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Franke GN, Pfannes R, Heyn S, Brückner M, Rieprecht S, Bach E, Remane Y, Leiblein S, Pönisch W, Niederwieser D, Schwind S, Platzbecker U, Jentzsch M, Vucinic V. Analysis of stem cell collections in adult patients with Ewing sarcoma. Transfusion 2022; 62:1612-1618. [PMID: 35801531 DOI: 10.1111/trf.17013] [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: 03/18/2022] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Ewing sarcoma is one of the most frequent soft-tissue tumors in pediatric patients. The current treatment protocols recommend stem cell apheresis (SCA) after completion of the second course of induction therapy with vincristine, ifosfamide, doxorubicine, and etoposide (VIDE). The feasibility of SCA and graft compositions in adult patients with Ewing sarcoma have not been previously analyzed. METHODS AND MATERIALS The authors analyzed 29 stem cell collections of 19 adult patients (9 male, 10 female) at a median age of 27 (range 19-53) years mobilized after VIDE (n = 17), cyclophosphamide/topotecan (n = 1) or vincristine, dactinomycin and ifosfamide (n = 1) chemotherapy. All patients were mobilized with filgrastim 5 μg/kg twice daily from day +7 of chemotherapy. The collections were performed if CD34+ cell count in peripheral blood was >10/μL. The target yields were ≥4×106 CD34+ cells/kg body weight. RESULTS Median CD34+ cells/μL in peripheral blood before SCA were 45.8 (range 6.7-614.4)/μL. The median cumulative yields were 10.6 (range 1.5-38.8) CD34+ cells/kg body weight and ≥2×106 in all but two patients (89%). CD34, CD3, and CD56 yields in collections after the third VIDE and after later courses did not differ. Four patients underwent high-dose therapy with autologous transplantation, and all were engrafted. DISCUSSION Stem cell mobilization is feasible in most Ewing sarcoma patients. Additionally, the present study's data suggest that it is safe to postpone stem cell collection to a later VIDE chemotherapy cycle if medically indicated.
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Affiliation(s)
- Georg-Nikolaus Franke
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Roald Pfannes
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Simone Heyn
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Mandy Brückner
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | | | - Enrica Bach
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Yvonne Remane
- Pharmacy, Leipzig University Medical Center, Leipzig, Germany
| | - Sabine Leiblein
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Wolfram Pönisch
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Dietger Niederwieser
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Sebastian Schwind
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Madlen Jentzsch
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
| | - Vladan Vucinic
- Medical Clinic for Hematology, Celltherapy and Hemostaseology, Leipzig University Medical Center, Leipzig, Germany
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Sharma A, Leonard A, West K, Gossett JM, Uchida N, Panch S, Stroncek D, Poston L, Akel S, Hankins JS, Fitzhugh C, Hsieh MM, Kang G, Tisdale JF, Weiss MJ, Zheng Y. Optimizing haematopoietic stem and progenitor cell apheresis collection from plerixafor-mobilized patients with sickle cell disease. Br J Haematol 2022; 198:740-744. [PMID: 35737751 DOI: 10.1111/bjh.18311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
We adjusted haematopoietic stem and progenitor cell (HSPC) apheresis collection from patients with sickle cell disease (SCD) by targeting deep buffy coat collection using medium or low collection preference (CP), and by increasing anticoagulant-citrate-dextrose-solution A dosage. In 43 HSPC collections from plerixafor-mobilized adult patients with SCD, we increased the collection efficiency to 35.79% using medium CP and 82.23% using low CP. Deep buffy coat collection increased red blood cell contamination of the HSPC product, the product haematocrit was 4.7% with medium CP and 6.4% with low CP. These adjustments were well-tolerated and allowed efficient HSPC collection from SCD patients.
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Affiliation(s)
- Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Alexis Leonard
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland, USA
| | - Kamille West
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jeffrey M Gossett
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Naoya Uchida
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland, USA
| | - Sandhya Panch
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - David Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Leigh Poston
- Human Applications Lab, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Salem Akel
- Human Applications Lab, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Courtney Fitzhugh
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew M Hsieh
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland, USA
| | - Guolian Kang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - John F Tisdale
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Maryland, USA
| | - Mitchell J Weiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yan Zheng
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Vucinic V, Jentzsch M, Leiblein S, Bach E, Remane Y, Schulze-Forster K, Cross M, Pönisch W, Schwind S, Franke GN, Platzbecker U, Niederwieser D. Stem-cell mobilization of healthy sibling donors with pegfilgrastim-A prospective open-label phase II trial (EudraCT no: 2005-004971-39). Transfusion 2021; 62:157-164. [PMID: 34893987 DOI: 10.1111/trf.16761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/10/2021] [Accepted: 10/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pegfilgrastim is a covalently bound conjugate of filgrastim and mono-methoxypolyethylene glycol with a longer half-life. STUDY DESIGN AND METHODS We report on phase II prospective monocentric trial examining the feasibility of stem cell mobilization with 12 mg single dose pegfilgrastim in related donors. The objectives were to determine the optimal collection day, defined as CD34+ concentration in peripheral blood (PB) >50 cells/μl, the number of donors collected with single leukapheresis, and the peak level of pegfilgrastim in donor-serum. Furthermore, the cell composition of grafts was assessed and compared to published data. RESULTS The results included about 28 matched related donors. The median pegfilgrastim serum level remained >200 ng/mL for 48 hours before declining, with the maximal measured concentration of 259.49 ng/ml 24 h after application. The median white blood cell count and CD34 count in PB peaked on day four with 52.6 (range 22.8-85.0) Gpt/l and 66.25 (range 22.9-136.6) cells/μl, respectively. A CD34+ count >50 cells/μl on day four was detected in 75% of donors. 79% of the donors underwent a single collection. Conventional filgrastim was administered additionally in two donors, due to insufficient CD 34+ concentration in PB. 89% of donors showed CD34+ yields ≥4 (median 6.5, range 4.6-14.5) × 10/kg body weight of the recipient. All grafts were administered without rejections. DISCUSSION The results of this trial showed that stem cell mobilization with pegfilgrastim is a feasible, and attractive option. This is the first trial presenting the kinetics of pegfilgrastim serum levels in healthy donors.
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Affiliation(s)
- Vladan Vucinic
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Madlen Jentzsch
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Sabine Leiblein
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Enrica Bach
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Yvonne Remane
- Leipzig Medical Center, Pharmacy, University Clinic Leipzig, Leipzig, Germany
| | | | - Michael Cross
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Wolfram Pönisch
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Sebastian Schwind
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Georg-Nikolaus Franke
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
| | - Dietger Niederwieser
- Leipzig Medical Center, Clinic for Hematology and Cell Therapy, University Clinic Leipzig, Leipzig, Germany
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Zhang D, Zhu Y, Jin Y, Kaweme NM, Dong Y. Leukapheresis and Hyperleukocytosis, Past and Future. Int J Gen Med 2021; 14:3457-3467. [PMID: 34285568 PMCID: PMC8286901 DOI: 10.2147/ijgm.s321787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Hyperleukocytosis is a hematologic crisis caused by excessive proliferation of leukemic cells and has a relatively high early mortality due to a series of severe complications. Therefore, prompt and effective intervention is required. Leukapheresis performed using apheresis equipment to separate leukocytes from peripheral blood, at the same time returns autologous plasma, platelets and erythrocytes to the patient, is applied clinically for the treatment of hyperleukocytosis. Leukapheresis not only removes excessive leukocytes rapidly and corrects metabolic abnormalities but also alleviates the symptoms of leukostasis. In addition, the procedure of leukapheresis is generally well tolerated. Leukapheresis has become one of the most imperative adjuvant therapies to treat hyperleukocytosis, especially in the patient who was not inappropriate to cytoreduce with Ara-C or hydroxyurea. In this review, we present the background of leukapheresis development and highlight its clinical application in hyperleukocytic leukemia patients.
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Affiliation(s)
- Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| | - Yufan Zhu
- Orthopedics department, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Yanxia Jin
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Natasha Mupeta Kaweme
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
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