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Balint MT, Lemajić N, Jurišić V, Pantelić S, Stanisavljević D, Kurtović NK, Balint B. An evidence-based and risk-adapted GSF versus GSF plus plerixafor mobilization strategy to obtain a sufficient CD34 + cell yield in the harvest for autologous stem cell transplants. Transl Oncol 2024; 39:101811. [PMID: 38235620 PMCID: PMC10728698 DOI: 10.1016/j.tranon.2023.101811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Plerixafor is a bicyclam molecule with the ability to reversibly bind to receptor CXCR-4 thus leading to an increased release of stem cells (SC) into the circulation. This study aims to evaluate the efficacy of G-CSF plus plerixafor versus G-CSF alone mobilizing regimens on the basis of CD34+ cell yield and engraftment kinetics following hematopoietic SC transplants. METHODS The study incorporated 173 patients with plasma cell neoplasms (PCN), Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), undergoing mobilization and following autologous SC-transplant. For patients with mobilization failure and those predicted to be at risk of harvesting inadequate CD34+ yields (poor-responders), plerixafor was administered. Data was collected and compared in relation to the harvesting protocols used, cell quantification, cell-engraftment potential and overall clinical outcome. RESULTS A total of 101 patients received plerixafor (58.4 %) and the median CD34+increase was 312 %. Chemotherapy-mobilized PCN-patients required less plerixafor administration (p = 0.01), no difference was observed in lymphoma groups (p = 0.46). The median CD34+cell yield was 7.8 × 106/kg bm. Patients requiring plerixafor achieved lower, but still comparable cell yields. Total cell dose infused was in correlation with engraftment kinetics. Patients requiring plerixafor had delayed platelet engraftment (p = 0.029). CONCLUSIONS Adequately selected plerixafor administration reduces "mobilization-related-failure" rate and assure a high-level cell dose for SC transplants, with superior "therapeutic-potential" and safety profile. The mobilization strategy that incorporates "just-in-time" plerixafor administration, also leads to a reduction of hospitalization days and healthcare resource utilization. For definitive conclusions, further controlled/larger clinical trials concerning correlation of CD34+ cell count/yield, with hematopoietic reconstitution are required.
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Affiliation(s)
- Milena Todorović Balint
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Serbia.
| | | | | | - Sofija Pantelić
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Dejana Stanisavljević
- Medical Faculty, University of Belgrade, Serbia; Institute for Medical Statistics and Informatics, Belgrade, Serbia
| | | | - Bela Balint
- Department of Medical Sciences, Serbian Academy of Sciences and Arts, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
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Mandić D, Nežić L, Amdžić L, Vojinović N, Gajanin R, Popović M, Đeri J, Balint MT, Dumanović J, Milovanović Z, Grujić-Milanović J, Škrbić R, Jaćević V. Overexpression of MRP1/ABCC1, Survivin and BCRP/ABCC2 Predicts the Resistance of Diffuse Large B-Cell Lymphoma to R-CHOP Treatment. Cancers (Basel) 2023; 15:4106. [PMID: 37627134 PMCID: PMC10452886 DOI: 10.3390/cancers15164106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Approximately 40% of patients with diffuse large B-cell lymphoma (DLBCL) experience treatment resistance to the first-line R-CHOP regimen. ATP binding cassette (ABC) transporters and survivin might play a role in multidrug resistance (MDR) in various tumors. The aim was to investigate if the coexpression of ABC transporters and survivin was associated with R-CHOP treatment response. METHODS The expression of Bcl-2, survivin, P-glycoprotein/ABCB1, MRP1/ABCC1, and BCRP/ABCC2 was analyzed using immunohistochemistry in tumor specimens obtained from patients with DLBCL, and classified according to the treatment response as Remission, Relapsed, and (primary) Refractory groups. All patients received R-CHOP or equivalent treatment. RESULTS Bcl-2 was in strong positive correlation with clinical parameters and all biomarkers except P-gp/ABCB1. The overexpression of MRP1/ABCC1, survivin, and BCRP/ABCC2 presented as high immunoreactive scores (IRSs) was detected in the Refractory and Relapsed groups (p < 0.05 vs. Remission), respectively, whereas the IRS of P-gp/ABCB1 was low. Significant correlations were found among either MRP1/ABCC1 and survivin or BCRP/ABCC2 in the Refractory and Relapsed groups, respectively. In multiple linear regression analysis, ECOG status along with MRP1/ABCC1 or survivin and BRCP/ABCG2 was significantly associated with the prediction of the R-CHOP treatment response. CONCLUSIONS DLBCL might harbor certain molecular signatures such as MRP1/ABCC1, survivin, and BCRP/ABCC2 overexpression that can predict resistance to R-CHOP.
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Affiliation(s)
- Danijela Mandić
- Department of Hematology, Clinic of Internal Medicine, University Clinical Center Republic of Srpska, 12 Beba, 78000 Banja Luka, Bosnia and Herzegovina;
- Department of Internal Medicine, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
| | - Lana Nežić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina; (L.N.); (R.Š.)
| | - Ljiljana Amdžić
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina; (L.A.); (N.V.)
| | - Nataša Vojinović
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina; (L.A.); (N.V.)
| | - Radoslav Gajanin
- Department of Pathology, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Miroslav Popović
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Jugoslav Đeri
- Department of Surgery, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Milena Todorović Balint
- Department of Hematology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Clinic of Hematology, University Clinical Center of Serbia, 2 Pasterova, 11000 Belgrade, Serbia
| | - Jelena Dumanović
- Department of Analytical Chemistry, Faculty of Chemistry, University of Belgrade, Studenski trg 16, 11000 Belgrade, Serbia;
- Medical Faculty of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
| | - Zoran Milovanović
- Special Police Unit, Ministry of Interior, Trebevićka 12/A, 11030 Belgrade, Serbia;
| | - Jelica Grujić-Milanović
- Institute for Medical Research, National Institute of the Republic of Serbia, Department for Cardiovascular Research, University of Belgrade, Dr. Subotića 4, 11000 Belgrade, Serbia;
| | - Ranko Škrbić
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina; (L.N.); (R.Š.)
- Center for Biomedical Research, Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina; (L.A.); (N.V.)
| | - Vesna Jaćević
- Medical Faculty of the Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
- Department for Experimental Toxicology and Pharmacology, National Poison Control Centre, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Serbia
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, Rokitanskeho 62, 50003 Hradec Kralove, Czech Republic
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