with grafts mobilized with G-CSF alone (G). METHODS Aliquots of apheresis samples were obtained from 36 patients with malignant diseases after mobilization with G (n = 18) or P+G (n = 18). The phenotype and cytokine secretion profile of T cell and dendritic cell subsets were characterized by multicolor cytometry including intracellular cytokine staining. RESULTS In grafts collected after mobilization with P+G, there was a significantly higher percentage of CD3(+) T cells compared with samples collected after mobilization with G alone. On a functional level, a significant increase of interferon-γ and tumor necrosis factor-α secreting CD8(+) T cells was observed in the P+G group compared with the G group. CD4(+)Foxp3(+) regulatory T cells were similar in both groups but exhibited a lower expression of inducible costimulatory molecule and a significantly higher expression of CD127 in the P+G group. Myeloid dendritic cells (MDCs) and BDCA3(+) dendritic cells were similar in both groups. In contrast, plasmacytoid dendritic cells (PDCs) (CD123(+)BDCA2(+)HLA-DR(+)) were significantly increased in the P+G grafts, leading to a higher PDC-to-MDC ratio. PDCs mobilized by P+G displayed different functional markers--a higher percentage of ILT7(+) PDCs and decreased expression of CD86--suggesting a potential regulatory capacity of PDCs mobilized by P+G. CONCLUSIONS Grafts mobilized with P+G exhibited major different functional features compared with grafts mobilized with G alone, suggesting that such grafts may have an impact on patient outcome after autologous stem cell transplantation.
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Sheng L, Fu S, Hu Y, Fu H, Huang H. Rapid mobilization of fully functional natural killer cells into blood by AMD3100. Transfusion 2013; 53:2108-10. [PMID: 24015944 DOI: 10.1111/trf.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lixia Sheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province; Department of Haematology, Ningbo no. 1 Hospital, Ningbo, Zhejiang Province, China.
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Giralt S, Costa L, Schriber J, Dipersio J, Maziarz R, McCarty J, Shaughnessy P, Snyder E, Bensinger W, Copelan E, Hosing C, Negrin R, Petersen FB, Rondelli D, Soiffer R, Leather H, Pazzalia A, Devine S. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant 2013; 20:295-308. [PMID: 24141007 DOI: 10.1016/j.bbmt.2013.10.013] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) is a well-established treatment for malignancies such as multiple myeloma (MM) and lymphomas. Various changes in the field over the past decade, including the frequent use of tandem aHSCT in MM, the advent of novel therapies for the treatment of MM and lymphoma, and the addition of new stem cell mobilization techniques, have led to the need to reassess current stem cell mobilization strategies. Mobilization failures with traditional strategies are common and result in delays in treatment and increased cost and resource utilization. Recently, plerixafor-containing strategies have been shown to significantly reduce mobilization failure rates, but the ideal method to maximize stem cell yields and minimize costs associated with collection has not yet been determined. A panel of experts convened to discuss the currently available data on autologous hematopoietic stem cell mobilization and transplantation and to devise guidelines to optimize mobilization strategies. Herein is a summary of their discussion and consensus.
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Affiliation(s)
- Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Luciano Costa
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - John Dipersio
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - John McCarty
- Adult Bone Marrow Transplant, Virginia Commonwealth University, Richmond, Virginia
| | - Paul Shaughnessy
- Adult Bone Marrow Transplant, Texas Transplant Institute, San Antonio, Texas
| | - Edward Snyder
- Yale University Medical School, New Haven, Connecticut
| | | | - Edward Copelan
- Levine Cancer Institute I, Carolinas HealthCare System, Charlotte, North Carolina
| | | | | | - Finn Bo Petersen
- Intermountain Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Damiano Rondelli
- Section of Hematology/Oncology, University of Illinois at Chicago Cancer Center, Chicago, Illinois
| | - Robert Soiffer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Amy Pazzalia
- Adult Bone Marrow Transplant, University of Florida, Gainesville, Florida
| | - Steven Devine
- Department of Internal Medicine/Hematology/Oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Varmavuo V, Rimpiläinen J, Kuitunen H, Nihtinen A, Vasala K, Mikkola M, Kutila A, Lehtonen P, Kuittinen T, Mäntymaa P, Nousiainen T, Kuittinen O, Jantunen E. Engraftment and outcome after autologous stem cell transplantation in plerixafor-mobilized non-Hodgkin's lymphoma patients. Transfusion 2013; 54:1243-50. [DOI: 10.1111/trf.12434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ville Varmavuo
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Johanna Rimpiläinen
- Department of Medicine; Tampere University Hospital; Tampere Finland
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Hanne Kuitunen
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Anne Nihtinen
- Department of Medicine; North Karelia Central Hospital; Joensuu Finland
| | - Kaija Vasala
- Department of Oncology; Central Finland Central Hospital; Jyväskylä Finland
| | - Maija Mikkola
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
- Department of Medicine; Päijät-Häme Central Hospital; Lahti Finland
| | - Anu Kutila
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
| | - Päivi Lehtonen
- Department of Medicine; Savonlinna Central Hospital; Savonlinna Finland
| | - Taru Kuittinen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | | | - Tapio Nousiainen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Outi Kuittinen
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Esa Jantunen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
- University of Eastern Finland/Clinical Medicine; Kuopio Finland
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Varmavuo V, Mäntymaa P, Silvennoinen R, Nousiainen T, Kuittinen T, Jantunen E. CD34+ cell subclasses and lymphocyte subsets in blood grafts collected after various mobilization methods in myeloma patients. Transfusion 2012; 53:1024-32. [PMID: 22897584 DOI: 10.1111/j.1537-2995.2012.03848.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Cyclophosphamide (CY) combined with granulocyte-colony-stimulating factor (G-CSF) is commonly used to mobilize stem cells in multiple myeloma (MM). Plerixafor may also be used with G-CSF in patients who mobilize poorly or it may be added to chemomobilization to boost mobilization. Limited data are available on graft content collected after various mobilization methods. STUDY DESIGN AND METHODS Blood grafts collected from 21 MM patients were retrospectively analyzed. We analyzed CD34+ subclasses and lymphocyte subsets from cryopreserved grafts collected on the next morning after plerixafor injection in nine MM patients mobilized with G-CSF with (n = 5) or without preceding CY (n = 4). As controls we had the first collections from 12 MM patients mobilized with low-dose CY with G-CSF. RESULTS The proportion of the most primitive stem cells (CD34+CD133+CD38-) from all CD34+ cells in the graft was higher in the plerixafor-treated patients but there was no significant difference in the total number of these cells. The numbers of CD19+ B lymphocytes and natural killer cells were higher in patients collected after G-CSF plus plerixafor when compared to the patients mobilized with CY plus G-CSF. Early engraftment after high-dose melphalan was comparable between the groups. CONCLUSION Plerixafor appears to have effects on blood stem cell graft composition in myeloma patients. A higher number of grafts should be evaluated in regard to cellular content and longer follow-up of the patients is needed to evaluate the potential clinical impact of graft content.
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Affiliation(s)
- Ville Varmavuo
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
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Varmavuo V, Mäntymaa P, Kuittinen T, Nousiainen T, Jantunen E. Pre-emptive plerixafor injection increases blood neutrophil, lymphocyte and monocyte counts in addition to CD34+ counts in patients with non-Hodgkin lymphoma mobilizing poorly with chemotherapy plus G-CSF: Potential implications for apheresis and graft composition. Transfus Apher Sci 2012; 46:257-62. [DOI: 10.1016/j.transci.2012.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 01/16/2012] [Accepted: 03/12/2012] [Indexed: 02/07/2023]
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Varmavuo V, Mäntymaa P, Nousiainen T, Valonen P, Kuittinen T, Jantunen E. Blood graft composition after plerixafor injection in patients with NHL. Eur J Haematol 2012; 89:128-35. [PMID: 22536949 DOI: 10.1111/j.1600-0609.2012.01794.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plerixafor is used to mobilize CD34(+) hematopoietic stem cells from bone marrow to circulation. Limited data are available in regard to graft cellular content collected after plerixafor. OBJECTIVES The aim of this study was to assess effects of plerixafor added to chemomobilization on graft CD34(+) cell subclasses, lymphocyte subsets, engraftment, and post-transplant course in non-Hodgkin lymphoma (NHL) patients. METHODS Thirty-four patients with NHL were included. All patients received chemotherapy plus G-CSF to mobilize stem cells. Nineteen patients received plerixafor pre-emptively owing to poor mobilization or poor collection yields. The rest of the patients constituted the control group. Flow cytometric analyzes were performed from cryopreserved graft samples. Also, data on post-transplant engraftment and outcome were collected. RESULTS The proportion of primitive stem cells (CD34(+) CD133(+) CD38(-) ) was significantly higher after the plerixafor injection when compared to the first collection in the control group. The amount of T cells (CD3(+) ), helper (CD3(+) CD4(+) ) T subsets, and suppressor (CD3(+) CD8(+) ) T subsets in the graft was all significantly higher in the plerixafor group. Also, the amount of NK cells (CD3(-) CD16/56(+) ) was higher. Engraftment after high-dose therapy was comparable between the groups, but leukocyte and platelet count at 6 months were higher in patients receiving plerixafor-mobilized grafts. CONCLUSION Plerixafor, when used pre-emptively in addition to chemomobilization, seems to mobilize more primitive CD34(+) stem cells, T lymphocytes, and NK cells. Whether these differences are associated with immune reconstitution, long-term engraftment, or patient outcomes needs to be evaluated in larger patient groups with longer follow-up.
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Affiliation(s)
- Ville Varmavuo
- Department of Medicine, Kuopio University Hospital, Finland
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