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Li Y, Qiu X, Lei Y, Zhou R. G-CSF + plerixafor versus G-CSF alone mobilized hematopoietic stem cells in patients with multiple myeloma and lymphoma: a systematic review and meta-analysis. Ann Med 2024; 56:2329140. [PMID: 38470973 PMCID: PMC10939106 DOI: 10.1080/07853890.2024.2329140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
AIM The combination of granulocyte-colony stimulating factor (G-CSF) and plerixafor is one of the approaches for hematopoietic stem cell mobilization in patients with multiple myeloma (MM), non-Hodgkin's lymphoma (NHL), and Hodgkin's lymphoma (HL). This systematic review and meta-analysis aimed to determine the ability of G-CSF + plerixafor to mobilize peripheral blood (PB) CD34+ cells and examine its safety profile. METHODS We performed a database search using the terms 'granulocyte colony stimulating factor', 'G-CSF', 'AMD3100', and 'plerixafor', published up to May 1, 2023. The methodology is described in further detail in the PROSPERO database (CRD42023425760). RESULTS Twenty-three studies were included in this systematic review and meta-analysis. G-CSF + plerixafor resulted in more patients achieving the predetermined apheresis yield of CD34+ cells than G-CSF alone (OR, 5.33; 95%, 4.34-6.55). It was further discovered that G-CSF + plerixafor could mobilize more CD34+ cells into PB, which was beneficial for the next transplantation in both randomized controlled (MD, 18.30; 95%, 8.74-27.85) and single-arm (MD, 20.67; 95%, 14.34-27.00) trials. Furthermore, G-CSF + plerixafor did not cause more treatment emergent adverse events than G-CSF alone (OR, 1.25; 95%, 0.87-1.80). CONCLUSIONS This study suggests that the combination of G-CSF and plerixafor, resulted in more patients with MM, NHL, and HL, achieving the predetermined apheresis yield of CD34+ cells, which is related to the more effective mobilization of CD34+ cells into PB.
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Affiliation(s)
- Yuyao Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xia Qiu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yupeng Lei
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruixi Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Pınar İE, Özkocaman V, Özkalemkaş F, Durgut H, Dakiki B, Ersal T, Gürsoy V, Yalçın C, Orhan B, Candar Ö, Ali R. Is split-dose better than single-dose? Results of Turkish Stem Cell Coordination Center (TURKOK) donors in the era of rising biosimilar G-CSF. J Clin Apher 2022; 37:430-437. [PMID: 35689647 DOI: 10.1002/jca.21995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Turkish Stem Cell Coordination Center (TURKOK) carries out the procurement process of unrelated allogeneic hematopoietic stem cells in Turkey. This study aims to compare the efficacy of both once-daily and divided-dose G-CSF administration and the original and biosimilar G-CSF use and the frequency and severity of adverse events in TURKOK donors. METHOD The study was conducted retrospectively with 142 healthy TURKOK donors. For PBSC mobilization, two different subcutaneous G-CSF programs were used as 10 μ/kg/day single-dose and 5 μ/kg/12 h. Neupogen (Amgen, Puerto Rico) and Tevagrastim (Teva, Kfar Saba, Israel) were used as G-CSF. All donors started apheresis on the fifth day, and all side effects were recorded during the procedure. RESULTS Stem cell yield was similar between single-dose and divided-doses based on donor weight, favoring the split-dose based on recipient weight (P = .506 and P = .023, respectively). Both G-CSF posologies were comparable if the target CD34+ cell yield was ≥4 × 106 /kg. CD34+ cell yield was equivalent when evaluated against recipient weight, significantly favoring Tevagrastim vs Neupogen by donor weight (P = .740 and P = .021, respectively). Side effects, duration of pain, and need for analgesia favor Tevagratim over Neupogen. CONCLUSION Split-dose may be recommended for cases where the need for large numbers of CD34+ cells to be harvested is anticipated due to significant cell yield relative to recipient weight. However, sufficient hematopoietic stem cells can be collected with both posology. Tevagrastim is non-inferiority effective to Neupogen. Side effects during administration are both low-grade and temporary.
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Affiliation(s)
- İbrahim Ethem Pınar
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Vildan Özkocaman
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fahir Özkalemkaş
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Himmet Durgut
- Republic of Turkey Ministry of Health, Turkish Stem Cell Coordination Center, Ankara, Turkey
| | - Bahar Dakiki
- Department of Internal Medicine, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tuba Ersal
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Vildan Gürsoy
- Department of Internal Medicine, Division of Hematology, Bursa City Hospital, Bursa, Turkey
| | - Cumali Yalçın
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Bedrettin Orhan
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ömer Candar
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Rıdvan Ali
- Department of Internal Medicine, Division of Hematology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
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Luo C, Wu G, Huang X, Zhang Y, Ma Y, Huang Y, Huang Z, Li H, Hou Y, Chen J, Li X, Xu S. Efficacy of hematopoietic stem cell mobilization regimens in patients with hematological malignancies: a systematic review and network meta-analysis of randomized controlled trials. Stem Cell Res Ther 2022; 13:123. [PMID: 35317856 PMCID: PMC8939102 DOI: 10.1186/s13287-022-02802-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/07/2022] [Indexed: 12/18/2022] Open
Abstract
Background Efficient mobilization of hematopoietic stem cells (HSCs) from bone marrow niche into circulation is the key to successful collection and transplantation in patients with hematological malignancies. The efficacy of various HSCs mobilization regimens has been widely investigated, but the results are inconsistent. Methods We performed comprehensive databases searching for eligible randomized controlled trials (RCTs) that comparing the efficacy of HSCs mobilization regimens in patients with hematological malignancies. Bayesian network meta-analyses were performed with WinBUGS. Standard dose of granulocyte colony-stimulating factor (G-CSF SD) was chosen as the common comparator. Estimates of relative treatment effects for other regimens were reported as mean differences (MD) or odds ratio (OR) with associated 95% credibility interval (95% CrI). The surface under the cumulative ranking curve (SUCRA) were obtained to present rank probabilities of all included regimens. Results Databases searching and study selection identified 44 eligible RCTs, of which the mobilization results are summarized. Then we compared the efficacy of mobilization regimens separately for patients with multiple myeloma (MM) and non-Hodgkin lymphoma (NHL) by including 13 eligible trials for network meta-analysis, involving 638 patients with MM and 592 patients with NHL. For patients with MM, data are pooled from 8 trials for 6 regimens, including G-CSF in standard dose (SD) or reduced dose (RD) combined with cyclophosphamide (CY), intermediate-dose cytarabine (ID-AraC) or plerixafor. The results show that compared with G-CSF SD alone, 3 regimens including ID-AraC + G-CSF SD (MD 14.29, 95% CrI 9.99–18.53; SUCRA 1.00), G-CSF SD + Plerixafor SD (MD 4.15, 95% CrI 2.92–5.39; SUCRA 0.80), and CY + G-CSF RD (MD 1.18, 95% CrI 0.29–2.07; SUCRA 0.60) are associated with significantly increased total number of collected CD34+ cells (× 106/kg), among which ID-AraC + G-CSF SD ranked first with a probability of being best regimen of 100%. Moreover, ID-AraC + G-CSF SD and G-CSF SD + Plerixafor SD are associated with significantly higher successful rate of achieving optimal target (collecting ≥ 4–6 × 106 CD34+ cells/kg). For patients with NHL, data are pooled from 5 trials for 4 regimens, the results show that compared with G-CSF SD alone, G-CSF SD + Plerixafor SD (MD 3.62, 95% CrI 2.86–4.38; SUCRA 0.81) and G-CSF SD plus the new CXC chemokine receptor-4 (CXCR-4) antagonist YF-H-2015005 (MD 3.43, 95% CrI 2.51–4.35; SUCRA 0.69) are associated with significantly higher number of total CD34+ cells collected. These 2 regimens are also associated with significantly higher successful rate of achieving optimal target. There are no significant differences in rate of achieving optimal target between G-CSF SD + Plerixafor SD and G-CSF + YF-H-2015005. Conclusions In conclusion, ID-AraC plus G-CSF is associated with the highest probability of being best mobilization regimen in patients with MM. For patients with NHL, G-CSF in combination with plerixafor or YF-H-2015005 showed similar improvements in HSCs mobilization efficacy. The relative effects of other chemotherapy-based mobilization regimens still require to be determined with further investigations. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02802-6.
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Affiliation(s)
- Chengxin Luo
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Guixian Wu
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xiangtao Huang
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Yali Zhang
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Yanni Ma
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Yarui Huang
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Zhen Huang
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Hui Li
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Yu Hou
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Jieping Chen
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China
| | - Xi Li
- Institute of Infectious Disease, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.
| | - Shuangnian Xu
- Center for Hematology, Southwest Hospital, Third Military Medical University, #30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China.
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Ostrovsky O, Beider K, Morgulis Y, Bloom N, Cid-Arregui A, Shimoni A, Vlodavsky I, Nagler A. CMV Seropositive Status Increases Heparanase SNPs Regulatory Activity, Risk of Acute GVHD and Yield of CD34 + Cell Mobilization. Cells 2021; 10:cells10123489. [PMID: 34943994 PMCID: PMC8700738 DOI: 10.3390/cells10123489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Heparanase is an endo-β-glucuronidase that is best known for its pro-cancerous effects but is also implicated in the pathogenesis of various viruses. Activation of heparanase is a common strategy to increase viral spread and trigger the subsequent inflammatory cascade. Using a Single Nucleotide Polymorphisms (SNP)-associated approach we identified enhancer and insulator regions that regulate HPSE expression. Although a role for heparanase in viral infection has been noticed, the impact of HPSE functional SNPs has not been determined. We investigated the effect of cytomegalovirus (CMV) serostatus on the involvement of HPSE enhancer and insulator functional SNPs in the risk of acute graft versus host disease (GVHD) and granulocyte-colony stimulating factor related CD34+ mobilization. A significant correlation between the C alleles of insulator rs4364254 and rs4426765 and CMV seropositivity was found in healthy donors and patients with hematological malignancies. The risk of developing acute GVHD after hematopoietic stem cell transplantation was identified only in CMV-seropositive patients. A significant correlation between the enhancer rs4693608 and insulator rs28649799 and CD34+ cell mobilization was demonstrated in the CMV-seropositive donors. It is thus conceivable that latent CMV infection modulates heparanase regulatory regions and enhances the effect of functional SNPs on heparanase function in normal and pathological processes.
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Affiliation(s)
- Olga Ostrovsky
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
- Correspondence: ; Tel.: +972-3-5305770
| | - Katia Beider
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
| | - Yan Morgulis
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
| | - Nira Bloom
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
| | | | - Avichai Shimoni
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
| | - Israel Vlodavsky
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa 3525433, Israel;
| | - Arnon Nagler
- Chaim Sheba Medical Center, Department of Hematology and Bone Marrow Transplantation, Tel-Hashomer, Ramat Gan 5266202, Israel; (K.B.); (Y.M.); (N.B.); (A.S.); (A.N.)
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The HPSE Gene Insulator-A Novel Regulatory Element That Affects Heparanase Expression, Stem Cell Mobilization, and the Risk of Acute Graft versus Host Disease. Cells 2021; 10:cells10102523. [PMID: 34685503 PMCID: PMC8534152 DOI: 10.3390/cells10102523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/30/2023] Open
Abstract
The HPSE gene encodes heparanase (HPSE), a key player in cancer, inflammation, and autoimmunity. We have previously identified a strong HPSE gene enhancer involved in self-regulation of heparanase by negative feedback exerted in a functional rs4693608 single-nucleotide polymorphism (SNP) dependent manner. In the present study, we analyzed the HPSE gene insulator region, located in intron 9 and containing rs4426765, rs28649799, and rs4364254 SNPs. Our results indicate that this region exhibits HPSE regulatory activity. SNP substitutions lead to modulation of a unique DNA-protein complex that affects insulator activity. Analysis of interactions between enhancer and insulator SNPs revealed that rs4693608 has a major effect on HPSE expression and the risk of post-transplantation acute graft versus host disease (GVHD). The C alleles of insulator SNPs rs4364254 and rs4426765 modify the activity of the HPSE enhancer, resulting in altered HPSE expression and increased risk of acute GVHD. Moreover, rs4426765 correlated with HPSE expression in activated mononuclear cells, as well as with CD3 levels and lymphocyte counts following G-CSF mobilization. rs4363084 and rs28649799 were found to be associated with CD34+ levels. Our study provides new insight into the mechanism of HPSE gene regulation and its impact on normal and pathological processes in the hematopoietic system.
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Sarıcı A, Erkurt MA, Bahçecioğlu ÖF, Biçim S, Berber İ, Gök S, Kaya E, Özgül M, Kuku İ. Lenograstim versus filgrastim in mobilization before autologous hematopoietic stem cell transplantation in patients with multiple myeloma and lymphoma - Single center experience. Transfus Apher Sci 2021; 60:103127. [PMID: 33863669 DOI: 10.1016/j.transci.2021.103127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Peripheral blood stem cell transplantation is frequently used in the treatment of various hematological malignancies after intensive chemotherapy. The primary aim of our study is to compare the amount of collected CD34+ cells and engraftment times in patients mobilized with filgrastim or lenograstim. MATERIAL AND METHODS Demographic and clinical data of multiple myeloma (MM) and lymphoma patients who underwent autologous transplantation and mobilized with G-CSF (filgrastim or lenograstim) without chemotherapy were collected retrospectively. RESULTS One hundred eleven MM and 58 lymphoma patients were included in the study. When mobilization with filgrastim and lenograstim was compared in MM patients, there was no significant difference in neutrophil and thrombocyte engraftment times of lenograstim and filgrastim groups (p = 0.931 p = 0.135, respectively). Similarly, the median number of CD34+ cells collected in patients receiving filgrastim and lenograstim was very similar (4.2 × 106/kg vs 4.3 × 106/kg, p = 0.977). When compared with patients who received lenalidomide before transplantation and patients who did not receive lenalidomide, the CD34+ counts of the two groups were similar. However, neutrophil and platelet engraftment times in the group not receiving lenalidomide tended to be shorter (p = 0.095 and p = 0.12, respectively). When lymphoma patients mobilized with filgrastim and lenograstim were compared, neutrophil engraftment time (p = 0.498), thrombocyte engraftment time (p = 0.184), collected CD34+ cell counts (p = 0.179) and mobilization success (p = 0.161) of the groups mobilized with filgrastim and lenograstim were similar. CONCLUSION The superiority of the two agents to each other could not be demonstrated. Multi-center prospective studies with larger numbers of patients are needed.
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Affiliation(s)
- Ahmet Sarıcı
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - Mehmet Ali Erkurt
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - Ömer Faruk Bahçecioğlu
- Inonu University, Faculty of Pharmacy, Department of Clinical Pharmacy, Malatya, Turkey.
| | - Soykan Biçim
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - İlhami Berber
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - Selim Gök
- Inonu University, Faculty of Pharmacy, Department of Clinical Pharmacy, Malatya, Turkey.
| | - Emin Kaya
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - Mustafa Özgül
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
| | - İrfan Kuku
- İnönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey.
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Restelli U, Croce D, Bonizzoni E, Marzanatti M, Andreini A, Sorio M, Tecchio C, Barison E, Benedetti F. Monocentric Analysis of the Effectiveness and Financial Consequences of the Use of Lenograstim versus Filgrastim for Mobilization of Peripheral Blood Progenitor Cells in Patients with Lymphoma and Myeloma Receiving Chemotherapy and Autologous Stem Cell Transplantation. J Blood Med 2020; 11:123-130. [PMID: 32308515 PMCID: PMC7135199 DOI: 10.2147/jbm.s224173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/09/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Granulocyte-colony stimulating factors (G-CSFs) are widely used to mobilize CD34+ stem cells and to support the engraftment after hematopoietic stem cell transplantation (HSCT). A budget impact analysis and an incremental cost-effectiveness study of two G-CSFs (Lenograstim and Filgrastim biosimilar), considering engraftment, number of hospitalization days and number of G-CSF vials administered were performed. Patients and Methods Between 2009 and 2016, 248 patients undergoing autologous HSCT have been evaluated and divided into three groups (100 Leno-Leno, 93 Leno-Fil, 55 Fil-Fil) according to the type of G-CSF used for hematopoietic stem cell mobilization and hematopoietic stem cell recovery after transplant. Results The following statistically significant differences have been observed between Leno-Leno, Leno-Fil, Fil-Fil groups: a higher number of harvested CD34+ cells (10.56 vs 8.00 vs 7.20; p=0.0003) and a lower number of G-CSF vials (8 vs 8 vs 9; p=0.00020) used for full bone marrow recovery favoring Lenograstim. No statistically significant differences were found regarding the number of G-CSF vials used for mobilization, apheresis number and CD34+ cell peak. The post-transplant hematological recovery was faster in Lenograstim group than Filgrastim group: median time to neutrophil count engraftment (>500/mmc) was 12 vs 13 days; median time for platelets recovery (>20.000/mmc) was 12 vs 15 days (p=0.0001). The use of Lenograstim achieved cost savings of €566/patient over Filgrastim biosimilar, related to a decreased number of days of hospitalization (16 vs 17 days; p=0.00012), a lower overall incidence of adverse events, laboratory tests, transfusions for platelet recovery following discharge. Conclusion In our experience, Lenograstim outperforms Filgrastim in terms of effectiveness and lower cost. This study shows a clinical superiority of Lenograstim over Filgrastim suggesting a potential cost savings favoring Lenograstim.
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Affiliation(s)
- Umberto Restelli
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Center for Health Economics, Social and Health Care Management, LIUC Università Cattaneo, Castellanza, VA, Italy
| | - Davide Croce
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Center for Health Economics, Social and Health Care Management, LIUC Università Cattaneo, Castellanza, VA, Italy
| | - Erminio Bonizzoni
- Section of Medical Statistics and Biometry "GA Maccacaro", Department of Clinica Science and Community, University of Milan, Milan, Italy
| | - Mario Marzanatti
- Section of Medical Statistics and Biometry "GA Maccacaro", Department of Clinica Science and Community, University of Milan, Milan, Italy
| | - Angelo Andreini
- Bone Marrow Transplant Unit- Hematology, University of Verona, Verona, Italy
| | - Marco Sorio
- Bone Marrow Transplant Unit- Hematology, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Bone Marrow Transplant Unit- Hematology, University of Verona, Verona, Italy
| | - Erika Barison
- Bone Marrow Transplant Unit- Hematology, University of Verona, Verona, Italy
| | - Fabio Benedetti
- Bone Marrow Transplant Unit- Hematology, University of Verona, Verona, Italy
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Gascon P, Krendyukov A, Mathieson N, Natek M, Aapro M. Extrapolation in Practice: Lessons from 10 Years with Biosimilar Filgrastim. BioDrugs 2019; 33:635-645. [PMID: 31440986 PMCID: PMC6875156 DOI: 10.1007/s40259-019-00373-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Biosimilar filgrastim (Sandoz) was approved in Europe in 2009 and, in 2015, was the first biosimilar approved in the USA. These authorizations were based on the "totality of evidence" concept, an approach that considers data from structural and functional characterization and comparability analysis and non-clinical and clinical studies. For biosimilar filgrastim, phase III confirmatory clinical studies were performed in the most sensitive population, patients with breast cancer undergoing myelosuppressive chemotherapy. In Europe and the USA, approval was granted for all indications of the reference biologic. Hence, stem cell mobilization and severe chronic neutropenia indications were approved on the basis of extrapolation, with no clinical data available at the time of market authorization in the EU. Although extrapolation is well-accepted in biologic development and regulatory contexts, it remains a misunderstood part of the biosimilarity concept in the medical community. Since approval, more than a decade of obtained clinical experience supports the totality of evidence and reassures clinicians regarding the efficacy and safety of biosimilar filgrastim. This includes real-world data from MONITOR-GCSF, a multicenter, prospective, observational study describing treatment patterns and clinical outcomes of patients with cancer (n = 1447) receiving biosimilar filgrastim for the prophylaxis of chemotherapy-induced neutropenia in solid tumors and hematological malignancies. Evidence is also available from unrelated healthy donors and those with severe chronic neutropenia. Together, the experience from a decade of use of biosimilar filgrastim includes over 24 million patient-days of exposure, which can help reassure oncologists that extrapolation is based on strong scientific evidence and works in practice.
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Affiliation(s)
- Pere Gascon
- Division of Medical Oncology, Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | | | - Matti Aapro
- Cancer Center, Clinique de Genolier, Route du Muids 3, 1272, Genolier, Switzerland.
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9
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Does use of biosimilar G-CSF change plerixafor utilization during stem cell mobilization for autologous stem cell transplant? Bone Marrow Transplant 2019; 55:1655-1657. [PMID: 31740765 DOI: 10.1038/s41409-019-0744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022]
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10
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Wicherska-Pawłowska K, Rybka J, Prajs I, Szmigiel K, Tyc J, Frączak E, Biedroń M, Kalicińska E, Szymczak D, Wróbel T. The comparison of effectiveness and safety between different biosimilars of G-CSF in the mobilization of peripheral blood stem cells (PBSCs) for autologous transplantation (autologous peripheral blood stem cell transplantation, auto-PBSCT). J Clin Apher 2019; 35:4-8. [PMID: 31663634 DOI: 10.1002/jca.21750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 08/17/2019] [Accepted: 09/07/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Autologous peripheral blood marrow stem cell transplantation (auto-PBSCT) preceded by high-dose chemotherapy is a well-known method of treatment for patients with hematological cancers. Performing the procedure entails obtaining from the patient their own stem cells from peripheral blood using G-CSF. Currently, various filgrastim biosimilars are widely used. AIM OF THE STUDY The purpose of this study is to compare the efficacy and safety of three different biosimilars of filgrastim in PBSC mobilization in patients with hematological malignancies. MATERIALS AND METHODS This is a retrospective analysis of 282 patients (118 women and 164 men) who underwent stem cells mobilization for auto-PBSCT in the Department of Hematology in Wroclaw in 2012-2014. Three filgrastim biosimilars were used: Tevagrastim (95), Nivestim (92), and Zarzio (95). Ninety patients (32%) were diagnosed with multiple myeloma, 55 (19%) with Hodgkin's lymphoma, 90 (32%) with NHLs, 20 (7%) with acute myeloid leukemia, and 27 (10%) with another hematological cancer. RESULTS The mean number of CD34+ cells collected during the first leukapheresis was 5.95 × 106 /kg for Tevagrastim, 7.08 × 106 /kg for Nivestim, and 6.8 × 106 /kg for Zarzio (P > .05). The necessary number of leukapheresis for patients receiving Zarzio, Nivestim, and Tevagrastim was 1.32, 1.37, and 1.66, respectively (P > .05). The percentage of effective mobilizations was 88.2% for Zarzio, 86.2% for Nivestim, and 84.9% for Tevagrastim. The side effects included bone pain and headache. CONCLUSION All tested biosimilars demonstrated similar effectiveness and safety profiles in patients with hematological tumors undergoing PBSC mobilization; therefore, they can be used interchangeably.
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Affiliation(s)
- Katarzyna Wicherska-Pawłowska
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Justyna Rybka
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Iwona Prajs
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | | | - Joanna Tyc
- Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
| | - Ewa Frączak
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Monika Biedroń
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Elżbieta Kalicińska
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Donata Szymczak
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland
| | - Tomasz Wróbel
- Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.,Wroclaw Medical University, Wroclaw, Lower Silesia, Poland
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11
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Krendyukov A, Schiestl M. Biosimilars in oncology: A decade of experience with granulocyte colony-stimulating factor and its implications for monoclonal antibodies. Crit Rev Oncol Hematol 2019:102785. [PMID: 31405784 DOI: 10.1016/j.critrevonc.2019.07.009] [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] [Received: 06/28/2018] [Revised: 09/24/2018] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
Biosimilars offer the potential for improved sustainability of cancer care. In oncology, granulocyte colony-stimulating factor and erythropoiesis-stimulating agent biosimilars have been available for almost a decade, with biosimilars of monoclonal antibodies a more recent development. Sandoz biosimilar filgrastim was approved based on Phase III confirmatory studies conducted in patients with breast cancer experiencing chemotherapy-induced neutropenia, with other indications granted based on extrapolation. Despite the fact that extrapolation is a well-established scientific principle in regulation of biological medicines, it is a commonly misunderstood part of the biosimilar concept. Broad experience from almost a decade of use of Sandoz biosimilar filgrastim includes >21 million patient-days exposure and >9 years of real-world clinical evidence, indicates extrapolation successfully at work. Together, this can help reassure oncologists that extrapolation is based on sound scientific principles. Efforts to improve understanding of extrapolation are critical to ensure the acceptance of future oncology biosimilar monoclonal antibodies.
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Affiliation(s)
- Andriy Krendyukov
- Former employee of HEXAL AG, Industriestr. 25, D-83607, Holzkirchen, Germany.
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12
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Partanen A, Valtola J, Ropponen A, Kuitunen H, Kuittinen O, Vasala K, Ågren L, Penttilä K, Keskinen L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Comparison of filgrastim, pegfilgrastim, and lipegfilgrastim added to chemotherapy for mobilization of CD34 + cells in non-Hodgkin lymphoma patients. Transfusion 2018; 59:325-334. [PMID: 30450652 DOI: 10.1111/trf.14993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Data are limited on the long-acting granulocyte-colony stimulating factors (G-CSFs) pegfilgrastim (PEG) and lipegfilgrastim (LIPEG) compared with filgrastim (FIL) regarding the mobilization efficiency of CD34+ cells, graft cellular composition, and engraftment. STUDY DESIGN AND METHODS In this prospective nonrandomized study, 36 patients with non-Hodgkin lymphoma received FIL, 67 received PEG, and 16 patients received LIPEG as a cytokine after chemotherapy. We analyzed the mobilization and collection of CD34+ cells, cellular composition of blood grafts, and hematologic recovery after auto-SCT according to the type of G-CSF used. RESULTS Patients in the LIPEG group had fewer apheresis sessions (1 vs. 2, p = 0.021 for FIL and p = 0.111 for PEG) as well as higher median blood CD34+ cell counts at the start of the first apheresis (LIPEG 74 × 106 /L vs. FIL 31 × 106 /L, p = 0.084 or PEG 27 × 106 /L, p = 0.021) and CD34+ yields of the first apheresis (FIL 5.1 × 106 /kg vs. FIL 2.3 × 106 /kg, p = 0.105 or PEG 1.8 × 106 /kg, p = 0.012). Also, the costs associated with G-CSF mobilization and apheresis were lower in the LIPEG group. The graft composition was comparable except for the higher infused CD34+ cell counts in the LIPEG group. The engraftment kinetics were significantly slower in the FIL group. CONCLUSION LIPEG appears to be more efficient compared with PEG after chemotherapy to mobilize CD34+ cells for auto-SCT demonstrated as fewer sessions of aphereses needed as well as 2.8-fold CD34+ cell yields on the first apheresis day. Early hematologic recovery was more rapid in the LIPEG group. Thus further studies on LIPEG in the mobilization setting are warranted.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - H Kuitunen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - O Kuittinen
- Department of Oncology, Oulu University Hospital, Oulu, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - L Ågren
- Siunsote- Hospital District of North Karelia, Joensuu, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland.,The Finnish Medicines Agency, Kuopio, Finland
| | - L Keskinen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Eastern Finland Laboratory Centre, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland.,Eastern Finland Laboratory Centre, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland.,Siunsote- Hospital District of North Karelia, Joensuu, Finland.,Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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13
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Current use of biosimilar G-CSF for haematopoietic stem cell mobilisation. Bone Marrow Transplant 2018; 54:858-866. [DOI: 10.1038/s41409-018-0350-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 11/08/2022]
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14
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Abstract
Transplants using peripheral blood hemopoietic stem/progenitor (PBHS) cells are widely performed for the treatment of patients with hematologic disorders in routine practice and clinical trials. Although the process from mobilization to infusion of PBHS cells has been mostly established, optimal conditions for each process remain undetermined. Adverse reactions caused by PBHS cell infusions have not been systematically recorded. In transplants using PBHS cells, a number of problems still exist. In this section, the current status of and future perspectives regarding PBHS cells are described.
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Affiliation(s)
- Kazuo Muroi
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
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15
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Tamura K, Hashimoto K, Nishikawa K. Clinical safety and efficacy of “filgrastim biosimilar 2” in Japanese patients in a post-marketing surveillance study. J Infect Chemother 2018; 24:363-369. [DOI: 10.1016/j.jiac.2017.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
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16
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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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17
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Krendyukov A, Schiestl M. Extrapolation concept at work with biosimilar: a decade of experience in oncology. ESMO Open 2018; 3:e000319. [PMID: 29644102 PMCID: PMC5890855 DOI: 10.1136/esmoopen-2017-000319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/26/2022] Open
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18
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Korkmaz S, Altuntas F. What is the role of biosimilar G-CSF agents in hematopoietic stem cell mobilization at present? Transfus Apher Sci 2017; 56:795-799. [PMID: 29153313 DOI: 10.1016/j.transci.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mobilization of hematopoietic stem cells, which has largely replaced bone marrow harvesting as a source of hematopoietic stem cells, using recombinant agents such as filgrastim or lenograstim has become a standard procedure in both patients and healthy donors prior to peripheral blood stem cell collection for autologous and allogeneic stem cell transplantation. Published literature data suggest that mobilization with recombinant granulocyte-colony stimulating factor (G-CSF) is safe and mobilization outcomes are satisfactory. In recent years, besides G-CSF originators, biosimilar G-CSF agents have been approved by the regulatory agencies for the same indications. Current data showed that by using the biosimilar G-CSF, similar results regarding safety and efficacy of hematopoietic stem cell mobilization may be achieved compared to the originator G-CSF. Although the issues such as the similarity to a licenced biological medicine, differences in manufacturing processes, the potential to cause immunogenicity, extrapolation and interchangeability of these biosimilar products are still being discussed by the scientific area, however, more experience with these agents now exists in approved endications and there seems to be no reason to expect significant differences between biosimilar G-CSF and originator G-CSF regarding their efficacy and safety in both patients and healthy donors. Also, the significant cost savings of biosimilars in real life setting may enhance the use of these agents in the future. Nonetheless, the collection of long-term follow-up data is mandatory for both patients and healthy donors, and multicentre randomized clinical trials that directly compare biosimilar G-CSF with the originator G-CSF are needed in order to allow the transplant community to make informed decisions regarding the choice of G-CSF.
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Affiliation(s)
- Serdal Korkmaz
- University of Health Sciences, Kayseri Training and Research Hospital, Department of Hematology, Kayseri, Turkey.
| | - Fevzi Altuntas
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology and BMT Unit, Ankara, Turkey; Yıldırım Beyazıt University, Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
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19
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Farhan R, Urbanowska E, Zborowska H, Król M, Król M, Torosian T, Piotrowska I, Bogusz K, Skwierawska K, Wiktor-Jędrzejczak W, Snarski E. Biosimilar G-CSF versus filgrastim and lenograstim in healthy unrelated volunteer hematopoietic stem cell donors. Ann Hematol 2017; 96:1735-1739. [PMID: 28801752 PMCID: PMC5569652 DOI: 10.1007/s00277-017-3060-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/03/2017] [Indexed: 01/02/2023]
Abstract
The World Marrow Donor Organization recommends original granulocyte-colony stimulating factor (G-CSF) for the mobilization of stem cells in healthy unrelated hematopoietic stem cell donors. We report the comparison of a biosimilar G-CSF (Zarzio) with two original G-CSFs (filgrastim and lenograstim) in mobilization in unrelated donors. We included data of 313 consecutive donors who were mobilized during the period from October 2014 to March 2016 at the Medical University of Warsaw. The primary endpoints of this study were the efficiency of CD34+ cell mobilization to the circulation and results of the first apheresis. The mean daily dose of G-CSF was 9.1 μg/kg for lenograstim, 9.8 μg/kg for biosimilar filgrastim, and 9.3 μg/kg for filgrastim (p < 0.001). The mean CD34+ cell number per microliter in the blood before the first apheresis was 111 for lenograstim, 119 for biosimilar filgrastim, and 124 for filgrastim (p = 0.354); the mean difference was even less significant when comparing CD34+ number per dose of G-CSF per kilogram (p = 0.787). Target doses of CD34+ cells were reached with one apheresis in 87% donors mobilized with lenograstim and in 93% donors mobilized with original and biosimilar filgrastim (p = 0.005). The mobilized apheresis outcomes (mean number of CD34+ cells/kg of donor collected during the first apheresis) was similar with lenograstim, biosimilar filgrastim, and filgrastim: 6.2 × 106, 7.6 × 106, and 7.3 × 106, respectively, p = 0.06. There was no mobilization failure in any of the donors. Biosimilar G-CSF is as effective in the mobilization of hematopoietic stem cells in unrelated donors as original G-CSFs. Small and clinically irrelevant differences seen in the study can be attributed to differences in G-CSF dose and collection-related factors. Active safety surveillance concurrent to clinical use and reporting to donor outcome registry (e.g., EBMT donor outcome registry or WMDA SEAR/SPEAR) might help to evaluate the possible short- and long-term complications of biosimilar G-CSF.
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Affiliation(s)
- Roiya Farhan
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland
| | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland
| | - Hanna Zborowska
- Central Laboratory, Independent Public Central Clinical Hospital, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland
| | - Maria Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland
| | | | | | - Krzysztof Bogusz
- Central Laboratory, Independent Public Central Clinical Hospital, Warsaw, Poland
| | - Kamila Skwierawska
- Central Laboratory, Independent Public Central Clinical Hospital, Warsaw, Poland
| | - Wiesław Wiktor-Jędrzejczak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland
| | - Emilian Snarski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Banacha 1a, Warsaw, Poland.
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20
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Nasillo V, Paolini A, Riva G, Morselli M, Potenza L, Coluccio V, Maccaferri M, Colaci E, Fantuzzi V, Messerotti A, Arletti L, Pioli V, Lugli E, Gilioli A, Quadrelli C, Zucchini P, Vallerini D, Lagreca I, Barozzi P, Cuoghi A, Bresciani P, Marasca R, Mariano MT, Ceccherelli G, Comoli P, Campioli D, Trenti T, Narni F, Luppi M, Forghieri F. Effectiveness of originator (Neupogen) and biosimilar (Zarzio) filgrastim in autologous peripheral blood stem cell mobilization in adults with acute myeloid leukemia: a single-center retrospective study. Leuk Lymphoma 2017; 59:225-228. [PMID: 28587560 DOI: 10.1080/10428194.2017.1321748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vincenzo Nasillo
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Ambra Paolini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Giovanni Riva
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Morselli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Leonardo Potenza
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Coluccio
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Monica Maccaferri
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Elisabetta Colaci
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Fantuzzi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Andrea Messerotti
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Laura Arletti
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Valeria Pioli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Elisabetta Lugli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Andrea Gilioli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Chiara Quadrelli
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Zucchini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Daniela Vallerini
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Ivana Lagreca
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Barozzi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Angela Cuoghi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Paola Bresciani
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Roberto Marasca
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Maria Teresa Mariano
- b Immuno-Transfusional Medicine Unit , Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Giovanni Ceccherelli
- b Immuno-Transfusional Medicine Unit , Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Patrizia Comoli
- c Pediatric Hematology Unit , Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo , Pavia , Italy
| | - Daniele Campioli
- d Department of Laboratory Medicine and Pathology , Unità Sanitaria Locale (USL) , Modena , Italy
| | - Tommaso Trenti
- d Department of Laboratory Medicine and Pathology , Unità Sanitaria Locale (USL) , Modena , Italy
| | - Franco Narni
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Mario Luppi
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
| | - Fabio Forghieri
- a Department of Medical and Surgical Sciences, Section of Hematology , University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy
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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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Yoshimura H, Hotta M, Nakanishi T, Fujita S, Nakaya A, Satake A, Ito T, Ishii K, Nomura S. Evaluation of a biosimilar granulocyte colony-stimulating factor (filgrastim XM02) for peripheral blood stem cell mobilization and transplantation: a single center experience in Japan. J Blood Med 2017; 8:5-12. [PMID: 28182150 PMCID: PMC5279847 DOI: 10.2147/jbm.s123374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Biosimilar granulocyte colony-stimulating factor (G-CSF) has recently been introduced into clinical practice. G-CSFs are used to mobilize CD34+ cells and accelerate engraftment after transplantation. However, in Asia, particularly in Japan, data for peripheral blood stem cell (PBSC) mobilization by this biosimilar G-CSF are currently lacking. Therefore, the clinical efficacy and safety of biosimilar G-CSF for hematopoietic stem cell transplantation needs to be evaluated in a Japanese context. Materials and methods The subjects included two groups of patients with malignant lymphoma and multiple myeloma. All patients received chemotherapy priming for the mobilization of PBSCs. All patients were treated with chemotherapy followed by the administration of either the biosimilar G-CSF, filgrastim XM02 (FBNK), or the originators, filgrastim, or lenograstim. Results There were no significant differences among FBNK, filgrastim, and lenograstim treatments in the numbers of CD34+ cells in harvested PBSCs, the scores for granulocyte/macrophage colony forming units, or for malignant lymphoma and multiple myeloma patients evaluated as separate or combined cohorts. In addition, there were no significant differences in safety, side effects, complications, or the time to engraftment after autologous hematopoietic stem cell transplantation. Conclusion Biosimilar FBNK shows the same efficacy and safety as originator G-CSFs for facilitating bone marrow recovery in Japanese malignant lymphoma and multiple myeloma patients undergoing stem cell transplantation. In addition, it is less expensive than the originators, reducing hospitalization costs.
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Affiliation(s)
- Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Update on biosimilars of granulocyte colony-stimulating factor - when no news is good news. Curr Opin Hematol 2016; 23:61-6. [PMID: 26554886 DOI: 10.1097/moh.0000000000000204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW With the approval of the first biosimilar granulocyte colony-stimulating factor (G-CSF), biosimilars - copies of therapeutic biologicals whose patent protection has expired - have finally reached the US healthcare market. Its advent is an occasion for a closer look at recent insights into biosimilar G-CSF and an attempt at prognosticating the future (future role) of biosimilars in general. RECENT FINDINGS Recent literature regarding biosimilar G-CSF orbits significantly around patient access and effects on healthcare expenditure. The advent of biosimilar G-CSF has induced unexpectedly large price reductions for short-acting G-CSF. On the clinical side, little excitement is tangible, probably appropriately so, since clinical data indicate nothing short of biological similarity. Although formal clinical trials are few, the plethora of case series and historic comparisons which have come forth offer reassurance about the appropriateness of the regulators' assessment of biosimilar G-CSF as indeed in all respects biologically similar to the originator. SUMMARY All evidence points to an overwhelming similarity of originator and biosimilar G-CSF in all indications. Overall clinical acceptance, albeit possibly significantly dictated by economic pressures, is good. Price reductions exceed predictions and may jeopardize the economic viability of biosimilar programs. A concurrent shift towards long-acting G-CSF ('biobetters') is observed in Europe.
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Harada K, Yamada Y, Konishi T, Nagata A, Takezaki T, Kaito S, Kurosawa S, Sakaguchi M, Yasuda S, Yoshioka K, Watakabe-Inamoto K, Igarashi A, Najima Y, Hagino T, Muto H, Kobayashi T, Doki N, Kakihana K, Sakamaki H, Ohashi K. Comparison of transplant outcomes and economic costs between biosimilar and originator filgrastim in allogeneic hematopoietic stem cell transplantation. Int J Hematol 2016; 104:709-719. [PMID: 27565504 DOI: 10.1007/s12185-016-2085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022]
Abstract
From January 2012 to September 2015, 49 patients received biosimilar filgrastim (BF) after allogeneic bone marrow transplantation (BMT, n = 31) or peripheral stem cell transplantation (PBSCT, n = 18) in our institution. To evaluate the clinical impact of BF on transplant outcomes of these patients, we compared hematological recovery, overall survival (OS), disease-free survival (DFS), transplantation-related mortality (TRM), cumulative incidence of relapse (CIR), and acute and chronic graft-versus-host disease (GVHD) with those of control patients who received originator filgrastim (OF) after BMT (n = 31) or PBSCT (n = 18). All cases were randomly selected from a clinical database in our institution. In both the BMT and PBSCT settings, neutrophil recovery (17 vs. 19 days in BMT; 13 vs. 15 days in PBSCT) and platelet recovery (27 vs. 31 days in BMT; 17 vs. 28 days in PBSCT) were essentially the same between BF and OF. They were also comparable in terms of OS, DFS, TRM, CIR, and the incidence of acute GVHD and chronic GVHD. On multivariate analysis, the use of BF in both BMT and PBSCT was not a significant factor for adverse transplant outcomes. Although BF significantly reduced filgrastim costs in both BMT and PBSCT, total hospitalization costs were not significantly different between BF and OF.
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Affiliation(s)
- Kaito Harada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Toshiaki Takezaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satoshi Kaito
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shuhei Kurosawa
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masahiro Sakaguchi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Shunichiro Yasuda
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kosuke Yoshioka
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kyoko Watakabe-Inamoto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Takeshi Hagino
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
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Biosimilars: Extrapolation for oncology. Crit Rev Oncol Hematol 2016; 104:131-7. [PMID: 27354233 DOI: 10.1016/j.critrevonc.2016.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/29/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022] Open
Abstract
A biosimilar is a biologic that is highly similar to a licensed biologic (the reference product) in terms of purity, safety and efficacy. If the reference product is licensed to treat multiple therapeutic indications, extrapolation of indications, i.e., approval of a biosimilar for use in an indication held by the reference product but not directly studied in a comparative clinical trial with the biosimilar, may be possible but has to be scientifically justified. Here, we describe the data required to establish biosimilarity and emphasize that indication extrapolation is based on scientific principles and known mechanism of action.
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Tbo-Filgrastim: A Review in Neutropenic Conditions. BioDrugs 2016; 30:153-60. [PMID: 27023705 DOI: 10.1007/s40259-016-0172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tbo-filgrastim (filgrastim XM02; Biograstim(®), Ratiograstim(®), Tevagrastim(®)) is approved in the EU as a biosimilar of filgrastim (Neupogen(®)) for use in all indications for which reference filgrastim is approved, including chemotherapy-induced neutropenia, neutropenia in patients undergoing myeloablative therapy followed by bone marrow transplantation, mobilization of peripheral blood stem cells (PBSCs), severe chronic neutropenia, and neutropenia in HIV infection. Tbo-filgrastim (Granix(®)) is also approved as a biologic in the USA for neutropenia associated with chemotherapy. Tbo-filgrastim has demonstrated bioequivalence to reference filgrastim in terms of its pharmacokinetic and pharmacodynamic profiles. In phase III trials, tbo-filgrastim was equivalent to reference filgrastim in ameliorating severe neutropenia in patients receiving chemotherapy for breast cancer, lung cancer, or non-Hodgkin lymphoma. In addition, the efficacy of tbo-filgrastim for PBSC mobilization in the allogeneic and autologous settings has been demonstrated in several small studies. Tbo-filgrastim was generally well tolerated, with a similar safety profile to that of reference filgrastim. Most adverse events were of mild or moderate severity. Biosimilars such as tbo-filgrastim have the potential to reduce healthcare costs compared with those of reference filgrastim; this may provide patients with more cost-effective treatment options. Current evidence indicates that tbo-filgrastim is a useful alternative to reference filgrastim in patients requiring filgrastim therapy for various neutropenic conditions.
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Maul JT, Stenner-Liewen F, Seifert B, Pfrommer S, Petrausch U, Kiessling MK, Schanz U, Nair G, Mischo A, Taverna C, Schmidt A, Bargetzi M, Stupp R, Renner C, Samaras P. Efficacious and save use of biosimilar filgrastim for hematopoietic progenitor cell chemo-mobilization with vinorelbine in multiple myeloma patients. J Clin Apher 2016; 32:21-26. [DOI: 10.1002/jca.21459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/06/2015] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Julia-Tatjana Maul
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | | | - Burkhardt Seifert
- Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich; Zurich Switzerland
| | - Sarah Pfrommer
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | - Ulf Petrausch
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | | | - Urs Schanz
- Department of Hematology; University Hospital Zurich; Zurich Switzerland
| | - Gayathri Nair
- Department of Hematology; University Hospital Zurich; Zurich Switzerland
| | - Axel Mischo
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | - Christian Taverna
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | - Adrian Schmidt
- Medical Oncology and Hematology; Triemli City Hospital; Zurich Switzerland
| | - Mario Bargetzi
- Center of Oncology, Hematology and Transfusion Medicine, Cantonal Hospital Aarau; Aargau Switzerland
| | - Roger Stupp
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | - Christoph Renner
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
| | - Panagiotis Samaras
- Department of Medical Oncology; University Hospital Zurich; Zurich Switzerland
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Schmitt M, Hoffmann JM, Lorenz K, Publicover A, Schmitt A, Nagler A. Mobilization of autologous and allogeneic peripheral blood stem cells for transplantation in haematological malignancies using biosimilar G-CSF. Vox Sang 2016; 111:178-86. [PMID: 27509033 DOI: 10.1111/vox.12397] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Biosimilars of the granulocyte colony stimulating factor (G-CSF) filgrastim were approved by the European Medicines Agency (EMA) for registered indications of the originator G-CSF, including prevention and treatment of neutropenia, as well as mobilization of peripheral blood stem cells in 2008. Nevertheless, there is still an ongoing debate regarding the quality, efficacy and safety of biosimilar G-CSF. MATERIALS AND METHODS This article is a meta-analysis of clinical studies on the use of biosimilar G-CSF for mobilization and transplantation of haematopoietic stem cells as available in public databases. All data sets were weighted for the number of patients and parameters and then subjected to statistical meta-analysis employing the Mann-Whitney U-test followed by the Hodges-Lehmann estimator to assess differences between biosimilar and originator G-SCF. RESULTS A total of 1892 individuals, mostly with haematological malignancies but also including 351 healthy donors have been successfully mobilized for autologous or allogeneic stem cell transplantation using biosimilar G-CSF (Zarzio(TM) : 1239 individuals; Ratiograstim(TM) /Tevagrastim(TM) : 653 individuals). A total of 740 patients with multiple myeloma, 491 with non-Hodgkin's lymphoma (NHL), 150 with Hodgkin's lymphoma (HL) and other diseases are included in this meta-analysis, as well as 161 siblings and 190 volunteer unrelated donors. For biosimilar and originator G-CSF, bioequivalence was observed for the yield of CD34+ stem cells as well as for the engraftment of the transplants. CONCLUSION Biosimilar G-CSF has equivalent effects and safety as originator G-CSF.
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Affiliation(s)
- M Schmitt
- University Clinic Heidelberg, Internal Medicine V (Hematology, Oncology and Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - J-M Hoffmann
- University Clinic Heidelberg, Internal Medicine V (Hematology, Oncology and Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - K Lorenz
- University Clinic Heidelberg, Internal Medicine V (Hematology, Oncology and Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - A Publicover
- Human Dendritic Cell Laboratory, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - A Schmitt
- University Clinic Heidelberg, Internal Medicine V (Hematology, Oncology and Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - A Nagler
- Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
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Biosimilar Filgrastim (Tevagrastim, XMO2) for Allogeneic Hematopoietic Stem Cell Mobilization and Transplantation in Patients with Acute Myelogenous Leukemia/Myelodysplastic Syndromes. Biol Blood Marrow Transplant 2016; 22:277-283. [DOI: 10.1016/j.bbmt.2015.08.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/28/2015] [Indexed: 01/12/2023]
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Abstract
Congress passed the Biologics Price Competition and Innovation Act (BPCI Act) as part of the Affordable Care Act on March 23, 2010. The BPCI Act authorized an approval pathway for biosimilar and interchangeable products. It defines biosimilarity to mean "that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components" and that "there are no clinically meaningful differences between the biological product and the reference product in terms of safety, purity, and potency of the product." The biosimilar pathway has the potential to facilitate access to biologic products through increased competition, in the same manner as biosimilars have done for almost 10 years in Europe. The goal of a biosimilar program is not to independently establish safety and effectiveness for each condition of use. Rather, the goal is to demonstrate biosimilarity through an extensive analytical characterization and a targeted clinical program designed to assess for clinically meaningful differences, if they exist. The regulatory approaches in both the United States and Europe involve a totality-of-the-evidence approach to demonstrate biosimilarity. Importantly, the biosimilar pathway allows for extrapolation of data across indications so that a sponsor, with adequate scientific justification, need not conduct clinical studies in each intended condition of use. Without extrapolation, development may not be feasible for many products, and patients and resources could be diverted from clinical studies of newer agents for cancer.
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Affiliation(s)
- Steven J Lemery
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Francisco J Esteva
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Martina Weise
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
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Trifilio S, Zhou Z, Galvin J, Fong JL, Monreal J, Mehta J. Filgrastim versus TBO-filgrastim to reduce the duration of neutropenia after autologous hematopoietic stem cell transplantation: TBO, or not TBO, that is the question. Clin Transplant 2015; 29:1128-32. [PMID: 26493022 DOI: 10.1111/ctr.12637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 12/01/2022]
Abstract
After a hospital-wide formulary change resulted in the replacement of filgrastim with TBO-filgrastim for all on- and off-label indications, we performed a retrospective comparison of patients with myeloma receiving 200 mg/m(2) melphalan with autologous hematopoietic stem cell transplantation to see whether the type of growth factor used post-transplant made a difference. One hundred and eighty-two consecutive patients with myeloma were studied, 91 receiving filgrastim immediately prior to the change and 91 receiving TBO-filgrastim afterward. The CD34(+) cell dose was comparable, as were other characteristics. Although the overall time to neutrophil recovery was similar for both groups, early engraftment (≤ 12 d) occurred more often (p = 0.05), and late engraftment (≥ 14 d) less often (p = 0.09) in filgrastim-treated patients. The number of documented infections was significantly less in the TBO-filgrastim group. Day 100 mortality and hospital stay were similar for the two groups. These data indicate that there is no material difference between filgrastim and TBO-filgrastim in this clinical setting.
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Affiliation(s)
- Steven Trifilio
- Department of Medicine and Pharmacy, Northwestern University, Chicago, IL, USA
| | - Zheng Zhou
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - John Galvin
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica L Fong
- Department of Pharmacy, Northwestern Hospital, Chicago, IL, USA
| | - Joanne Monreal
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jayesh Mehta
- Department of Medicine, Northwestern University, Chicago, IL, USA
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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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Martino M, Recchia AG, Moscato T, Fedele R, Neri S, Gentile M, Alati C, Vincelli ID, Piro E, Penna G, Musolino C, Ronco F, Molica S, Morabito F. Efficacy of biosimilar granulocyte colony-stimulating factor versus originator granulocyte colony-stimulating factor in peripheral blood stem cell mobilization in de novo multiple myeloma patients. Cytotherapy 2015; 17:1485-93. [PMID: 26188967 DOI: 10.1016/j.jcyt.2015.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/08/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AIMS Filgrastim and lenograstim are the standard granulocyte colony-stimulating factor (G-CSF) agents for peripheral blood stem cell mobilization (PBSC) in patients who undergo autologous stem cell transplantation. METHODS To assess whether biosimilars are effective, we conducted a single-center, prospective study that included 40 consecutive de novo multiple myeloma patients who received cyclophosphamide 4 g/m(2) per day plus biosimilar filgrastim G-CSF to mobilize PBSC. These patients were compared with a group of 37 patients matched for age, diagnosis, previous chemotherapy and mobilization who had been treated with originator G-CSF. The mean number of CD34+ cells/μL in the peripheral blood was 199.6 ± 207.4 in the biosimilar and 192.8 ± 154.7 in the originator group (P = 0.87). The median number of CD34+ cells/kg recipient collected was 11.5 ± 5.8 and 12.3 ± 5.3 in the biosimilar and originator groups, respectively (P = 0.51). The mobilization failure rate was 2.5% and 2.7% in the biosimilar filgrastim and originator filgrastim cohorts (P = NS), respectively. RESULTS Twenty-nine patients in the biosimilar group and 28 patients in the originator group underwent autologous transplantation. There were no statistically significant differences between the biosimilar and originator G-CSF cohorts in terms of hematopoietic recovery parameters and transplant-related toxicities. CONCLUSIONS The efficacy of biosimilar G-CSF appears to be equivalent to the reference G-CSF.
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Affiliation(s)
- Massimo Martino
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy.
| | - Anna Grazia Recchia
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy
| | - Tiziana Moscato
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Roberta Fedele
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Santo Neri
- Hematology Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | | | - Caterina Alati
- Hematology Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | | | - Eugenio Piro
- Hematology Unit, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Giuseppa Penna
- School and Division of Hematology, University Hospital "G. Martino", Messina, Italy
| | - Caterina Musolino
- School and Division of Hematology, University Hospital "G. Martino", Messina, Italy
| | - Francesca Ronco
- Hematology Unit, Azienda Ospedaliera BMM, Reggio Calabria, Italy
| | - Stefano Molica
- Hematology Unit, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Fortunato Morabito
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy; Haematology Unit, Azienda Ospedaliera Cosenza, Italy
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Antelo ML, Zabalza A, Sánchez Antón MP, Zalba S, Aznar M, Mansilla C, Ramírez N, Olavarría E. Mobilization of hematopoietic progenitor cells from allogeneic healthy donors using a new biosimilar G-CSF (Zarzio®). J Clin Apher 2015; 31:48-52. [PMID: 26011178 DOI: 10.1002/jca.21401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 04/15/2015] [Indexed: 11/07/2022]
Affiliation(s)
- María Luisa Antelo
- Department of Haematology; Complejo Hospitalario De Navarra, Navarra Health Service; Pamplona Spain
| | - Amaya Zabalza
- Oncohematology Research Group; Navarrabiomed-Miguel Servet Foundation; Pamplona Spain
| | - María Piva Sánchez Antón
- Department of Haematology; Complejo Hospitalario De Navarra, Navarra Health Service; Pamplona Spain
| | - Saioa Zalba
- Department of Haematology; Complejo Hospitalario De Navarra, Navarra Health Service; Pamplona Spain
| | - Mariví Aznar
- Department of Haematology; Complejo Hospitalario De Navarra, Navarra Health Service; Pamplona Spain
| | - Cristina Mansilla
- Oncohematology Research Group; Navarrabiomed-Miguel Servet Foundation; Pamplona Spain
| | - Natalia Ramírez
- Oncohematology Research Group; Navarrabiomed-Miguel Servet Foundation; Pamplona Spain
| | - Eduardo Olavarría
- Department of Haematology; Complejo Hospitalario De Navarra, Navarra Health Service; Pamplona Spain
- Oncohematology Research Group; Navarrabiomed-Miguel Servet Foundation; Pamplona Spain
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Uddin S, Russell P, Farrell M, Davy B, Taylor J, Agrawal SG. Use of biosimilar filgrastim compared with lenograstim in autologous haematopoietic stem-cell transplant and in sibling allogeneic transplant. Ther Adv Hematol 2015; 6:53-60. [PMID: 25830013 DOI: 10.1177/2040620714565962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Biosimilar filgrastim was compared with lenograstim for autologous haematopoietic stem-cell transplant (HSCT) in patients with haematological malignancies. Data from a separate group of sibling donors who underwent allogeneic HSCT are also reported. METHODS Patients with lymphoma or multiple myeloma (MM) who underwent autologous HSCT with biosimilar filgrastim were compared with a historical control group of patients who received lenograstim. Peripheral blood (PB) cells counts were monitored after 7-8 consecutive days of granulocyte-colony stimulating factor (G-CSF) injection and apheresis was performed on day 8 if PB CD34+ cell count was ⩾10 cells/µl. The target PB CD34+ cell doses were ⩾2.0 × 10(6)/kg (lymphoma), ⩾4.0 × 10(6)/kg (MM ⩾60 years old) or ⩾8.0 × 10(6)/kg (MM <60 years old). RESULTS A total of 259 patients were included in the autologous HSCT comparison (biosimilar filgrastim, n = 104; lenograstim, n = 155). In patients with lymphoma and older MM patients (⩾60 years old), no significant differences were observed between groups with regard to stem-cell mobilization parameters. However, in MM patients <60 years old, all parameters were significantly superior in the biosimilar filgrastim group, including the need for 1 rather than 2 apheresis procedures. No significant differences were observed between groups in median number of days to absolute neutrophil count (ANC) or platelet recovery. In the allogeneic setting, 47 sibling donors received biosimilar filgrastim. Mean CD34+ count at the first apheresis was 6.1 × 10(6)/kg. A total of 13 donors needed a second apheresis and 4 required a third. Among recipients, median days to ANC recovery was 16 (10-28) and to platelet recovery was 13 (9-54). CONCLUSIONS Biosimilar filgrastim is as effective as lenograstim for autologous HSCT in patients with lymphoma or MM patients ⩾60 years old. However, mobilization with biosimilar filgrastim appeared to be superior to that with lenograstim in younger MM patients.
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Affiliation(s)
- Shab Uddin
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pippa Russell
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Maresa Farrell
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Barbara Davy
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Joe Taylor
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Samir G Agrawal
- Barts Health NHS Trust and Blizard Institute, Queen Mary University of London, Division of Haemato-Oncology, St Bartholomew's Hospital, London EC1A 7BE, UK
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Safety and efficacy of granulocyte colony-stimulating factor biosimilars in engraftment after autologous stem cell transplantation for haematological malignancies: a 4-year, single institute experience with different conditioning regimens. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:478-83. [PMID: 25761321 DOI: 10.2450/2015.0198-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/03/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Filgrastim biosimilars have recently been introduced into clinical practice. To date biosimilars have demonstrated comparable efficacy and safety as the originator in chemotherapy-induced neutropenia. Published experience in engraftment after autologous stem cell transplantation (ASCT) is limited and concerns relatively few patients. MATERIALS AND METHODS With the aim of assessing the efficacy and the safety of filgrastim biosimilars in post-ASCT bone marrow recovery, we conducted a single institution, retrospective study in 56 lymphoma and myeloma patients who received filgrastim biosimilars (Tevagrastim(®) and Zarzio(®)) at standard doses from day 5. We compared our results with recently published data on the originator. A cost analysis of each biosimilar was performed. RESULTS Neutrophil counts recovered in 55 patients. The median number of filgrastim biosimilar vials injected was seven per patient. The median time to neutrophil and platelet recovery was 10 and 12 days, respectively. Twenty-six patients had febrile neutropenia, in half of whom the agent involved was identified. In the cost analysis, the use of Tevagrastim(®) and Zarzio(®) was associated with cost reductions of 56% and of 86%, respectively. DISCUSSION Despite differences in CD34+ cell counts and time of starting filgrastim, our results in terms of time to engraftment and median number of vials injected are similar to published data. Comparing our results by single conditioning regimen to recent literature data, the time to engraftment and duration of hospitalisation were equivalent. Significant differences were observed in the incidence of febrile neutropenia, perhaps due to different preventive and prophylactic protocols for infections. Although prospective studies should be performed to confirm our results, filgrastim biosimilars were found to be effective and safe in engraftment after ASCT.
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Abstract
Despite the establishment of a specific approval pathway, the issuance of detailed scientific guidelines for the development of similar biological medicinal products (so-called "biosimilars") and the approval of several biosimilars in the European Union, acceptance of biosimilars in the medical community continues to be low. This is especially true in therapeutic indications for which no specific clinical trials with the biosimilar have been performed and that have been licensed based on extrapolation of efficacy and safety data from other indications. This article addresses the concerns frequently raised in the medical community about the use of biosimilars in such extrapolated indications and explains the underlying scientific and regulatory decision making including some real-life examples from recently licensed biosimilars.
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Cesaro S, Tridello G, Prete A, Dallorso S, Cannata E, Massaccesi E, Risso M, De Bortoli M, Caselli D. Biosimilar granulocyte-colony-stimulating factor for mobilization of autologous peripheral blood stem cells in pediatric hematology-oncology patients. Transfusion 2014; 55:246-52. [DOI: 10.1111/trf.12789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Simone Cesaro
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Gloria Tridello
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Arcangelo Prete
- Pediatric Hematology Oncology; Ospedale Lalla Seragnoli; Bologna Italy
| | - Sandro Dallorso
- Pediatric Hematology Oncology; Istituto G. Gaslini; Genova Italy
| | - Elisa Cannata
- Pediatric Hematology Oncology; Azienda Ospedaliera Universitaria Integrata; Verona Italy
| | - Erika Massaccesi
- Pediatric Hematology Oncology; Ospedale Lalla Seragnoli; Bologna Italy
| | - Marco Risso
- Immunohematology and Transfusion Service; Istituto G. Gaslini; Genova Italy
| | | | - Désirée Caselli
- Medical Direction Department; Azienda Ospedaliero-Universitaria Meyer Children Hospital; Firenze Italy
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