1
|
Ye P, Cheng Y, Lian J, Tong H, Li L, Guo Q, Zhu W, Feng W, Huang L, Shou L, Chen D, Liu X, Li S, Du X, Yang M, Yu W, Qian J, Hu C, Wang H, Jin Y, Shen J, Hong P, Pei R, Jin J, Lu Y. Etoposide combined with cytarabine and pegfilgrastim for poorly mobilizing patients with multiple myeloma and lymphoma: A prospective multicentre study. Br J Haematol 2024; 204:2342-2350. [PMID: 38400570 DOI: 10.1111/bjh.19367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
A chemotherapy-based mobilization regimen in patients who mobilize poorly, based on etoposide, cytarabine and pegfilgrastim (EAP), has recently been introduced. The aim of this prospective study was to investigate the efficacy and safety of the EAP regimen in patients with poorly mobilizing multiple myeloma (MM) or lymphoma. This single-arm clinical trial was performed at eight public hospitals in China and was registered as a clinical trial (NCT05510089). The inclusion criteria were; (1) diagnosis of MM or lymphoma, (2) defined as a 'poor mobilizer' and (3) aged 18-75 years. The EAP regimen consisted of etoposide 75 mg/m2/day on days 1-2, cytarabine 300 mg/m2 every 12 h on days 1-2 and pegfilgrastim 6 mg on day 6. The primary endpoint of the study was the ratio of patients achieving adequate mobilization (≥2.0 × 106 CD34+ cells/kg). From 1 September 2022 to 15 August 2023, a total of 58 patients were enrolled, 53 (91.4%) achieved adequate mobilization, while 41 (70.7%) achieved optimal mobilization with a median number of cumulative collected CD34+ cells was 9.2 (range 2.1-92.7) × 106/kg and the median number of apheresis per patient of 1.2. The median time from administration of the EAP regimen to the first apheresis was 12 days. Approximately 8.6% of patients required plerixa for rescue, which was successful. Twelve (20.7%) of the 58 patients suffered grade 2-3 infections, while 25 (43.1%) required platelet transfusions. The duration of neutrophil and platelet engraftment was 11 days. In conclusion, these results suggest that the EAP mobilization regimen might be a promising option for poorly mobilizing patients with MM or lymphoma.
Collapse
Affiliation(s)
- Peipei Ye
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Yixuan Cheng
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Jiaying Lian
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Linjie Li
- Department of Hematology, The Central Hospital of Lishui City, Lishui, Zhejiang, China
| | - Qunyi Guo
- Department of Hematology, Taizhou Hospital of Zhejiang, Wenzhou Medical College, Taizhou, Zhejiang, China
| | - Weiguo Zhu
- Department of Hematology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Weiying Feng
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Li Huang
- Department of Hematology, Jinhua People's Hospital, Jinhua, Zhejiang, China
| | - Lihong Shou
- Department of Hematology, The Central Hospital of Huzhou City, Huzhou, Zhejiang, China
| | - Dong Chen
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Xuhui Liu
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Shuangyue Li
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Xiaohong Du
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Min Yang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Wenjuan Yu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Chao Hu
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Huafeng Wang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Yangjin Jin
- Department of Hematology, The Central Hospital of Lishui City, Lishui, Zhejiang, China
| | - Jian Shen
- Department of Hematology, Taizhou Hospital of Zhejiang, Wenzhou Medical College, Taizhou, Zhejiang, China
| | - Pan Hong
- Department of Hematology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Renzhi Pei
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Ying Lu
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
- Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China
| |
Collapse
|
2
|
Çelik S, Kaynar L, Güven ZT, Begendi NK, Demir F, Keklik M, Ünal A. The impact of diabetes mellitus on hematopoietic stem cell mobilization, a-single center cohort study. Transfus Apher Sci 2023; 62:103838. [PMID: 37925340 DOI: 10.1016/j.transci.2023.103838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Factors such as age, underlying hematological disease, chemotherapy and radiotherapy used, and bone marrow infiltration may cause mobilization failure. Several preclinical observed that diabetes mellitus (DM) leads to profound remodeling of the hematopoietic stem cell (HSC) niche, resulting in the impaired release of HSCs. We aim to examine the effect of DM on HSC mobilization and to investigate whether there is a relationship between complications developing in the DM process and drugs used to treat DM and mobilization failure. METHODS In Erciyes University Bone Marrow Transplantation Unit, 218 patients who underwent apheresis for stem cell mobilization between 2011 and 2021 were evaluated retrospectively. One hundred and nine patients had a diagnosis of DM, and 109 did not. RESULTS Mobilization failure developed in 17 (15.6 %) of the patients in the DM group, while it developed in 7 (6.4 %) patients in the non-DM group (p = 0.03). CD34+ stem cell count was 8.05 (1.3-30.2) × 106/kg in the DM group, while it was 8.2 (1.7-37.3) × 106/kg in the other group (p = 0.55). There was no statistically significant relationship between glucose and hemoglobin A1c levels and the amount of CD34+ cells (p = 0.83 and p = 0.14, respectively). Using sulfonylurea was the only independent predictor of mobilization failure (OR 5.75, 95 % CI: 1.38-24.05, p = 0.02). CONCLUSION DM should be considered a risk factor for mobilization failure. Further research is needed fully to understand the mechanisms underlying the mobilization failure effects of sulfonylureas and to develop strategies to improve stem cell mobilization in diabetic patients.
Collapse
Affiliation(s)
- Serhat Çelik
- Department of Hematology, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkiye.
| | - Leylagül Kaynar
- Department of Hematology, Faculty of Medicine, Medipol Mega University, İstanbul, Turkiye
| | | | - Nermin Keni Begendi
- Department of Hematology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkiye
| | - Fatma Demir
- Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkiye
| | - Muzaffer Keklik
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkiye
| | - Ali Ünal
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkiye
| |
Collapse
|
3
|
Pessach I, Nagler A. Leukapheresis for CAR-T cell production and therapy. Transfus Apher Sci 2023; 62:103828. [PMID: 37838564 DOI: 10.1016/j.transci.2023.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is an effective, individualized immunotherapy, and novel treatment for hematologic malignancies. Six commercial CAR-T cell products are currently approved for lymphatic malignancies and multiple myeloma. In addition, an increasing number of clinical centres produce CAR-T cells on-site, which enable the administration of CAR-T cells on site. The CAR-T cell products are either fresh or cryopreserved. Manufacturing CAR-T cells is a complicated process that begins with leukapheresis to obtain T cells from the patient's peripheral blood. An optimal leukapheresis product is crucial step for a successful CAR-T cell therapy; therefore, it is imperative to understand the factors that may affect the quality or T cells. The leukapheresis for CAR-T cell production is well tolerated and safe for both paediatric and adult patients and CAR-Τ cell therapy presents high clinical response rate in many studies. CAR-T cell therapy is under continuous improvement, and it has transformed into an almost standard procedure in clinical haematology and stem cell transplantation facilities that provide both autologous and allogeneic stem cell transplantations. In patients suffering from advanced haematological malignancies, CAR-T cell therapy shows incredible antitumor efficacy. Even after a single infusion of autologous CD19-targeting CAR-T cells in patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) and acute lymphoblastic leukaemia (ALL), long lasting remission is observed, and a fraction of the patients are being cured. Future novel constructs are being developed with better T cell persistence and better expansion. New next-generation CAR-T cells are currently designed to avoid toxicities such as cytokine release syndrome and neurotoxicity.
Collapse
Affiliation(s)
- Ilias Pessach
- Hematology Department, Athens Medical Center, Athens, Greece
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Israel.
| |
Collapse
|
4
|
Teipel R, Rieprecht S, Trautmann-Grill K, Röllig C, Klötzer C, Zimmer K, Rathaj G, Bach E, Brückner M, Heyn S, Wang SY, Jentzsch M, Schwind S, Kretschmann T, Egger-Heidrich K, Remane Y, Franke GN, von Bonin M, Bornhäuser M, Platzbecker U, Hölig K, Merz M, Vučinić V. Steady-state versus chemotherapy-based hematopoietic cell mobilization after anti-CD38-based induction therapy in newly diagnosed multiple myeloma. Transfusion 2023; 63:2131-2139. [PMID: 37850414 DOI: 10.1111/trf.17566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND The incorporation of anti-CD38 monoclonal antibodies (mAb) in induction regimens of newly diagnosed transplant-eligible multiple myeloma (MM) patients has been established as a new standard. However, the optimal strategy of stem cell mobilization in this context is not yet clear. STUDY DESIGN AND METHODS From May 2020 till September 2022, we retrospectively reviewed patients receiving anti-CD38 mAb-based induction therapy followed by stem cell mobilization either in a steady-state protocol (SSM) using 10 μg/kg granulocyte colony-stimulating factor (G-CSF) for 5 days or in a chemotherapy-based protocol (CM) using 1-4 g/m2 cyclophosphamide and G-CSF. RESULTS Overall, 85 patients (median age 61 years) were included in the analysis. In total, 90 mobilization attempts were performed, 42 with SSM and 48 with CM. There was no significant difference in the median concentration of CD34+ cells in peripheral blood (PB) prior to apheresis between SSM and CM (61/μL vs. 55.4/μL; p = .60). Cumulative CD34+ yields did not differ between the groups with median of 6.68 and 6.75 × 106 /kg body weight, respectively (p = .35). The target yield (≥4 × 106 CD34+ cells/kg body weight) was reached in 88% (CM) and 86% (SSM), with a high proportion even after a single apheresis session (76% vs. 75%). Plerixafor was found to be more frequently used in SSM (52%) than in CM (23%; p < .01). A total of 83 patients underwent autologous transplantation and all were engrafted. CONCLUSIONS Stem cell collection in patients undergoing anti-CD38-based induction therapy is feasible with either CM or SSM, although SSM more frequently requires plerixafor.
Collapse
Affiliation(s)
- Raphael Teipel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Susanne Rieprecht
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
- Pharmacy, University Leipzig Medical Center, Leipzig, Germany
| | | | - Christoph Röllig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christina Klötzer
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Kristin Zimmer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Grit Rathaj
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Enrica Bach
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Mandy Brückner
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Simone Heyn
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Song-Yau Wang
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Madlen Jentzsch
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | | | - Theresa Kretschmann
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Yvonne Remane
- Pharmacy, University Leipzig Medical Center, Leipzig, Germany
| | - Georg-Nikolaus Franke
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Malte von Bonin
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
- National Center for Tumor Disease (NCT), Dresden, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Kristina Hölig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maximilian Merz
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| | - Vladan Vučinić
- Department of Hematology, Cellular Therapy, Hemostaseology, and Infectious Diseases, University Leipzig Medical Center, Leipzig, Germany
| |
Collapse
|
5
|
de Andrade KJS, Botelho LFB, Calixto RF, de Oliveira MG, Etto LY, Loureiro LVM. Evaluation of efficacy and safety in the use of cytarabine for mobilization of hematopoietic stem cells in a reference hospital in northeastern Brazil. Hematol Transfus Cell Ther 2023:S2531-1379(23)02580-4. [PMID: 37951835 DOI: 10.1016/j.htct.2023.08.007] [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: 03/05/2023] [Revised: 07/01/2023] [Accepted: 08/13/2023] [Indexed: 11/14/2023] Open
Abstract
Autologous hematopoietic stem cell transplantation (Auto-HSCT) is widely used in the treatment of patients with hematological neoplasms. Since these cells circulate in small quantities in the periphery, the use of regimens that promote their mobilization is essential. In this study, we retrospectively evaluated the efficacy and safety of using intermediate doses of cytarabine (1.6 g/m²) + filgrastim (10 mcg/kg/day) in the mobilization of stem cells in 157 patients treated by the Unified Health System at the Hematology and Bone Marrow Transplant Service of the Hospital Real Português de Beneficência, in Recife, Pernambuco. The sample included patients with multiple myeloma (MM) (58.6 %), lymphomas (29.9 %), and other neoplasms (11.5 %). The target of 2.0 × 10 6 CD34+ cells/kg was achieved by 148 (94.3 %) patients, in most cases (84.1 %) in a single apheresis and the median number of cells collected was 9.5 × 10 6 CD34+ cells/kg. No episode of febrile neutropenia was observed, however, 79 patients (50.3 %) required platelet transfusion (no cases attributed to bleeding). The median engraftment time was 11 days. Given these results, we suggest that the use of intermediate doses of cytarabine, combined with filgrastim, is safe and effective in mobilizing hematopoietic stem cells (HSCs).
Collapse
|
6
|
Ye P, Pei R, Lian J, Chen D, Li S, Cheng Y, Li F, Yuan J, Chen Y, Lu Y. Higher efficacy of Etoposide + Cytarabine Plus Pegfilgrastim in poorly mobilizing Multiple Myeloma and lymphoma Patients. Cytotherapy 2023; 25:885-890. [PMID: 37212754 DOI: 10.1016/j.jcyt.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AIMS An optimal strategy for mobilizing hematopoietic stem cells in poorly mobilizing patients with multiple myeloma (MM) and lymphoma has not yet been determined. METHODS We retrospectively analyzed the efficacy and safety of etoposide combined with cytarabine (etoposide 75 mg/m2, daily d1∼2; Ara-C 300 mg/m2, every 12 h d1∼2), plus pegfilgrastim (6 mg d6) in 32 patients with MM or lymphoma, among whom 53.1% were defined as "proven poor mobilizers." RESULTS This approach resulted in adequate mobilization (≥2.0 × 106 CD34+ cells/kg) in 93.8% of patients and optimal mobilization (≥5.0 × 106 CD34+ cells/kg) in 71.9% of patients. A total of 100% of patients with MM reached at least 5 × 106 CD34+ cells/kg collected, the amount required for double autologous stem cell transplant. In total, 88.2% of patients with lymphoma reached at least 2 × 106 CD34+ cells/kg collected, the amount required for a single autologous stem cell transplant. This was achieved with a single leukapheresis in 78.1% of cases. A median peak number of 42.0/μL circulating CD34+ cells and a median number of blood CD34+ cells counts in 6.7 × 106/L were collected among 30 successful mobilizers. Approximately 6.3% of patients required plerixafor rescue, which was successful. Nine (28.1%) of the 32 patients suffered grade 2∼3 infections, and 50% required platelet transfusions. CONCLUSIONS We conclude that chemo-mobilization with etoposide, Ara-C and pegfilgrastim in poorly mobilizing patients with MM or lymphoma is very effective and has acceptable toxicity.
Collapse
Affiliation(s)
- Peipei Ye
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Renzhi Pei
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Jiaying Lian
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Dong Chen
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Shuangyue Li
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Yixuan Cheng
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Fenglin Li
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Jiaojiao Yuan
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Yao Chen
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China
| | - Ying Lu
- Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China; Institute of Hematology, Ningbo university, Ningbo, Zhejiang, China.
| |
Collapse
|
7
|
Day -1 CD34+ Cells and Platelet Count Predict the Number of Apheresis in Poor-Mobilizer Patients Rescued by Plerixafor. J Clin Med 2023; 12:jcm12020618. [PMID: 36675546 PMCID: PMC9866585 DOI: 10.3390/jcm12020618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Plerixafor is widely used as up-front treatment with G-CSF to enhance peripheral blood hematopoietic stem cell output in patients failing previous mobilizations. Less frequently, plerixafor is used to rescue an unsatisfactory mobilization following chemotherapy (CT) and G-CSF. This study investigates if pre-collection factors affect the CD34+ cell harvest in chemotherapy and G-CSF mobilizations rescued by plerixafor. Clinical and hematological data relative to patients, mobilization, and apheresis products were retrospectively examined. The outcome was completing a target cell dose ≥ 2 × 106 CD34+ cells/kg at first apheresis. The effect exerted on the outcome by patient- and disease-related factors was investigated by univariate and multivariate logistic regression analysis. The analysis included data from 42 patients affected by hematological (39 patients) and non-hematological malignancies (three patients). Twenty-nine patients (69%) attained the target cell dose at first apheresis. Twelve out of the remaining 13 patients received an additional plerixafor administration, and all accomplished the transplant dose at a second apheresis procedure. Day -1 CD34+ PB count (OR1.46, 95% CI 1.1-1.9, p = 0.008) and platelet count (OR1.0, 95% CI 1.0-1.0, p = 0.033) predicted the achievement of the target dose at first apheresis, independently of pre-mobilization CT, radiation therapy, and disease status at mobilization. At ROC curve analysis, the best cut-off value predicting the successful collection at first apheresis was 7.5/µL for Day -1 CD34+ cell count (AUC 0.830, 0.69 sensitivity, and 0.92 specificity) and 75 × 109/L for Day -1 platelet count (AUC = 0.736, 0.65 sensitivity and 0.85 specificity). In conclusion, on-demand plerixafor rescue allows a successful stem cell collection, irrespectively of disease type and status, prior CT lines, and radiation exposure. Pre-apheresis CD34+ cells and platelet count predict the need for one or two aphereses.
Collapse
|
8
|
Lemonakis K, Tätting L, Lisak M, Carlson K, Crafoord J, Blimark CH, Santamaria AI, Wichert S, Lenhoff S, Hansson M. Impact of daratumumab-based induction on stem cell collection parameters in Swedish myeloma patients. Haematologica 2022; 108:610-614. [PMID: 36200424 PMCID: PMC9890000 DOI: 10.3324/haematol.2022.281610] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
| | - Love Tätting
- Department of Hematology, University Hospital Linköping, Linköping
| | - Mikael Lisak
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Jacob Crafoord
- Department of Hematology, Örebro University Hospital, Örebro
| | - Cecilie H Blimark
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| | | | - Stina Wichert
- Department of Hematology, Skåne University Hospital, Lund
| | - Stig Lenhoff
- Department of Hematology, Skåne University Hospital, Lund
| | - Markus Hansson
- Department of Hematology, Sahlgrenska University Hospital, Gothenburg
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Yang C, Dehghani M, Hopman W, Bhella S. Are we choosing mobilization regimens for autologous stem cell transplantation in multiple myeloma wisely: A single center comparison of GCSF+/-plerixafor vs cyclophosphamide/GCSF+/-plerixafor. J Clin Apher 2022; 37:348-353. [PMID: 35218068 DOI: 10.1002/jca.21976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) is a standard consolidation treatment for eligible patients with multiple myeloma (MM). There is no standardized mobilization regimen for collection of CD34+ stem cells, which is crucial to the success of ASCT. Cyclophosphamide/GCSF is an effective regimen, although reported associated toxicities include risk of febrile neutropenia (FN). Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. This single center, retrospective, quality improvement study evaluates mobilization and ASCT outcomes of MM patients who had undergone stem cell mobilization at KHSC with cyclophosphamide/GCSF+/-plerixafor without antibiotics, cyclophosphamide/GCSF+/-plerixafor with antibiotics, and GCSF+/-plerixafor without antibiotics. METHODS A retrospective chart review was conducted evaluating 137 patients. The primary outcome measure was FN rates with mobilization. Balancing measures include CD34+ cell collected, plerixafor usage, days of apheresis and transplant outcomes. Chi-square, ANOVA, or Kruskal-Wallis methods were used to test statistical significance where appropriate. RESULTS Our study noted a higher total and day one CD34+ count in the two groups utilizing cyclophosphamide in mobilization. All nine cases of FN occurred in these two groups (P < .05). Addition of antibiotics decreased, but did not eliminate risk of FN. There were no significant differences in the rate of plerixafor usage and number of apheresis days. Difference in transplant outcomes, including engraftment and transfusion support, were statistically but not clinically significant. A larger sample size may be needed to explore this fully. There was no significant difference in length of transplant hospital stay. CONCLUSION The elimination of cyclophosphamide from mobilization regimens for MM appears to significantly reduce FN rates, without increasing balancing measures such as total number of apheresis days, plerixafor usage, duration of transplant hospitalization or mortality outcomes.
Collapse
Affiliation(s)
- Chloe Yang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Dehghani
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Dijkstra S, Kraal KCJM, Tytgat GAM, van Noesel MM, Wijnen MHWA, Hoogerbrugge PM. Use of quality indicators in neuroblastoma treatment: A feasibility assessment. Pediatr Blood Cancer 2021; 68:e28301. [PMID: 32735384 DOI: 10.1002/pbc.28301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality indicators (QIs) may be used to monitor the quality of neuroblastoma (NBL) care during treatment, in addition to survival and treatment toxicity, which can only be evaluated in the years after treatment. The present study aimed to assess the feasibility of a new set of indicators for the quality of NBL therapy. PROCEDURE Seven QIs have been proposed based on literature and consensus of experts: (a) duration of complete diagnostic work-up, (b) prescription of thyroid prophylaxis before metaiodobenzylguanidine imaging, (c) treatment intensity, (d) use of tumor board meetings, (e) number of outpatient visits and sedation procedures during follow-up, (f) protocolled follow-up, and (g) required apheresis sessions. A retrospective data analysis from October 2014 to November 2017 including all patients with NBL in the centralized Princess Máxima Center in the Netherlands was performed to assess these parameters and determine practicality of measurement. RESULTS A total number of 72 patients (aged between 2 weeks and 15 years) were analyzed. Adherence to all QIs could be determined for all eligible patients using their electronic medical records. Three indicators were compared over time, and an increase in adherence was observed. CONCLUSIONS Assessment of QIs in neuroblastoma treatment is feasible. Seven new QIs were found to be feasible to measure and showed improvement over time for three indicators. Monitoring of these QIs during treatment may provide tools for quality improvement activities and comparisons of treatment quality over time or between centers. Further study is required to investigate their association with long-term outcomes.
Collapse
Affiliation(s)
- Suzan Dijkstra
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Kathelijne C J M Kraal
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Godelieve A M Tytgat
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max M van Noesel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Peter M Hoogerbrugge
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
12
|
Demiroğlu H, Çiftçiler R, Büyükaşık Y, Göker H. Prediction of Stem Cell Mobilization Failure in Patients with Hodgkin and Non-Hodgkin Lymphoma. Turk J Haematol 2021; 38:204-210. [PMID: 33161684 PMCID: PMC8386314 DOI: 10.4274/tjh.galenos.2020.2020.0409] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: Autologous stem cell transplantation (ASCT) is a significant and potentially curative treatment modality for patients with relapsed/refractory lymphoma. Insufficient mobilization and harvest of peripheral stem cells can be a major obstacle for performing ASCT. The aim of this study was to evaluate the factors that might influence mobilization failure in patients with lymphoma. Materials and Methods: Eighty-seven patients diagnosed with non-Hodgkin and Hodgkin lymphoma who underwent stem cell mobilization afterwards at the Hacettepe University Medical School Bone Marrow Transplantation Center, Turkey, between the years of 2000 and 2018 were evaluated. Results: A total of 87 patients were included in this study. In 66 of 87 patients (75.9%), the first mobilization trial was successful. Adequate (≥2x106/kg) CD34+ cells were collected in the first apheresis for 66 patients (9.5±8.1). For 21 of 87 (24.1%), the first mobilization trial was unsuccessful. Therefore, a second mobilization trial was performed for these patients with plerixafor (5.5±3.3). The number of CD34+ cells was significantly higher in patients who were successful in the first mobilization (p=0.002). Conclusion: The success rate of the first mobilization trial was found to be higher in patients with high platelet counts before mobilization and patients who received chemotherapy-based mobilization protocols. In the patients who had mobilization failure in the first trial, plerixafor was used in a later mobilization, and those patients had an adequate amount of stem cells for ASCT. Parameters predicting mobilization failure would allow for preemptive, more cost-effective use of such agents during the first mobilization attempt; however, risk factors for mobilization failure are still not clear.
Collapse
Affiliation(s)
- Haluk Demiroğlu
- Hacettepe University Faculty of Medicine, Departments of Hematology, Ankara, Turkey
| | - Rafiye Çiftçiler
- Hacettepe University Faculty of Medicine, Departments of Hematology, Ankara, Turkey
| | - Yahya Büyükaşık
- Hacettepe University Faculty of Medicine, Departments of Hematology, Ankara, Turkey
| | - Hakan Göker
- Hacettepe University Faculty of Medicine, Departments of Hematology, Ankara, Turkey
| |
Collapse
|
13
|
Uzoka C, Liu LC, Park Y, Lin Y, Patel P, Campbell-Lee S, Sweiss K, Wang X, Tepak E, Peace D, Saraf S, Rondelli D, Mahmud N. Race/ethnicity and underlying disease influences hematopoietic stem/progenitor cell mobilization response: A single center experience. J Clin Apher 2021; 36:634-644. [PMID: 34046928 DOI: 10.1002/jca.21914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Whether race/ethnicity plays a role in hematopoietic stem/progenitor cells (HSPC) mobilization in autologous donors has not been studied. We hypothesize that donor characteristic including race/ethnicity, age, sex, body mass index, and diagnostic groups influences HSPC mobilization. Diagnostic groups include healthy allogeneic donors, autologous multiple myeloma (MM) and non-MM donors. STUDY DESIGN AND METHODS Here, we conducted a single-center retrospective study in 64 autologous patients and 48 allogeneic donors. Autologous donors were patients diagnosed with MM or non-MM. All donors were grouped as African American (AA), White (W), or "Other"(O). RESULTS Multivariate analysis demonstrated diagnostic group differences for CD34+ cell yields between race/ethnicity. Specifically, non-MM patients had the lowest CD34+ cell yields in AA and O, but not in W. For pre-apheresis peripheral blood (PB) CD34+ cell numbers, race/ethnicity had a significant effect both in bivariate and multivariate analyses. Non-MM patients had the lowest, and AA patients had the highest PB CD34+ cells. The results support the view that past therapies used in MM are likely more conducive of recovery of HSPC. CONCLUSIONS Our study shows that race/ethnicity and diagnostic group differences influenced CD34+ cell mobilization response across donor types. Interestingly, autologous MM donors with the aid of plerixafor displayed comparable CD34 yields to allogeneic donors. Even though both MM and non-MM donors received plerixafor, non-MM donors had significantly lower CD34 yields among AA and O donors but not in W donors. Larger studies would be required to validate the role of diagnostic groups and race/ethnicity interactions.
Collapse
Affiliation(s)
- Chukwuemeka Uzoka
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Li C Liu
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Youngmin Park
- Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Yuankai Lin
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Pritesh Patel
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Sally Campbell-Lee
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Karen Sweiss
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xinhe Wang
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elena Tepak
- Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - David Peace
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Santosh Saraf
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Damiano Rondelli
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Nadim Mahmud
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA.,Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| |
Collapse
|
14
|
Ferdjallah A, Young JAH, MacMillan ML. A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Front Pediatr 2021; 9:634449. [PMID: 34386464 PMCID: PMC8353083 DOI: 10.3389/fped.2021.634449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.
Collapse
Affiliation(s)
- Asmaa Ferdjallah
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Transplant Infectious Disease, University of Minnesota, Minneapolis, MN, United States
| | - Margaret L MacMillan
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
15
|
Tang C, Espin-Garcia O, Prica A, Kurkreti V, Kridel R, Keating A, Patriquin CJ, Kuruvilla J, Crump M. Efficacy and safety of stem cell mobilization following gemcitabine, dexamethasone, cisplatin (GDP) salvage chemotherapy in patients with relapsed or refractory lymphoma. Leuk Lymphoma 2020; 61:2153-2160. [PMID: 32482114 DOI: 10.1080/10428194.2020.1762882] [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] [Indexed: 10/24/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplant (ASCT) remains a cornerstone of treatment in relapsed/refractory (R/R) aggressive-histology lymphomas. This retrospective study examined efficacy and safety of peripheral blood stem cell (PBSC) mobilization using cyclophosphamide/etoposide and GCSF (CE + GCSF, n = 129) versus gemcitabine, dexamethasone and cisplatin and GCSF (GDP + GCSF, n = 210). All patients received first salvage with GDP. Patients mobilized with CE + GCSF required fewer days of leukapheresis (median 1 vs 2 day; p = .001) and achieved higher total CD34+ yield than GDP + GCSF patients (8.5 vs 7.1 × 106 CD34+ cells/kg, p = .001). Rates of febrile neutropenia and CD34+ collection ≥5 × 106 CD34+ cells/kg were similar (OR 1.19, 95% CI: 0.54-2.6, p = .66). In multivariable analysis, days to engraftment and admission duration were not statistically different between the two mobilization strategies. While CE + GCSF appeared more efficacious for mobilization after GDP salvage, this did not translate to significant differences in clinical outcomes.
Collapse
Affiliation(s)
- Catherine Tang
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Anca Prica
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Vishal Kurkreti
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Kridel
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Armand Keating
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Christopher J Patriquin
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada.,Toronto General Hospital, Toronto, Canada
| | - John Kuruvilla
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Michael Crump
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| |
Collapse
|
16
|
Cowan AJ, Green DJ, Karami M, Becker PS, Tuazon S, Coffey DG, Hyun TS, Libby EN, Gopal AK, Holmberg LA. KRD-PACE Mobilization for Multiple Myeloma Patients With Significant Residual Disease Before Autologous Stem-Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:602-609. [PMID: 32457024 DOI: 10.1016/j.clml.2020.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/11/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Bortezomib has been incorporated into thalidomide and dexamethasone provided with cisplatin, doxorubicin, cyclophosphamide, and etoposide (PACE) as an intensive regimen before autologous stem-cell transplantation for multiple myeloma (MM). We examined MM patients at our center who received chemomobilization with a regimen that substituted carfilzomib and lenalidomide for bortezomib and thalidomide (KRD-PACE). PATIENTS AND METHODS This was a retrospective study of 27 MM patients who received KRD-PACE for chemomobilization. Our analysis included patients who had circulating plasma cells (CPCs) by flow cytometry, ≥ 10% bone marrow plasma cells (BMPC), a monoclonal protein ≥ 1 g/dL, or an involved serum free light chain ≥ 10 mg/dL. RESULTS The most common indication for KRD-PACE was BMPC ≥ 10% in 16 patients (60%), followed by CPCs in 11 (41%). The median (range) age was 61 (35-69) years, and the median (range) BMPC before treatment was 10% (5%-47%). The overall response rate was 43%, and a median (range) of 20.24 (8.08-69.88) × 106 CD34+ cells/kg were collected. CPC clearance rate was 50%, and the median reduction in BMPC was 75%. Two patients had sinus bradycardia and 5 (19%) had neutropenic fever. CONCLUSION KRD-PACE is an effective therapy to mobilize peripheral blood stem cells in MM patients with residual disease burden. This regimen was successful at clearing CPCs and reducing BMPC burden, with an overall response rate of 43%. Despite theoretical concern regarding the combination of 3 cardiotoxic agents, we observed a low frequency of cardiac issues.
Collapse
Affiliation(s)
- Andrew J Cowan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Damian J Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Mehdi Karami
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Pamela S Becker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; Division of Hematology, Department of Medicine, University of Washington, Seattle, WA
| | - Sherilyn Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - David G Coffey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Teresa S Hyun
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pathology, University of Washington, Seattle, WA
| | - Edward N Libby
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Ajay K Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA
| | - Leona A Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA.
| |
Collapse
|
17
|
Furlong E, Jensen J, Woodard M, Griffiths K, Knight G, Sturm M, Kerr F, Gough H, Bear N, Carter TL, Cole CH, Kotecha RS, Ramachandran S. Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies. Pediatr Transplant 2020; 24:e13602. [PMID: 31631445 DOI: 10.1111/petr.13602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/15/2019] [Accepted: 09/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. PATIENTS/METHODS A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. RESULTS Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. CONCLUSION Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.
Collapse
Affiliation(s)
- Eliska Furlong
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Jesper Jensen
- PathWest Laboratory Medicine WA, Perth, WA, Australia
| | - Mark Woodard
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Katherine Griffiths
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Geoff Knight
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Marian Sturm
- Cell and Tissue Therapy, Royal Perth Hospital, Perth, WA, Australia
| | - Fiona Kerr
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Hazel Gough
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Perth Children's Hospital, Perth, WA, Australia
| | - Tina L Carter
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,PathWest Laboratory Medicine WA, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Catherine H Cole
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia.,Paediatric Haematology and Oncology, Sidra Medicine, Doha, Qatar
| | - Rishi S Kotecha
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia.,Division of Children's Leukaemia and Cancer Research, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Shanti Ramachandran
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
18
|
Zhu J, Hao SG, Hu J, Zhuang JL, Wang C, Bai HT. rhTPO combined with chemotherapy and G-CSF for autologous peripheral blood stem cells in patients with refractory/relapsed non-Hodgkin's lymphoma. Cancer Manag Res 2019; 11:8371-8377. [PMID: 31571993 PMCID: PMC6750872 DOI: 10.2147/cmar.s219242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The mobilization and collection of sufficient autologous peripheral blood stem cells (APBSCs) are important for the fast and sustained reconstruction of hematopoietic function after autologous transplantation. This study aims to evaluate the mobilization effect and safety of thrombopoietin (TPO) combined with chemotherapy + G-CSF for APBSCs in patients with refractory/relapsed non-Hodgkin’s lymphoma. Methods A total of 78 patients were included in the present study. After receiving mobilization chemotherapy, all patients were randomly divided into two groups: TPO group (n=40), patients were given subcutaneous injection of rhTPO + G-CSF, and control group (n=38), patients were given subcutaneous injection of G-CSF. The primary endpoint was the total number of obtained CD34+ cells. The secondary endpoints were the mononuclear cell count, the proportion of target and minimum mobilization, the engraftment time of neutrophils and platelets after APBSCT, the number of platelet and red blood cell infusions, the incidence of infectious fever and fever duration, and TPO-related side effects in patients. Results TPO participation significantly increased the total CD34+ cell count. A higher proportion of patients in the TPO group achieved the minimum and target CD34+ cells, when compared to the control group. TPO-related adverse events were not observed in either of these groups. In addition, there were no significant differences in engraftment time, the number of platelet and red blood cell transfusions, the incidence of infectious fever, and fever duration between these two groups. Conclusion TPO combined with chemotherapy + G-CSF can safely and effectively enhance the mobilization effect for APBSCs in patients with refractory/relapsed non-Hodgkin’s lymphoma.
Collapse
Affiliation(s)
- Jun Zhu
- Department of Haematology, Shanghai General Hospital, Shanghai 200080, People's Republic of China
| | - Si-Guo Hao
- Department of Haematology, Shanghai Jiaotong University Affiliated Xinhua Hospital, Shanghai 200092, People's Republic of China
| | - Jiong Hu
- Department of Haematology, Shanghai Jiaotong University Affiliated Ruijing Hospital, Shanghai 200020, People's Republic of China
| | - Jing-Li Zhuang
- Department of Haematology, Fudan University Affiliated Zhongshan Hospital, Shanghai 200032, People's Republic of China
| | - Chun Wang
- Department of Haematology, Shanghai General Hospital, Shanghai 200080, People's Republic of China
| | - Hai-Tao Bai
- Department of Haematology, Shanghai General Hospital, Shanghai 200080, People's Republic of China
| |
Collapse
|
19
|
Al Hamed R, Bazarbachi AH, Malard F, Harousseau JL, Mohty M. Current status of autologous stem cell transplantation for multiple myeloma. Blood Cancer J 2019; 9:44. [PMID: 30962422 PMCID: PMC6453900 DOI: 10.1038/s41408-019-0205-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
More than 30 years after its introduction, autologous stem cell transplantation (ASCT) remains the standard of care for young patients with newly diagnosed multiple myeloma. Not only did the arrival of novel agents such as immunomodulatory drugs (IMiDs), proteasome inhibitors (PI) and monoclonal antibodies not replace ASCT, instead they solidified its central role as standard of care. Novel agent use is now inarguably essential in induction, maintenance, and possibly consolidation. In light of these new advancements, new challenges arise in deciding on optimal practice. Who is most suited to undergo ASCT? Is there an age threshold that should not be surpassed? Should transplantation be embarked on early or is it reasonable to delay it? What are the optimal induction, consolidation, and maintenance therapies? What is the role of tandem transplantation in the era of novel agents and where do patient-specific cytogenetics come into the equation when deciding on treatment? These are some of the questions addressed in this review which we will attempt to answer with the latest currently available data.
Collapse
Affiliation(s)
- Rama Al Hamed
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Abdul Hamid Bazarbachi
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Florent Malard
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France
| | - Jean-Luc Harousseau
- Institut de Cancerologie de l'Ouest, Centre René Gauducheau, Nantes-St Herblain, France
| | - Mohamad Mohty
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938 and université Sorbonne, Paris, France.
| |
Collapse
|
20
|
Czerw T, Sadus-Wojciechowska M, Michalak K, Najda J, Mendrek W, Sobczyk-Kruszelnicka M, Glowala-Kosinska M, Chwieduk A, Mitrus I, Smagur A, Holowiecki J, Giebel S. Increased Efficacy of Stem Cell Chemomobilization with Intermediate-Dose Cytarabine Plus Granulocyte Colony-Stimulating Factor (G-CSF) Compared with G-CSF Alone in Patients with Multiple Myeloma: Results of a Randomized Trial. Biol Blood Marrow Transplant 2019; 25:248-255. [DOI: 10.1016/j.bbmt.2018.09.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/16/2018] [Indexed: 12/27/2022]
|
21
|
Plerixafor for patients who fail cytokine-or chemotherapy-based stem cell mobilization: Results of a prospective study by the Polish Lymphoma Research Group (PLRG). ACTA ACUST UNITED AC 2018. [DOI: 10.2478/ahp-2018-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractAutologous hematopoietic stem cell transplantation (autoHSCT) requires collection of sufficient number of hematopoietic stem cells. The goal of this study was to evaluate efficacy of plerixafor used in patients with lymphoid malignancies failing conventional stem cell mobilization.This was a prospective, non-interventional study. All consecutive patients (n = 109) treated with plerixafor in 11 centers were reported. The drug was used either in case of previous mobilization failure (n = 67) or interventionally, in case of insufficient CD34+ cell output during current mobilization (n = 42). Successful mobilization was defined as resulting in collection of ≥ 2 × 106 CD34+ cells/kg for single autoHSCT or ≥ 4 × 106 CD34+ cells/kg for double procedure.The overall rate of successful mobilization was 55% (55% for single and 56% for double autoHSCT). The median total number of collected CD34+ cells/kg was 2.4 (range, 0-11.5) for patients intended for a single transplantation while 4.0 (0.6-16.9) for double procedure. The number of circulating CD34+ cells increased after the use of plerixafor regardless of baseline values. The median fold increase was 3.3 (0.3-155). Data from this observational study confirm high efficacy of plerixafor used in routine clinical practice as salvage for patients with lymphoid malignancies failing conventional stem cell mobilization.
Collapse
|
22
|
Cytarabine + G-CSF is more effective than cyclophosphamide + G-CSF as a stem cell mobilization regimen in multiple myeloma. Bone Marrow Transplant 2018; 54:1107-1114. [DOI: 10.1038/s41409-018-0396-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/03/2018] [Accepted: 11/01/2018] [Indexed: 01/06/2023]
|
23
|
Peripheral blood stem cell mobilisation with G-CSF alone versus G-CSF and cyclophosphamide after bortezomib, cyclophosphamide and dexamethasone induction in multiple myeloma. Bone Marrow Transplant 2018. [DOI: 10.1038/s41409-018-0152-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Dogu MH, Batgi H, Erkurt MA, Hacioglu S, Tekgunduz E, Kaya E, Iskender D, Eren R, Kuku I, Altuntas F. Stem cell mobilization kinetics in elderly patients with multiple myeloma. Transfus Apher Sci 2018; 57:204-207. [PMID: 29439920 DOI: 10.1016/j.transci.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/17/2017] [Accepted: 01/23/2018] [Indexed: 11/15/2022]
Abstract
In this study, we aimed to investigate whether the procedure and product kinetics differ according to age groups in advanced-age MM patients who underwent autologous HSCT. 59 patients who underwent autologous HSCT were retrospectively analyzed. Then, the patients were divided into two groups as 60-65 years and ≥65 years. It was significantly lower in ≥65 years group (p = 0.008) and proportionally, the procedure duration was also significantly shortened in this group (p = 0.013). Total number of collected CD34 positive stem cells was 6.20 × 106 (±3.83) in 60-65 years group while it was 5.51 × 106 (±2.48) in ≥65 years group with no statistically significant difference (p = 0.825). In conclusion, there was no significant difference in terms of the number of collected CD34-positive stem cells in this study that investigates the mobilization data, procedure and product kinetics, we think that successful stem cell mobilization can be performed in appropriately selected patients regardless of age.
Collapse
Affiliation(s)
- Mehmet Hilmi Dogu
- Istanbul Education and Research Hospital, Hematology Clinic, Istanbul, Turkey.
| | - Hikmetullah Batgi
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Mehmet Ali Erkurt
- Department of Hematology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Sibel Hacioglu
- Department of Hematology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Emre Tekgunduz
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Emin Kaya
- Department of Hematology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Dicle Iskender
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Rafet Eren
- Istanbul Education and Research Hospital, Hematology Clinic, Istanbul, Turkey
| | - Irfan Kuku
- Department of Hematology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Fevzi Altuntas
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| |
Collapse
|
25
|
Nishiwaki S, Sugiura I, Miyata Y, Saito S, Sawa M, Nishida T, Miyamura K, Kuwatsuka Y, Kohno A, Yuge M, Kasai M, Iida H, Kurahashi S, Osaki M, Goto T, Terakura S, Murata M, Nishikawa H, Kiyoi H. Efficacy and safety of autologous peripheral blood stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia: A study protocol for a multicenter exploratory prospective study (Auto-Ph17 study). Medicine (Baltimore) 2017; 96:e9568. [PMID: 29384978 PMCID: PMC6393033 DOI: 10.1097/md.0000000000009568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The prognosis of Philadelphia chromosome positive acute lymphoblastic leukemia (Ph + ALL) has been dramatically improved since the introduction of tyrosine kinase inhibitors (TKIs). Although allogeneic hematopoietic cell transplantation (allo-HCT) is a major treatment option, the role of autologous peripheral blood stem cell transplantation (auto-PBSCT) has been reconsidered, especially in patients who achieved early molecular remission. METHODS AND ANALYSIS This is a multicenter exploratory study for Ph + ALL patients aged between 55 and 70 years who achieved complete molecular remission within 3 cycles of chemotherapy. The target sample size is 5, and the registration period is 2 years. The primary endpoint is Day100- mortality after transplantation, and the secondary endpoints are survival, relapse rate, nonrelapse mortality, and adverse events.This study is divided into 3 phases: peripheral blood stem cell harvest, transplantation, and maintenance. Chemomobilization is performed using a combination of cyclophosphamide (CPM), doxorubicin, vincristine (VCR), and prednisolone (PSL). As a preparative regimen, the LEED regimen is used, which consists of melphalan, CPM, etoposide, and dexamethasone. Twelve cycles of maintenance therapy using a combination of VCR, PSL, and dasatinib are performed.In association with relapse, the minimal residual disease (MRD) of BCR-ABL chimeric gene and T-cell subsets are analyzed both before and after auto-PBSCT. ETHICS AND DISSEMINATION The protocol was approved by the institutional review board of Nagoya University Hospital and all the participating hospitals. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. Results of the study will be disseminated via publications in peer-reviewed journals. TRIAL REGISTRATION Trial registration number UMIN000026445.
Collapse
Affiliation(s)
- Satoshi Nishiwaki
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya
| | - Isamu Sugiura
- Division of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi
| | - Yasuhiko Miyata
- Department of Hematology, National Hospital Organization Nagoya Medical Center
| | - Shigeki Saito
- Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya
| | - Masashi Sawa
- Department of Hematology, Anjo Kosei Hospital, Anjo
| | - Tetsuya Nishida
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya
| | - Yachiyo Kuwatsuka
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya
| | - Akio Kohno
- Department of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan
| | - Masaaki Yuge
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya
| | - Masanobu Kasai
- Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya
| | - Hiroatsu Iida
- Department of Hematology, National Hospital Organization Nagoya Medical Center
| | - Shingo Kurahashi
- Division of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi
| | - Masahide Osaki
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya
| | - Tatsunori Goto
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Hiroyoshi Nishikawa
- Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| |
Collapse
|
26
|
Abstract
In contemporary clinical practice, almost all allogeneic transplantations and autologous transplantations now capitalize on peripheral blood stem cells (PBSCs) as opposed to bone marrow (BM) for the source of stem cells. In this context, granulocyte colony-stimulating factor (G-CSF) plays a pivotal role as the most frequently applied frontline agent for stem cell mobilization. For patients classified as high-risk, chemotherapy based mobilization regimens can be preferred as a first choice and it is notable that this also used for remobilization. Mobilization failure occurs at a rate of 10%-40% with traditional strategies and it typically leads to low-efficiency practices, resource wastage, and delayed in treatment intervention. Notably, however, several factors can impact the effectiveness of CD34+ progenitor cell mobilization, including patient age and medical history (prior chemotherapy or radiotherapy, disease and marrow infiltration at the time of mobilization). In recent years, main (yet largely ineffective) approach was to increase G-CSF dose and add SCF, but novel and promising pathways have been opened up by the synergistic impact of a reversible inhibitor of CXCR4, plerixafor, with G-CSF. The literature shows to its favorable results in upfront and failed mobilizers, and it is necessary to use plerixafor (or equivalent agents) to optimize HSC harvest in poor mobilizers. Different CXCR4 inhibitors, growth hormone, VLA4 inhibitors, and parathormone, have been cited as new agents for mobilization failure in recent years. In view of the above considerations, the purpose of this paper is to examine the mobilization of PBSC while focusing specifically on poor mobilizers.
Collapse
Affiliation(s)
- Sinem Namdaroglu
- Izmir Bozyaka Training and Research Hospital, Department of Hematology, Izmir, Turkey.
| | - Serdal Korkmaz
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey
| | - Fevzi Altuntas
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey; Yıldırım Beyazıt University, Medical Faculty, Department of Hematology, Ankara, Turkey
| |
Collapse
|
27
|
Dale DC, Crawford J, Klippel Z, Reiner M, Osslund T, Fan E, Morrow PK, Allcott K, Lyman GH. A systematic literature review of the efficacy, effectiveness, and safety of filgrastim. Support Care Cancer 2017; 26:7-20. [PMID: 28939926 PMCID: PMC5827957 DOI: 10.1007/s00520-017-3854-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
Purpose Filgrastim (NEUPOGEN®) is the originator recombinant human granulocyte colony-stimulating factor widely used for preventing neutropenia-related infections and mobilizing hematopoietic stem cells. This report presents findings of a systematic literature review and meta-analysis of efficacy and safety of originator filgrastim to update previous reports. Methods A literature search of electronic databases, congress abstracts, and bibliographies of recent reviews was conducted to identify English-language reports of clinical trials and observational studies evaluating filgrastim in its US-approved indications up to February 2015. Two independent reviewers assessed titles/abstracts and full texts of publications, and extracted data from studies that compared originator filgrastim vs placebo or no treatment. For outcomes with sufficient homogeneous data reported across studies, meta-analysis was performed and relative risk (RR) determined. Data were summarized descriptively for all other evaluated outcomes. Results A total of 1194 unique articles evaluating originator filgrastim were identified, with 25 meeting eligibility criteria for data extraction: 18 randomized controlled trials, 2 nonrandomized clinical trials, and 5 observational studies. In chemotherapy-induced neutropenia (CIN), filgrastim vs placebo or no treatment significantly reduced febrile neutropenia incidence (RR 0.63, 95% CI 0.53–0.75) and grade 3 or 4 neutropenia incidence (RR 0.50, 95% CI 0.37–0.68). The most commonly reported adverse event (AE) with filgrastim was bone pain (RR 2.61, 95% CI 1.29–5.27 in CIN). Additional efficacy and safety outcomes are described within indications. Conclusions This systematic literature review and meta-analysis confirms and updates previous reports on the efficacy and safety of originator filgrastim. Bone pain was the commonly reported AE associated with filgrastim use. Electronic supplementary material The online version of this article (10.1007/s00520-017-3854-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Jeffrey Crawford
- Duke Cancer Institute, Duke University Medical Center, 30 Duke Medicine Circle, Duke South 25177 Morris Bldg, Durham, NC, 27710, USA
| | - Zandra Klippel
- Clinical Development, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Maureen Reiner
- Global Biostatistical Sciences, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Timothy Osslund
- Pre-Pivotal Drug Product Technologies, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Ellen Fan
- Global Scientific Affairs, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Phuong Khanh Morrow
- Clinical Development, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Kim Allcott
- Oxford PharmaGenesis Ltd, Tubney Warren Barn, Tubney, Oxford, OX13 5QJ, UK
| | - Gary H Lyman
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Public Health Sciences Division and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| |
Collapse
|
28
|
Abstract
Peripheral blood stem cell collection is an effective approach to obtain a hematopoietic graft for stem cell transplantation. Developing hematopoietic stem/progenitor cell (HSPC) mobilization methods and collection algorithms have improved efficiency, clinical outcomes, and cost effectiveness. Differences in mobilization mechanisms may change the HSPC content harvested and result in different engraftment kinetics and complications. Patient-specific factors can affect mobilization. Incorporating these factors in collection algorithms and improving assays for evaluating mobilization further extend the ability to obtain sufficient HSPCs for hematopoietic repopulation. Technological advance and innovations in leukapheresis have improved collection efficiency and reduced adverse effects.
Collapse
Affiliation(s)
- Yen-Michael S Hsu
- Pathology and Laboratory Medicine, Transfusion Medicine and Cellular Therapy, Weill Cornell Medical College, 525 East 68th Street, Box 251, New York, NY 10065, USA.
| | - Melissa M Cushing
- Transfusion Medicine and Cellular Therapy, Weill Cornell Medical College, 525 East 68th Street, Box 251, M09, New York, NY 10065, USA.
| |
Collapse
|
29
|
Baertsch MA, Schlenzka J, Lisenko K, Krzykalla J, Becker N, Weisel K, Noppeney R, Martin H, Lindemann HW, Haenel M, Nogai A, Scheid C, Salwender H, Fenk R, Graeven U, Reimer P, Schmidt-Hieber M, Goerner M, Schmidt-Wolf IGH, Klein S, Ho AD, Goldschmidt H, Wuchter P. Cyclophosphamide-based stem cell mobilization in relapsed multiple myeloma patients: A subgroup analysis from the phase III trial ReLApsE. Eur J Haematol 2017; 99:42-50. [PMID: 28370401 DOI: 10.1111/ejh.12888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Analysis of the efficiency and toxicity of cyclophosphamide-based stem cell mobilization in patients with relapsed multiple myeloma (RMM). METHODS Peripheral blood stem cells (PBSCs) were mobilized with high dose cyclophosphamide (2 g/m2 daily on days 1 and 2) and G-CSF plus pre-emptive/rescue plerixafor in RMM patients (first to third relapse) treated within the ReLApsE trial of the German-Speaking Myeloma Multicenter Group (GMMG). RESULTS Mobilization was initiated with high-dose cyclophosphamide (HD-CY) and G-CSF in 30 patients. Fifteen patients received additional pre-emptive/rescue administration of plerixafor. Stem cell collection was successful (≥2×106 CD34+ cells per kg bw) in 77% (23/30 patients). Patients with prior high-dose melphalan collected a significantly lower median total number of PBSCs than patients without prior high-dose melphalan (3.3×106 vs 17×106 CD34+ cells/kg bw). Toxicity of HD-CY was frequent with 12 serious adverse events (SAE) in 37% of patients (11/30 patients). Infections accounted for the majority of SAE reports. In two patients, SAEs were lethal (septic shock). CONCLUSIONS These data proof feasibility of PBSC collection at relapse but emphasize the importance of collection and storage of additional PBSC transplants during first-line treatment when mobilization is more efficient and less toxic.
Collapse
Affiliation(s)
| | - Jana Schlenzka
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Lisenko
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Krzykalla
- Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Natalia Becker
- Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Katja Weisel
- Hematology, Oncology and Immunology, University of Tuebingen, Tuebingen, Germany
| | | | - Hans Martin
- Hematology and Oncology, Goethe University, Frankfurt, Germany
| | - Hans W Lindemann
- Hematology and Oncology, Kath. Krankenhaus Hagen gem. GmbH - St.-Marien-Hospital, Hagen, Germany
| | - Mathias Haenel
- Hematology, Oncology and Stem Cell Transplantation, Klinikum Chemnitz GmbH, Chemnitz, Germany
| | - Axel Nogai
- Internal Medicine III, Charité Campus Benjamin Franklin, Berlin, Germany
| | | | - Hans Salwender
- Hematology, Oncology and Palliative Care, Asklepios Klinik Altona, Hamburg, Germany
| | - Roland Fenk
- Hematology, Oncology and Clinical Immunology, University of Duesseldorf, Duesseldorf, Germany
| | - Ullrich Graeven
- Hematology, Oncology and Gastroenterology, Maria-Hilf-Krankenhaus, Mönchengladbach, Germany
| | - Peter Reimer
- Hematology, Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden gGmbH, Essen, Germany
| | | | - Martin Goerner
- Hematology, Oncology and Palliative Care, Community Hospital Bielefeld, Bielefeld, Germany
| | - Ingo G H Schmidt-Wolf
- Center for Integrated Oncology, Med. Klinik III, University Hospital Bonn, Bonn, Germany
| | - Stefan Klein
- Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Anthony D Ho
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Wuchter
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| |
Collapse
|
30
|
Kondo E. Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma. J Clin Exp Hematop 2017; 56:100-108. [PMID: 27980299 DOI: 10.3960/jslrt.56.100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
High-dose chemotherapy supported by autologous stem cell support/transplantation (HDT/ASCT) has been a standard of care over the last two decades in patients with relapsed or refractory(R/R) diffuse large B-cell lymphoma (DLBCL), which is sensitive to salvage chemotherapy. HDT/ASCT for high-risk DLBCL in upfront setting remains controversial, so it is not recommended for clinical practice. Various promising salvage chemotherapy regimens have been reported in phase 2 studies; however, two large randomized phase 3 studies showed similar efficacy of R-ICE vs. R-DHAP and R-GDP vs. R-DHAP. Since the registry data shows feasibility and efficacy of HDT/ASCT in elderly R/R DLBCL patients, older age (> 65 years) itself is not a contraindication for HDT/ASCT. Rituximab maintenance failed to demonstrate a significant benefit compared with observation only after HDT/ASCT. While sensitive R/R DLBCL might be cured by HDT/ASCT even in third-line therapy, the prognosis of insensitive R/R DLBCL is extremely poor. Further study to establish treatment strategies for high-risk patients defined by prognostic factors or biomarkers, and insensitive patients is warranted.
Collapse
Affiliation(s)
- Eisei Kondo
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| |
Collapse
|
31
|
Gettys SC, Gulbis A, Wilhelm K, Sasaki K, Dinh Y, Rondon G, Qazilbash MH. Modified CVAD and modified CBAD compared to high-dose cyclophosphamide for peripheral blood stem cell mobilization in patients with multiple myeloma. Eur J Haematol 2017; 98:388-392. [PMID: 28009447 DOI: 10.1111/ejh.12843] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The optimal regimen for peripheral blood stem cell (PBSC) mobilization in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (auto-HCT) has not been established. Experience at The University of Texas MD Anderson Cancer Center suggests in addition to single-agent cyclophosphamide (Cy), modified cyclophosphamide, vincristine, doxorubicin, and dexamethasone (mCVAD), and modified cyclophosphamide, bortezomib, doxorubicin, and dexamethasone (mCBAD) may be successful chemomobilization regimens. METHODS This retrospective review included 167 patients (66 with Cy, 74 with mCVAD, and 27 with mCBAD) with multiple myeloma undergoing mobilization for auto-HCT between January 1, 2006 and September 30, 2013. The primary objective was to evaluate and compare the successful mobilization of CD34+ cells among high-dose Cy, mCVAD or mCBAD. RESULTS Successful mobilization (≥2×106 CD34+ cells/kg) was achieved in all patients, while 65 (98%), 72 (97%), and 27 (100%) patients achieved an optimal mobilization (≥4×106 CD34+ cells/kg) in the Cy, mCVAD, and mCBAD groups, respectively. There was no significant difference in the number of apheresis sessions (P=.63), incidence of febrile neutropenia (P=.57), or hospital admission rates (P=.55). CONCLUSION Either Cy, mCVAD, or mCBAD can yield successful PBSC mobilization in patients with multiple myeloma undergoing auto-HCT.
Collapse
Affiliation(s)
- Suzanne C Gettys
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alison Gulbis
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Koji Sasaki
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Dinh
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
32
|
A single center's experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation. Bone Marrow Transplant 2017; 52:561-566. [PMID: 28067870 PMCID: PMC5382040 DOI: 10.1038/bmt.2016.304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
In an otherwise eligible patient with relapsed lymphoma, inadequate mobilization of peripheral blood stem cells is a limiting factor to proceeding with an autologous hematopoietic cell transplantation (auto-HCT). Multiple strategies have been used to mobilize an adequate number of hematopoietic stem cells (HSCs) with no obvious front-line strategy. We report a single institutional experience mobilizing HSCs using four different approaches in lymphoma patients. We prospectively collected mobilization outcomes on patients planning to undergo auto-HCT at Ohio State University. We report results of first mobilization attempt for all relapsed or refractory lymphoma patients between 2008–2014. We identified 255 lymphoma patients who underwent mobilization for planned auto-HCT. The 255 lymphoma patients underwent the following front line mobilization strategies: 95 (37%) GCSF alone, 38 (15%) chemomobilization (GCSF+chemotherapy), 97 (38%) preemptive day 4 plerixafor, and 25 (10%) rescue day 5 plerixafor. As expected, there were significant differences between cohorts including age, comorbid indices, histology, and amount of prior chemotherapy. After controlling for differences between groups, the odds of collecting 2×106/kg HSCs on the first day of collection and 5×106/kg HSCs in total was highest in the cohort undergoing chemomobilization. In conclusion, our experience highlights the effectiveness of chemomobilization.
Collapse
|
33
|
Benyamini N, Avivi I, Dann EJ, Zuckerman T, Lavi N, Katz T. Comparison of engraftment following different stem cell mobilization modalities in patients with multiple myeloma treated with a uniform induction regimen containing bortezomib, cyclophosphamide and dexamethasone. Ann Hematol 2016; 96:461-467. [DOI: 10.1007/s00277-016-2897-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 12/07/2016] [Indexed: 11/29/2022]
|
34
|
Duarte FB, Prado BDPA, Vieira GMM, Costa LJ. Mobilization of hematopoietic progenitor cells for autologous transportation: consensus recommendations. Rev Assoc Med Bras (1992) 2016; 62 Suppl 1:10-15. [PMID: 27982316 DOI: 10.1590/1806-9282.62.suppl1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Selected patients with certain hematological malignancies and solid tumors have the potential to achieve long-term survival with autologous hematopoietic progenitor cell transplant. The collection of these cells in peripheral blood avoids multiple bone marrow aspirations, results in faster engraftment and allows treatment of patients with infection, fibrosis, or bone marrow hypocellularity. However, for the procedure to be successful, it is essential to mobilize a sufficient number of progenitor cells from the bone marrow into the blood circulation. Therefore, a group of Brazilian experts met in order to develop recommendations for mobilization strategies adapted to the reality of the Brazilian national health system, which could help minimize the risk of failure, reduce toxicity and improve the allocation of financial resources.
Collapse
Affiliation(s)
- Fernando Barroso Duarte
- Service of Hematology and Hematopoietic Cell Transplantation, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Brazil
| | | | | | - Luciano J Costa
- Department of Bone Marrow Transplantation and Cell Therapy Program, Department of Medicine and UAB-CCC, Birmingham, AL, USA
| |
Collapse
|
35
|
Green DJ, Bensinger WI, Holmberg LA, Gooley T, Till BG, Budde LE, Pagel JM, Frayo SL, Roden JE, Hedin L, Press OW, Gopal AK. Bendamustine, etoposide and dexamethasone to mobilize peripheral blood hematopoietic stem cells for autologous transplantation in patients with multiple myeloma. Bone Marrow Transplant 2016; 51:1330-1336. [PMID: 27214069 PMCID: PMC5052091 DOI: 10.1038/bmt.2016.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 12/11/2022]
Abstract
Chemotherapeutic agents without cross-resistance to prior therapies may enhance PBSC collection and improve patient outcomes by exacting a more potent direct antitumor effect before autologous stem cell transplant. Bendamustine has broad clinical activity in transplantable lymphoid malignancies, but concern remains over the potential adverse impact of this combined alkylator-nucleoside analog on stem cell mobilization. We performed a prospective, nonrandomized phase II study including 34 patients with multiple myeloma (MM) (n=34; International Staging System (ISS) stages I (35%), II (29%) and III (24%); not scored (13%)) to evaluate bendamustine's efficacy and safety as a stem cell mobilizing agent. Patients received bendamustine (120 mg/m2 IV days 1, 2), etoposide (200 mg/m2 IV days 1-3) and dexamethasone (40 mg PO days 1- 4) (bendamustine, etoposide and dexamethasone (BED)) followed by filgrastim (10 μg/kg/day SC; through collection). All patients (100%) successfully yielded stem cells (median of 21.60 × 106/kg of body weight; range 9.24-55.5 × 106/kg), and 88% required a single apheresis. Six nonhematologic serious adverse events were observed in 6 patients including: neutropenic fever (1, grade 3), bone pain (1, grade 3) and renal insufficiency (1, grade 1). In conclusion, BED safely and effectively mobilizes hematopoietic stem cells.
Collapse
Affiliation(s)
- Damian J. Green
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - William I. Bensinger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Leona A. Holmberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brian G. Till
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lihua E. Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - John M. Pagel
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Shani L. Frayo
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer E. Roden
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lacey Hedin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Oliver W. Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ajay K. Gopal
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
36
|
Comparison of two dose levels of cyclophosphamide for successful stem cell mobilization in myeloma patients. J Cancer Res Clin Oncol 2016; 142:2603-2610. [DOI: 10.1007/s00432-016-2270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/10/2016] [Indexed: 12/19/2022]
|
37
|
Wu CY, Chiou TJ, Liu CY, Lin FC, Lin JS, Hung MH, Hsiao LT, Yen CC, Gau JP, Yen HJ, Hung GY, Hsu HC, Tzeng CH, Liu JH, Yu YB. Decision-tree algorithm for optimized hematopoietic progenitor cell-based predictions in peripheral blood stem cell mobilization. Transfusion 2016; 56:2042-51. [PMID: 27232662 DOI: 10.1111/trf.13666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Enumerating hematopoietic progenitor cells (HPCs) by using an automated hematology analyzer is a rapid, inexpensive, and simple method for predicting a successful harvest compared with enumerating circulating CD34+ cells. However, the optimal HPC cutoff count and the indicating factors to be considered for improved predicting have not yet been determined. STUDY DESIGN AND METHODS Between 2007 and 2012, a total of 189 consecutive patients who proceeded to peripheral blood stem cell (PBSC) harvesting were retrospectively recruited. Baseline characteristics were analyzed to identify the risk factors for a failed harvest, which were defined as less than 2 × 10(6) CD34+ cells/kg. Variables identified by multivariate logistic regression and correlation analysis for predicting a successful harvest were subjected to classification and regression tree (CART) analysis. RESULTS PBSCs were successfully harvested in 154 (81.5%) patients. An age of at least 60 years, a diagnosis of a solid tumor, at least five prior chemotherapy cycles, prior radiotherapy, and mobilization with granulocyte-colony-stimulating factor alone or high-dose cyclophosphamide were independent baseline predictors of poor mobilization. In CART analysis, patients with zero to two host risk factors and either higher HPC (≥28 × 10(6) /L) or mononuclear cell (MNC; ≥3.5 × 10(9) /L) counts were categorized as good mobilizers and their harvest success rate was 92.3%. By contrast, 30.3% of harvests were adequate in the patients with three to five host risk factors and lower HPC and MNC counts. CONCLUSION A CART algorithm incorporating host predictors and HPC and MNC counts improves predictions in a successful harvest and might reduce the necessity of monitoring peripheral CD34+ cells.
Collapse
Affiliation(s)
- Chia-Yun Wu
- Division of Hematology, Department of Medicine.,Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Hematology, Department of Medicine.,Division of Transfusion Medicine, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeong-Shi Lin
- Division of Hematology, Department of Medicine.,Division of Transfusion Medicine, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Man-Hsin Hung
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chueh-Chuan Yen
- Division of Medical Oncology, Department of Oncology.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chi Hsu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, Saint Mary's Hospital Luodong, Yilan, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jing-Hwang Liu
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Hematology, Department of Medicine.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
38
|
Teusink A, Pinkard S, Davies S, Mueller M, Jodele S. Plerixafor is safe and efficacious for mobilization of peripheral blood stem cells in pediatric patients. Transfusion 2016; 56:1402-5. [PMID: 27079854 DOI: 10.1111/trf.13599] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chemotherapy followed by filgrastim is the most common strategy used to mobilize autologous peripheral blood stem cells (PBSCs) for high-dose chemotherapy and autologous stem cell transplantation. Unfortunately, this method does not always lead to adequate PBSC collection in heavily treated patients with relapsed malignancies or if multiple transplants are required. Plerixafor, a hematopoietic stem cell mobilizer that inhibits the CXCR4 chemokine receptor and blocks binding of its cognate ligand, stromal cell-derived factor-1α (SDF-1α), has been shown to be safe and efficacious in the mobilization of autologous PBSC in adults. Despite its use in adults, little evidence exists to support its use in children. STUDY DESIGN AND METHODS We report a retrospective review of 16 consecutive pediatric patients receiving plerixafor as part of their mobilization regimen at Cincinnati Children's Hospital Medical Center. All patients but one were given 0.24 mg/kg dose of plerixafor and the median number of plerixafor doses received was two (range, one to four doses). One patient received higher doses of plerixafor. RESULTS An adequate number of CD34+ cells were obtained in 14 of 16 patients (87.5%). The median number of CD34+ cells collected for patients who reached collection goal was 6 × 10(6) CD34+ cells/kg (range, 1.6 × 10(6) -12.4 × 10(6) /kg). No acute adverse events were noted to be attributable to plerixafor administration. CONCLUSION Our findings suggest that plerixafor use in children is safe and efficacious for the mobilization of autologous PBSCs in subjects with relapsed malignancies or requiring stem cells for multiple transplants.
Collapse
Affiliation(s)
- Ashley Teusink
- Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan Pinkard
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | - Stella Davies
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mueller
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sonata Jodele
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
39
|
Dogu MH, Kaya AH, Berber I, Sari İ, Tekgündüz E, Erkurt MA, Iskender D, Kayıkçı Ö, Kuku I, Kaya E, Keskin A, Altuntaş F. Does the preference of peripheral versus central venous access in peripheral blood stem cell collection/yield change stem cell kinetics in autologous stem cell transplantation? Transfus Apher Sci 2016; 54:76-9. [DOI: 10.1016/j.transci.2016.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Sheppard D, Tay J, Palmer D, Xenocostas A, Doulaverakis C, Huebsch L, McDiarmid S, Tinmouth A, Mallick R, Martin L, Birch P, Hamelin L, Allan D, Bredeson C. Improved Prediction of CD34+ Cell Yield before Peripheral Blood Hematopoietic Progenitor Cell Collection Using a Modified Target Value-Tailored Approach. Biol Blood Marrow Transplant 2015; 22:763-767. [PMID: 26643030 DOI: 10.1016/j.bbmt.2015.11.016] [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] [Received: 07/31/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
The most commonly used stem cell source for both autologous and allogeneic transplantation is mobilized peripheral blood hematopoietic progenitor cells collected by apheresis. In the 1990s, an Italian group used the correlation between the preapheresis peripheral blood CD34+ cell count and the final number of CD34+ cells collected to devise a formula for "target value-tailored" (TVT) apheresis. Using local patient data, the Canadian Blood Services Stem Cell Laboratory created a similar model to determine the blood volume to process during apheresis collection. The objectives of this study were to determine the correlation between the number of CD34+ cells predicted by the TVT formula and the actual number of CD34+ cells collected and to determine whether the TVT formula remains predictive when applied to an external data set. All apheresis collections performed at the Ottawa Hospital between January 1, 2003 and October 2, 2013 were reviewed. The primary outcome was the correlation between the number of CD34+ cells predicted by the TVT formula and the actual number of CD34+ cells collected on day 1 of apheresis. For the external data set, all autologous collections performed at the London Health Sciences Centre between December 1, 2008 and December 1, 2013 were reviewed. The external data set was divided into test and validation sets to determine whether a model could be created to predict the final number of CD34+ cells collected on day 1 based on the preapheresis CD34+ count. A total of 1252 collections were included in the analysis. The Ottawa data set included 1012 collections, 836 of which were autologous and 176 of which were from donors. Of the autologous collections in Ottawa, 764 (92.5%) were first collections. In 759 (91%) collections, chemotherapy plus granulocyte colony-stimulating factor (G-CSF) was used as the mobilization regimen. In 747 collections (89%), only 1 collection day was required to achieve the desired number of CD34+ cells. The TVT estimate was highly predictive of the number of CD34+ cells × 10(6)/kg actually collected on apheresis day 1 (r = .90, P < .0001). The London data set included 240 autologous collections. All mobilizations were with G-CSF alone. For the test set, the precollection CD34+ count was highly predictive of the number of CD34+ cells × 10(6)/kg collected on day 1 of apheresis. Applying this model to the validation set, the correlation between the predicted and final and day 1 CD34+ cells × 10(6)/kg count was .9186 (P < .0001). Using a modified TVT approach, the preapheresis CD34+ count can be used to accurately predict the number of CD34+ cells × 10(6)/kg collected on day 1. This approach can be applied at other centers and for different diseases and mobilization regimens. This method can be used to individualize the blood volume processed and, thus, optimize resource utilization.
Collapse
Affiliation(s)
| | - Jason Tay
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Douglas Palmer
- Canadian Blood Services Stem Cell Processing Laboratory, Ottawa, Canada
| | | | | | | | | | | | | | - Lisa Martin
- Canadian Blood Services Stem Cell Processing Laboratory, Ottawa, Canada
| | - Paul Birch
- Canadian Blood Services Stem Cell Processing Laboratory, Ottawa, Canada
| | | | - David Allan
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | |
Collapse
|
41
|
Sun T, Hu L, Jiang M, Ning H, Zhang B, Ren J, Li Y, Li B, Chen J, Yang F, Xu C, Wang J, Lou X, Hu J, Chen H. [Therapeutic effect of CY-fTBI and BMM conditioning regimen in the process of allo-HSCT treating Ⅲ,Ⅳ non-Hodgkin lymphoma: 15 years analysis of single-center]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:830-4. [PMID: 26477760 PMCID: PMC7364953 DOI: 10.3760/cma.j.issn.0253-2727.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 比较预处理方案Cy-fTBI(环磷酰胺+分次全身照射)与BMM(白消安+马法兰+米托蒽醌)在异基因造血干细胞移植(allo-HSCT)治疗Ⅲ、Ⅳ期非霍奇金淋巴瘤(NHL)疗效上的差异。 方法 对1998年11月至2014年5月接受allo-HSCT治疗的47例Ⅲ、Ⅳ期NHL病例进行回顾性分析,观察比较Cy-fTBI和BMM预处理方案两组患者移植后造血重建时间、急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)累积发生率、移植相关死亡率(TRM)、复发率(RR)、无病生存率(DFS)和总体生存率(OS)。 结果 移植后中性粒细胞≥0.5×109/L和血小板计数≥50×109/L的中位时间为17(10~72) d和27(5~98) d; aGVHD发生率为53.19%,Ⅰ~Ⅱ度占42.55%,Ⅲ~Ⅳ度占10.64%;cGVHD发生率为21.28%;中位随访9.7(0.2~149.1)个月,47例患者中21例生存。Cy-fTBI组1、3、5年OS率分别为73.5%、49.3%、40.1%,DFS率分别为71.4%、45.6%、39.3%。BMM组1、3、5年OS率分别为67.8%、32.9%、31.4%,DFS率分别为65.3%、31.1%、30.2%。Cy-fTBI组1、3、5年RR率分别为18.9%、19.5%、35.2%,TRM率分别为23.0%、38.3%、39.2%。BMM组1、3、5年RR分别为27.4%、38.9%、39.2%,TRM率分别为24.5%、46.4%、48.2%,两组在OS、DFS、RR、TRM等指标上差异无统计学意义。 结论 Allo-HSCT是治疗Ⅲ、Ⅳ期NHL的有效手段,但TRM仍相对较高。Cy-fTBI预处理方案与BMM方案相比,减少了TRM、RR,增加了DFS和OS,但差异无统计学意义。
Collapse
Affiliation(s)
- Ting Sun
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Liangding Hu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Min Jiang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Hongmei Ning
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Bin Zhang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jing Ren
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Yuhang Li
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Botao Li
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jianlin Chen
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Fan Yang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Chen Xu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jun Wang
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Xiao Lou
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Jiangwei Hu
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| | - Hu Chen
- Institute of Hematology 307 PLA Hospital, Beijing 100071, China
| |
Collapse
|
42
|
Hartmann T, Hübel K, Monsef I, Engert A, Skoetz N. Additional plerixafor to granulocyte colony-stimulating factors for haematopoietic stem cell mobilisation for autologous transplantation in people with malignant lymphoma or multiple myeloma. Cochrane Database Syst Rev 2015; 2015:CD010615. [PMID: 26484982 PMCID: PMC9468901 DOI: 10.1002/14651858.cd010615.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Autologous stem cell transplantation is widely used to restore functioning bone marrow in people with malignant lymphoma or multiple myeloma after myeloablative chemotherapy. Results of some clinical trials indicate that plerixafor in addition to granulocyte colony-stimulating factors (G-CSF) compared to G-CSF only could lead to an increased mobilisation and release of CD34-positive cells, facilitating effective apheresis. OBJECTIVES To evaluate the efficacy and safety of additional plerixafor to G-CSF for haematopoietic stem cell mobilisation in people with malignant lymphoma or multiple myeloma. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1990 to September 2015), as well as conference proceedings (American Society of Hematology; American Society of Clinical Oncology; European Hematology Association; American Society for Blood and Marrow Transplantation; European Group for Blood and Marrow Transplantation) for studies. Two review authors independently screened search results. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing plerixafor in addition to G-CSF compared to G-CSF only for stem cell mobilisation in people with malignant lymphoma or multiple myeloma of all stages and ages. We included full text as well as abstracts and unpublished data if sufficient information on study design, participant characteristics, interventions, and outcomes was available. We excluded cross-over trials, quasi-randomised trials, and post-hoc retrospective trials. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the search strategies, extracted data, assessed quality, and analysed data according to standard Cochrane methods. We performed final interpretation with an experienced clinician. MAIN RESULTS We identified four RCTs fitting the inclusion criteria. However, two of these closed prematurely due to low recruitment and did not report results. The remaining two trials evaluated 600 participants with multiple myeloma or non-Hodgkin lymphoma. In both studies the experimental group received G-CSF plus plerixafor and the control group received G-CSF plus placebo.The meta-analysis showed no evidence for differences between plerixafor and placebo group regarding mortality at 12 months (600 participants; risk ratio (RR) 1.00, 95% confidence interval (CI) 0.59 to 1.69; P = 1.00; moderate-quality evidence) and adverse events during stem cell mobilisation and collection (593 participants; RR 1.02, 95% CI 0.99 to 1.06; P = 0.19; high-quality evidence).Regarding the outcome successful stem cell collection, the meta-analysis showed an advantage for those participants randomised to the plerixafor group (600 participants; RR 2.42, 95% CI 1.98 to 2.96; P < 0.00001; high-quality evidence).As there was high heterogeneity between studies for the number of transplanted participants, we did not meta-analyse these data. In the multiple myeloma study, 95.9% (142 participants) in the plerixafor arm and 88.3% (136 participants) in the placebo arm underwent transplantation (RR 1.09, 95% CI 1.02 to 1.16); in the non-Hodgkin lymphoma trial, 90% (135 participants) in the plerixafor group versus 55.4% (82 participants) in the placebo group could be transplanted (RR 1.62, 95% CI 1.39 to 1.89). In both trials there was no evidence for a difference between participants in the plerixafor and placebo group in terms of time to neutrophil and platelet engraftment in transplanted participants.None of the trials reported on the outcomes quality of life and progression-free survival. AUTHORS' CONCLUSIONS The results of the analysed data suggest that additional plerixafor leads to increased stem cell collection in a shorter time. There was insufficient evidence to determine whether additional plerixafor affects survival or adverse events.The two trials included in the meta-analysis, both of which were conducted by the Genzyme Corporation, the manufacturer of plerixafor, were published several times. Two more RCTs examining the addition of plerixafor to a G-CSF mobilisation regimen terminated early without publishing any outcome. The trials included nine and five participants, respectively. Another RCT with 100 participants was recently completed, but has not yet published outcomes. Due to the unpublished RCTs, it is possible that our review is affected by publication bias, even though two trials failed to recruit a sufficient number of participants to analyse any data.
Collapse
Affiliation(s)
- Tim Hartmann
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | - Kai Hübel
- University Hospital of CologneDepartment I of Internal Medicine, Center of Integrated Oncology Köln BonnKerpener Str. 62CologneGermany50924
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineCologneGermany
| | | |
Collapse
|
43
|
A randomized phase II study of stem cell mobilization with cyclophosphamide+G-CSF or G-CSF alone after lenalidomide-based induction in multiple myeloma. Bone Marrow Transplant 2015; 51:372-6. [PMID: 26437056 PMCID: PMC4777887 DOI: 10.1038/bmt.2015.236] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
Abstract
The most common means of mobilizing autologous stem cells is G-CSF alone or combined with cyclophosphamide (CY) to obtain sufficient CD34+ cells for one to two transplants. There are few prospective, randomized studies investigating mobilization regimens in multiple myeloma (MM), especially after lenalidomide-based induction. We designed this prospective, randomized study to compare low-dose CY 2 g/m2+G-CSF (arm A) and G-CSF alone (arm B) after lenalidomide-based up-front induction in MM. Of the 80 initially randomized patients, 69 patients were evaluable, 34 and 35 patients in arms A and B, respectively. The primary end point was the proportion of patients achieving a yield of ⩾3 × 106/kg CD34+ cells with 1−2 aphereses, which was achieved in 94% and 77% in arms A and B, respectively (P=0.084). The median number of aphereses needed to reach the yield of ⩾3 × 106/kg was lower in arm A than in arm B (1 vs 2, P=0.035). Two patients needed plerixafor in arm A and five patients in arm B (P=0.428). Although CY-based mobilization was more effective, G-CSF alone was successful in a great majority of patients to reach the defined collection target after three cycles of lenalidomide-based induction.
Collapse
|
44
|
Martin AP, Richards S, Haycox A, Houten R, McLeod C, Braithwaite B, Clark JO, Bell J, Clark RE. Evaluating the use of plerixafor in stem cell mobilisation - an economic analysis of the PHANTASTIC trial. J Clin Apher 2015; 31:434-42. [DOI: 10.1002/jca.21433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/06/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Antony P. Martin
- Liverpool Health Economics, Department of Economics; University of Liverpool Management School; Liverpool United Kingdom
| | - Sarah Richards
- Liverpool Health Economics, Department of Economics; University of Liverpool Management School; Liverpool United Kingdom
| | - Alan Haycox
- Liverpool Health Economics, Department of Economics; University of Liverpool Management School; Liverpool United Kingdom
| | - Rachel Houten
- Liverpool Health Economics, Department of Economics; University of Liverpool Management School; Liverpool United Kingdom
| | - Claire McLeod
- Liverpool Health Economics, Department of Economics; University of Liverpool Management School; Liverpool United Kingdom
| | - Barbara Braithwaite
- Haematology Department; Royal Liverpool University Hospital; Liverpool United Kingdom
| | - Jack O. Clark
- Haematology Department; Royal Liverpool University Hospital; Liverpool United Kingdom
| | - Joanne Bell
- Haematology Department; Royal Liverpool University Hospital; Liverpool United Kingdom
| | - Richard E. Clark
- Haematology Department; Royal Liverpool University Hospital; Liverpool United Kingdom
| |
Collapse
|
45
|
Shi Y, Zhou P, Han X, He X, Zhou S, Liu P, Yang J, Zhang C, Gui L, Qin Y, Yang S, Zhao L, Yao J, Zhang S. Autologous peripheral blood stem cell mobilization following dose-adjusted cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy alone or in combination with rituximab in treating high-risk non-Hodgkin's lymphoma. CHINESE JOURNAL OF CANCER 2015; 34:522-30. [PMID: 26370464 PMCID: PMC4593367 DOI: 10.1186/s40880-015-0045-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 07/26/2015] [Indexed: 01/27/2023]
Abstract
Background The regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is an efficient treatment of non-Hodgkin’s lymphoma (NHL). This study aimed to assess the efficacy and toxicity of dose-adjusted CHOP alone or in combination with rituximab (R-CHOP) by examining the stem cell mobilization in NHL patients. Factors affecting the collection of CD34+ cells were also explored. Methods Our retrospective study included 39 patients eligible for autologous stem cell transplantation: 14 patients who expressed CD20 and were financially eligible received R-CHOP for autologous peripheral blood stem cell (APBSC) mobilization; the remaining 25 patients received CHOP. Results The median CD34+ cell yield was 7.01 × 106 cells/kg body weight (range 1.49–28.39 × 106 cells/kg body weight), with only two patients failing to meet the target CD34+ cell harvest of ≥2.0 × 106 cells/kg body weight. The median number of apheresis procedures per patient was 1 (range 1–3). The APBSC mobilization yield of the CHOP group appeared to be higher than that of the R-CHOP group (P = 0.005), whereas the success rate was similar between groups. R-CHOP elevated the complete response (CR) rate in B cell lymphoma patients as compared with CHOP (P = 0.01). No significant differences in toxicity or engraftment were observed between the two groups. Conclusion The present study demonstrated that dose-adjusted CHOP chemotherapy effectively mobilized APBSCs in NHL patients and that the addition of rituximab to dose-adjusted CHOP chemotherapy elevated the CR rate for patients with B-cell lymphoma.
Collapse
Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Ping Zhou
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Xiaohong Han
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Xiaohui He
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Shengyu Zhou
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Peng Liu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Jianliang Yang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Changgong Zhang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Lin Gui
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Yan Qin
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Sheng Yang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Liya Zhao
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Jiarui Yao
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| | - Shuxiang Zhang
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, P. R. China.
| |
Collapse
|
46
|
Salvino MA, Ruiz J. Hematopoietic progenitor cell mobilization for autologous transplantation - a literature review. Rev Bras Hematol Hemoter 2015; 38:28-36. [PMID: 26969772 PMCID: PMC4786760 DOI: 10.1016/j.bjhh.2015.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 12/27/2022] Open
Abstract
The use of high-dose chemotherapy with autologous support of hematopoietic progenitor cells is an effective strategy to treat various hematologic neoplasms, such as non-Hodgkin lymphomas and multiple myeloma. Mobilized peripheral blood progenitor cells are the main source of support for autologous transplants, and collection of an adequate number of hematopoietic progenitor cells is a critical step in the autologous transplant procedure. Traditional strategies, based on the use of growth factors with or without chemotherapy, have limitations even when remobilizations are performed. Granulocyte colony-stimulating factor is the most widely used agent for progenitor cell mobilization. The association of plerixafor, a C-X-C Chemokine receptor type 4 (CXCR4) inhibitor, to granulocyte colony stimulating factor generates rapid mobilization of hematopoietic progenitor cells. A literature review was performed of randomized studies comparing different mobilization schemes in the treatment of multiple myeloma and lymphomas to analyze their limitations and effectiveness in hematopoietic progenitor cell mobilization for autologous transplant. This analysis showed that the addition of plerixafor to granulocyte colony stimulating factor is well tolerated and results in a greater proportion of patients with non-Hodgkin lymphomas or multiple myeloma reaching optimal CD34+ cell collections with a smaller number of apheresis compared the use of granulocyte colony stimulating factor alone.
Collapse
|
47
|
Goker H, Etgul S, Buyukasik Y. Optimizing mobilization strategies in difficult-to-mobilize patients: The role of plerixafor. Transfus Apher Sci 2015; 53:23-9. [PMID: 26099666 DOI: 10.1016/j.transci.2015.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Peripheral blood stem cell collection is currently the most widely used source for hematopoietic autologous transplantation. Several factors such as advanced age, previous chemotherapy, disease and marrow infiltration at the time of mobilization influence the efficacy of CD34(+) progenitor cell mobilization. Despite the safety and efficiency of the standard mobilization protocols (G-CSF ± chemotherapy), there is still a significant amount of mobilization failure rate (10-40%), which necessitate novel agents for effective mobilization. Plerixafor, is a novel agent, has been recently approved for mobilization of hematopoietic stem cells (HSCs). The combination of Plerixafor with G-CSF provides the collection of large numbers of stem cells in fewer apheresis sessions and can salvage those who fail with standard mobilization regimens. The development and optimization of practical algorithms for the use Plerixafor is crucial to make hematopoietic stem cell mobilization more efficient in a cost-effective way. This review is aimed at summarizing how to identify poor mobilizers, and define rational use of Plerixafor for planning mobilization in hard-to-mobilize patients.
Collapse
Affiliation(s)
- Hakan Goker
- Hematology Department, Hacettepe University School of Medicine, Ankara, Turkey.
| | - Sezgin Etgul
- Hematology Department, Hacettepe University School of Medicine, Ankara, Turkey
| | - Yahya Buyukasik
- Hematology Department, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
48
|
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) is an important and often life saving treatment for many hematological malignancies and selected solid tumors. To rescue hematopoiesis after high-dose chemotherapy in autologous HSCT depends on maintaining sufficient stem cells. Hematopoietic stem cells and progenitor cells expressing CD34 in the BM are mobilized into the circulation with granulocyte-colony stimulating factor ± chemotherapy prior to autologous HSCT. One of the most important factors for success of autologous HSCT is hematopoietic stem cell (HSC) count. Minimum threshold for the engraftment of hematopoietic cells is accepted as 2 × 10(6) CD34 + cells/kg especially for platelet engraftment. Below this level it is defined as stem cell mobilization failure. There are several factors affecting stem cell mobilization: prior chemotherapy (such as fludarabine, melphalan, lenalidomide) and radiotherapy, age, type of disease, bone marrow cellularity. We tried to summarize the reasons of peripheral stem cell mobilization failure.
Collapse
Affiliation(s)
- Fatih Kurnaz
- Hematology Department, Harran University Medical School, Yenişehir Campus, Sanliurfa 63000, Turkey
| | - Leylagül Kaynar
- Apheresis Unit, Dedeman Hematology-Oncology Hospital, Medical Faculty, Erciyes University, Kayseri, Turkey.
| |
Collapse
|
49
|
Afable M, Caimi PF, Hosing C, de Lima M, Khouri I, William BM, Nieto Y, Cooper BW, Anderlini P, Gerson SL, Lazarus HM, Champlin R, Popat U. Hematopoietic Progenitor Cell Harvesting Is Feasible after Treatment with Brentuximab Vedotin in CD30(+) Lymphoma Patients Who Received Multiple Prior Lines of Treatment. Biol Blood Marrow Transplant 2015; 21:1529-1531. [PMID: 25937397 DOI: 10.1016/j.bbmt.2015.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/22/2015] [Indexed: 01/16/2023]
Abstract
Brentuximab vedotin (BV), an antibody-drug conjugate that targets CD30, induces high response rates in CD30(+) lymphoid malignancies. It is unknown if BV use affects procurement of autologous CD34(+) stem cells and hematopoietic engraftment after autologous stem cell transplantation (ASCT). We examined 42 patients treated with BV before mobilization. Median times from diagnosis to transplantation, from initial BV treatment to transplantation, and from last BV treatment to stem cell collection were 21 months (range, 10 to 210), 5 months (range, 1.5 to 16.8), and 30 days (range, 2 to 280), respectively. Mobilization was successful on the first attempt in 38 patients (90.4%). The median number of infused CD34(+) cells was 5.46 × 10(6)/kg (range, 1.65 to 54.78 × 10(6)/kg). The median times to neutrophil and platelet engraftment were 10 (range, 9 to 13), and 10.5 days (range, 7 to 35), respectively. BV before high-dose chemotherapy-ASCT did not adversely affect peripheral blood stem cell mobilization and subsequent engraftment in a cohort of heavily pretreated patients with CD30(+) lymphomas.
Collapse
Affiliation(s)
- Manuel Afable
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Paolo F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Chitra Hosing
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcos de Lima
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Issa Khouri
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Basem M William
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Yago Nieto
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brenda W Cooper
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Paolo Anderlini
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stanton L Gerson
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Hillard M Lazarus
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.,Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Richard Champlin
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uday Popat
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
50
|
Hequet O. Hematopoietic stem and progenitor cell harvesting: technical advances and clinical utility. J Blood Med 2015; 6:55-67. [PMID: 25733943 PMCID: PMC4340371 DOI: 10.2147/jbm.s52783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hematopoietic stem and progenitor cell (HSPC) transplantations require prior harvesting of allogeneic or autologous HSPCs. HSPCs are usually present in bone marrow (BM) during the entire life, in cord blood (CB) at birth, or in peripheral blood (PB) under particular circumstances. HSPCs were first harvested in BM and later in CB and PB, as studies showed interesting features of such grafts. All harvesting methods were in use throughout the years, except BM harvesting for HSPC autologous transplantation, which was replaced by PB harvesting. BM, CB, and PB harvesting methods have been developed, and materials and devices technically improved to increase the number of HSPCs harvested. In parallel, knowing the features of the donors or patients associated with successful numbers of HSPCs allows the adaptation of appropriate harvesting methods. Moreover, it is important to ensure the safety of donors or patients while harvesting. This review describes the methods used for harvesting based on recent studies or developments around these methods, and more particularly, the means developed to increase the numbers of HSPCs harvested in each method. It also explains briefly the influence of technical improvements in HSPC harvesting on potential changes in HSPC graft composition.
Collapse
Affiliation(s)
- Olivier Hequet
- Etablissement Français du Sang Rhône Alpes, Apheresis Unit, Centre Hospitalier Lyon Sud France, Lyon, France ; Cell Therapy Unit, Etablissement Français du Sang (EFS) Rhône-Alpes, Hospital Edouard Herriot, Lyon, France
| |
Collapse
|