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Abhyankar S, Lubanski P, DeJarnette S, Merkel D, Bunch J, Daniels K, Aljitawi O, Lin T, Ganguly S, McGuirk J. A novel hematopoietic progenitor cell mobilization regimen, utilizing bortezomib and filgrastim, for patients undergoing autologous transplant. J Clin Apher 2016; 31:559-563. [PMID: 26939585 DOI: 10.1002/jca.21449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/08/2016] [Accepted: 01/16/2016] [Indexed: 12/20/2022]
Abstract
Adequate hematopoietic progenitor cell (HPC) collection is critical for patients undergoing autologous HPC transplant (AHPCT). Historically, 15 - 30% of patients failed HPC mobilization with granulocyte-colony stimulating factor (G-CSF) alone. Bortezomib, a proteasome inhibitor, has been shown to down regulate very late antigen-4 (VLA-4), an adhesion molecule expressed on HPCs. In this pilot study, bortezomib was administered on days -11 and -8 at a dose of 1.3 mg/m2 intravenously (IV) or subcutaneously (SQ), followed by G-CSF 10 mcg/kg SQ, on days -4 to -1 prior to HPC collection (Day 1). Nineteen patients, with multiple myeloma (n = 12) or non-Hodgkin lymphoma (n = 7) undergoing AHPCT for the first time, were enrolled. Patients were excluded if they had worse than grade II neuropathy or platelet count less than 100 x 109 /L. Bortezomib was well tolerated and all patients had adequate HPC collections with no mobilization failures. One patient (6%) had a CD34+ cell count of 3.9 cells/µL on Day 1 and received plerixafor per institutional algorithm. Eleven patients completed HPC collection in 1 day and eight in 2 days. All patients underwent AHPCT and had timely neutrophil and platelet engraftment. Comparison with a historical control group of 70 MM and lymphoma patients, who were mobilized with G-CSF, showed significantly higher CD 34+ cells/kg collected in the bortezomib mobilization study group. Bortezomib plus G-CSF is an effective HPC mobilizing regimen worth investigating further in subsequent studies. J. Clin. Apheresis 31:559-563, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Sunil Abhyankar
- Department of Medicine, the University of Kansas Hospital, Blood and Marrow Transplant, Kansas City, Kansas
| | - Philip Lubanski
- Department of Pharmacy, the University of Kansas Hospital, Kansas City, Kansas
| | - Shaun DeJarnette
- Apheresis and Cell Processing, the University of Kansas Hospital, Kansas City, Kansas
| | - Dean Merkel
- Apheresis and Cell Processing, the University of Kansas Hospital, Kansas City, Kansas
| | - Jennifer Bunch
- Clinical Trials Office, the University of Kansas Medical Center, Kansas City, Kansas
| | - Kelly Daniels
- Clinical Trials Office, the University of Kansas Medical Center, Kansas City, Kansas
| | - Omar Aljitawi
- Department of Medicine, the University of Kansas Hospital, Blood and Marrow Transplant, Kansas City, Kansas
| | - Tara Lin
- Department of Medicine, the University of Kansas Hospital, Blood and Marrow Transplant, Kansas City, Kansas
| | - Sid Ganguly
- Department of Medicine, the University of Kansas Hospital, Blood and Marrow Transplant, Kansas City, Kansas
| | - Joseph McGuirk
- Department of Medicine, the University of Kansas Hospital, Blood and Marrow Transplant, Kansas City, Kansas
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Abstract
The use of mobilized peripheral blood stem cells (PBSCs) has largely replaced the use of bone marrow as a source of stem cells for both allogeneic and autologous stem cell transplantation. G-CSF with or without chemotherapy is the most commonly used regimen for stem cell mobilization. Some donors or patients, especially the heavily pretreated patients, fail to mobilize the targeted number of stem cells with this regimen. A better understanding of the mechanisms involved in hematopoietic stem cell (HSC) trafficking could lead to the development of newer mobilizing agents and therapeutic approaches. This review will cover the current methods for stem cell mobilization and recent developments in the understanding of the biology of stem cells and the bone marrow microenvironment.
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Affiliation(s)
- Ibraheem H Motabi
- Siteman Cancer Center, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
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