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Ernst AM, Steiner M, Kainz V, Tempfer H, Spitzer G, Plank T, Bauer HC, Bresgen N, Habenbacher A, Bauer H, Lipp AT. Lipedema: The Use of Cultured Adipocytes for Identification of Diagnostic Markers. Plast Reconstr Surg 2023; 152:1036-1046. [PMID: 36912938 DOI: 10.1097/prs.0000000000010392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Lipedema, diagnosed most often in women, is a progressive disease characterized by the disproportionate and symmetrical distribution of adipose tissue, primarily in the extremities. Although numerous results from in vitro and in vivo studies have been published, many questions regarding the pathology and genetic background of lipedema remain unanswered. METHODS In this study, adipose tissue-derived stromal/stem cells were isolated from lipoaspirates derived from nonobese and obese donors with or without lipedema. Growth and morphology, metabolic activity, differentiation potential, and gene expression were evaluated using quantification of lipid accumulation, metabolic activity assay, live-cell imaging, reverse transcription polymerase chain reaction, quantitative polymerase chain reaction, and immunocytochemical staining. RESULTS The adipogenic potential of lipedema and nonlipedema adipose tissue-derived stromal/stem cells did not rise in parallel with the donors' body mass index and did not differ significantly between groups. However, in vitro differentiated adipocytes from nonobese lipedema donors showed significant upregulation of adipogenic gene expression compared with nonobese controls. All other genes tested were expressed equally in lipedema and nonlipedema adipocytes. The adiponectin/leptin ratio was significantly reduced in adipocytes from obese lipedema donors compared with their nonobese lipedema counterparts. Increased stress fiber-integrated smooth muscle actin was visible in lipedema adipocytes compared with nonlipedema controls and appeared enhanced in adipocytes from obese lipedema donors. CONCLUSIONS Not only lipedema per se but also body mass index of donors affect adipogenic gene expression substantially in vitro. The significantly reduced adiponectin/leptin ratio and the increased occurrence of myofibroblast-like cells in obese lipedema adipocyte cultures underscores the importance of attention to the co-occurrence of lipedema and obesity. These are important findings toward accurate diagnosis of lipedema. CLINICAL RELEVANCE STATEMENT Our study highlights not only the difficulty in lipedema diagnostics but also the tremendous need for further studies on lipedema tissue. Although lipedema might seem to be an underestimated field in plastic and reconstructive surgery, the power it holds to provide better treatment to future patients can not be promoted enough.
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Affiliation(s)
- Anna M Ernst
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Marianne Steiner
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Verena Kainz
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University Salzburg
- Austrian Cluster for Tissue Regeneration
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University Salzburg
- Austrian Cluster for Tissue Regeneration
| | - Tanja Plank
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Hans-Christian Bauer
- From the Department of Biosciences, Paris Lodron University of Salzburg
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University Salzburg
- Austrian Cluster for Tissue Regeneration
| | - Nikolaus Bresgen
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Andreas Habenbacher
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich
| | - Hannelore Bauer
- From the Department of Biosciences, Paris Lodron University of Salzburg
| | - Anna-Theresa Lipp
- Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich
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Tempfer H, Spitzer G, Lehner C, Wagner A, Gehwolf R, Fierlbeck J, Weissenbacher N, Jessen M, Heindl LM, Traweger A. VEGF-D-mediated signaling in tendon cells is involved in degenerative processes. FASEB J 2022; 36:e22126. [PMID: 35044682 DOI: 10.1096/fj.202100773rrr] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022]
Abstract
Vascular endothelial growth factor (VEGF) signaling is crucial for a large variety of cellular processes, not only related to angiogenesis but also in nonvascular cell types. We have previously shown that controlling angiogenesis by reducing VEGF-A signaling positively affects tendon healing. We now hypothesize that VEGF signaling in non-endothelial cells may contribute to tendon pathologies. By immunohistochemistry we show that VEGFR1, VEGFR2, and VEGFR3 are expressed in murine and human tendon cells in vivo. In a rat Achilles tendon defect model we show that VEGFR1, VEGFR3, and VEGF-D expression are increased after injury. On cultured rat tendon cells we show that VEGF-D stimulates cell proliferation in a dose-dependent manner; the specific VEGFR3 inhibitor SAR131675 reduces cell proliferation and cell migration. Furthermore, activation of VEGFR2 and -3 in tendon-derived cells affects the expression of mRNAs encoding extracellular matrix and matrix remodeling proteins. Using explant model systems, we provide evidence, that VEGFR3 inhibition prevents biomechanical deterioration in rat tail tendon fascicles cultured without load and attenuates matrix damage if exposed to dynamic overload in a bioreactor system. Together, these results suggest a strong role of tendon cell VEGF signaling in mediation of degenerative processes. These findings give novel insight into tendon cell biology and may pave the way for novel treatment options for degenerative tendon diseases.
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Affiliation(s)
- Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Christine Lehner
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | | | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Malik Jessen
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University-Spinal Cord Injury & Tissue Regeneration Center Salzburg, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Lehner C, Spitzer G, Langthaler P, Jakubecova D, Klein B, Weissenbacher N, Wagner A, Gehwolf R, Trinka E, Iglseder B, Paulweber B, Aigner L, Couillard-Després S, Weiss R, Tempfer H, Traweger A. Allergy-induced systemic inflammation impairs tendon quality. EBioMedicine 2022; 75:103778. [PMID: 35007819 PMCID: PMC8749446 DOI: 10.1016/j.ebiom.2021.103778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023] Open
Abstract
Background Treatment of degenerating tendons still presents a major challenge, since the aetiology of tendinopathies remains poorly understood. Besides mechanical overuse, further known predisposing factors include rheumatoid arthritis, diabetes, obesity or smoking all of which combine with a systemic inflammation. Methods To determine whether the systemic inflammation accompanying these conditions contributes to the onset of tendinopathy, we studied the effect of a systemic inflammation induced by an allergic episode on tendon properties. To this end, we induced an allergic response in mice by exposing them to a timothy grass pollen allergen and subsequently analysed both their flexor and Achilles tendons. Additionally, we analysed data from a health survey comprising data from more than 10.000 persons for an association between the occurrence of an allergy and tendinopathy. Findings Biomechanical testing and histological analysis revealed that tendons from allergic mice not only showed a significant reduction of both elastic modulus and tensile stress, but also alterations of the tendon matrix. Moreover, treatment of 3D tendon-like constructs with sera from allergic mice resulted in a matrix-remodelling expression profile and the expression of macrophage-associated markers and matrix metalloproteinase 2 (MMP2) was increased in allergic Achilles tendons. Data from the human health study revealed that persons suffering from an allergy have an increased propensity to develop a tendinopathy. Interpretation Our study demonstrates that the presence of a systemic inflammation accompanying an allergic condition negatively impacts on tendon structure and function. Funding This study was financially supported by the Fund for the Advancement of Scientific Research at Paracelsus Medical University (PMU-FFF E-15/22/115-LEK), by the Land Salzburg, the Salzburger Landeskliniken (SALK, the Health Care Provider of the University Hospitals Landeskrankenhaus and Christian Doppler Klinik), the Paracelsus Medical University, Salzburg and by unrestricted grants from Bayer, AstraZeneca, Sanofi-Aventis, Boehringer-Ingelheim.
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Affiliation(s)
- Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dominika Jakubecova
- Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sebastien Couillard-Després
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Weiss
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Atta G, Schroedl F, Kaser-Eichberger A, Spitzer G, Traweger A, Heindl LM, Tempfer H. Scleraxis expressing scleral cells respond to inflammatory stimulation. Histochem Cell Biol 2021; 156:123-132. [PMID: 33966129 PMCID: PMC8397666 DOI: 10.1007/s00418-021-01985-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/15/2022]
Abstract
The sclera is an ocular tissue rich of collagenous extracellular matrix, which is built up and maintained by relatively few, still poorly characterized fibroblast-like cells. The aims of this study are to add to the characterization of scleral fibroblasts and to examine the reaction of these fibroblasts to inflammatory stimulation in an ex vivo organotypic model. Scleras of scleraxis-GFP (SCX-GFP) mice were analyzed using immunohistochemistry and qRT-PCR for the expression of the tendon cell associated marker genes scleraxis (SCX), mohawk and tenomodulin. In organotypic tissue culture, explanted scleras of adult scleraxis GFP reporter mice were exposed to 10 ng/ml recombinant interleukin 1-ß (IL1-ß) and IL1-ß in combination with dexamethasone. The tissue was then analyzed by immunofluorescence staining of the inflammation- and fibrosis-associated proteins IL6, COX-2, iNOS, connective tissue growth factor, MMP2, MMP3, and MMP13 as well as for collagen fibre degradation using a Collagen Hybridizing Peptide (CHP) binding assay. The mouse sclera displayed a strong expression of scleraxis promoter-driven GFP, indicating a tendon cell-like phenotype, as well as expression of scleraxis, tenomodulin and mohawk mRNA. Upon IL1-ß stimulation, SCX-GFP+ cells significantly upregulated the expression of all proteins analysed. Moreover, IL1-ß stimulation resulted in significant collagen degradation. Adding the corticosteroid dexamethasone significantly reduced the response to IL1-ß stimulation. Collagen degradation was significantly enhanced in the IL1-ß group. Dexamethasone demonstrated a significant rescue effect. This work provides insights into the characteristics of scleral cells and establishes an ex vivo model of scleral inflammation.
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Affiliation(s)
- Ghada Atta
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Falk Schroedl
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Alexandra Kaser-Eichberger
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
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5
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Lehner C, Spitzer G, Gehwolf R, Wagner A, Weissenbacher N, Deininger C, Emmanuel K, Wichlas F, Tempfer H, Traweger A. Tenophages: a novel macrophage-like tendon cell population expressing CX3CL1 and CX3CR1. Dis Model Mech 2019; 12:dmm.041384. [PMID: 31744815 PMCID: PMC6918766 DOI: 10.1242/dmm.041384] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022] Open
Abstract
Tendon disorders frequently occur and recent evidence has clearly implicated the presence of immune cells and inflammatory events during early tendinopathy. However, the origin and properties of these cells remain poorly defined. Therefore, the aim of this study was to determine the presence of cells in healthy rodent and human tendon tissue fulfilling macrophage-like functions. Using various transgenic reporter mouse models, we demonstrate the presence of tendon-resident cells in the dense matrix of the tendon core expressing the fractalkine (Fkn) receptor CX3CR1 and its cognate ligand CX3CL1/Fkn. Pro-inflammatory stimulation of 3D tendon-like constructs in vitro resulted in a significant increase in the expression of IL-1β, IL-6, Mmp3, Mmp9, CX3CL1 and epiregulin, which has been reported to contribute to inflammation, wound healing and tissue repair. Furthermore, we demonstrate that inhibition of the Fkn receptor blocked tendon cell migration in vitro, and show the presence of CX3CL1/CX3CR1/EREG-expressing cells in healthy human tendons. Taken together, we demonstrate the presence of CX3CL1+/CX3CR1+ 'tenophages' within the healthy tendon proper, which potentially fulfill surveillance functions in tendons.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Christian Deininger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Department of Orthopedics and Traumatology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Katja Emmanuel
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Florian Wichlas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria .,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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Jung F, Pindur G, Ohlmann P, Spitzer G, Sternitzky R, Franke R, Leithäuser B, Wolf S, Park JW. Microcirculation in hypertensive patients. Biorheology 2013; 50:241-55. [DOI: 10.3233/bir-130645] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Jung
- Institute of Biomaterial Science and Berlin–Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
| | - G. Pindur
- Institute for Clinical Haemostasiology and Transfusion Medicine, University Saarland, Homburg/Saar, Germany
| | - P. Ohlmann
- Marienkrankenhaus Papenburg, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Papenburg, Germany
| | - G. Spitzer
- Praxisklinik Herz und Gefäße, Dresden, Germany
| | | | - R.P. Franke
- Department of Biomaterials, University of Ulm, Ulm, Germany
| | | | - S. Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - J.-W. Park
- Asklepios Klinik Harburg, 1st Medical Department, Cardiology, Hamburg, Germany
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7
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Kirchmair J, Distinto S, Schuster D, Spitzer G, Langer T, Wolber G. Enhancing Drug Discovery Through In Silico Screening: Strategies to Increase True Positives Retrieval Rates. Curr Med Chem 2008; 15:2040-53. [DOI: 10.2174/092986708785132843] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Rifkin R, Beveridge R, Spitzer G, Orloff G, Mandanas R, McGaughey D, Zhan F, Boehm K, Asmar L. 79: Pegfilgrastim (P) Appears to be Equivalent to Multiple Daily Doses of Filgrastim (F) to Treat Neutropenia Post-Autologous Peripheral Blood Stem Cell Transplant (PBSCT) in Patients with Non-Hodgkin's Lymphoma: Results of a Randomized Phase II Trial. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Spitzer G, Zackon I, Stella P, Zehngebot L, Henderson C. Anti-epidermal growth factor (EGFR) antibody, cetuximab, in patients with stage IV colorectal carcinoma who failed all standard therapy: Final report of an access protocol. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. Spitzer
- Cancer Ctrs of the Carolinas, Greenville, SC; New York Hematology Oncology Assoc, Latham, NY; McCauley Cancer Ctr, Ypsilanti, MI; Florida Hosp Cancer Institute, Orlando, FL; Peachtree Hematology and Oncology Consultants, Altanta, GA
| | - I. Zackon
- Cancer Ctrs of the Carolinas, Greenville, SC; New York Hematology Oncology Assoc, Latham, NY; McCauley Cancer Ctr, Ypsilanti, MI; Florida Hosp Cancer Institute, Orlando, FL; Peachtree Hematology and Oncology Consultants, Altanta, GA
| | - P. Stella
- Cancer Ctrs of the Carolinas, Greenville, SC; New York Hematology Oncology Assoc, Latham, NY; McCauley Cancer Ctr, Ypsilanti, MI; Florida Hosp Cancer Institute, Orlando, FL; Peachtree Hematology and Oncology Consultants, Altanta, GA
| | - L. Zehngebot
- Cancer Ctrs of the Carolinas, Greenville, SC; New York Hematology Oncology Assoc, Latham, NY; McCauley Cancer Ctr, Ypsilanti, MI; Florida Hosp Cancer Institute, Orlando, FL; Peachtree Hematology and Oncology Consultants, Altanta, GA
| | - C. Henderson
- Cancer Ctrs of the Carolinas, Greenville, SC; New York Hematology Oncology Assoc, Latham, NY; McCauley Cancer Ctr, Ypsilanti, MI; Florida Hosp Cancer Institute, Orlando, FL; Peachtree Hematology and Oncology Consultants, Altanta, GA
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10
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Richards DA, Oettle H, Vervenne WL, Saif MW, Thomas JP, Spitzer G, Visseren-Grul C, Enas N, Weitzman A. Randomized double-blind phase II trial comparing gemcitabine (GEM) plus LY293111 vs. GEM plus placebo in advanced adenocarcinoma of the pancreas. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. A. Richards
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - H. Oettle
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - W. L. Vervenne
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - M. W. Saif
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - J. P. Thomas
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - G. Spitzer
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - C. Visseren-Grul
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - N. Enas
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
| | - A. Weitzman
- Tyler Cancer Ctr (US Oncology, Inc), Tyler, TX; Charité, Campus Virchow-Klinikum, Berlin, Germany; Acad Medcl Ctr, Amsterdam, The Netherlands; Univ of Alabama - Wallace Tumour Institute, Birmingham, AL; Univ of Wisconsin - Hospitals and Clinics, Madison, WI; Cancer Centers of the Carolinas (US Oncology, Inc), Greenville, SC; Eli Lilly, Houten, The Netherlands; Eli Lilly & Company - Lilly Corporate Ctr, Indianapolis, IN
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Vij R, Berenson JR, Borrello IM, Spitzer G, Bashey A, Martin T, Boccia RV, Simic A, Siegel D, Frohlich MW. A randomized phase II study of Xcellerated T Cells with or without prior fludarabine therapy in patients with multiple myeloma (MM). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Vij
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - J. R. Berenson
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - I. M. Borrello
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - G. Spitzer
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - A. Bashey
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - T. Martin
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - R. V. Boccia
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - A. Simic
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - D. Siegel
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - M. W. Frohlich
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
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Zehngebot L, Zackon I, Henderson CA, Spitzer G, Stella PJ, Levine M, Rosen LS. Anti-epidermal growth factor (EGFR) antibody cetuximab in patients with stage IV colorectal carcinoma who failed all standard therapy: An Access Protocol. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L. Zehngebot
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - I. Zackon
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - C. A. Henderson
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - G. Spitzer
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - P. J. Stella
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - M. Levine
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
| | - L. S. Rosen
- Hematology & Oncology Consultants, PA, Orlando, FL; New York Oncology Hematology, P.C., Albany, NY; Peachtree Hematology-Oncology, Atlanta, GA; Cancer Centers of the Carolinas, Greenville, SC; St. Joseph Mercy Hospital, Ann Arbor, MI; Greater Baltimore Medical Center, Baltimore, MD; Cancer institute Medical Group, Los Angeles, CA
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13
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Mandanas R, Beveridge R, Rifkin R, Wallace H, Greenspan A, Spitzer G, Guo H, Asmar L. Open-label, randomized comparison of dolasetron versus ondansetron for prevention of nausea and vomiting during high-dose chemotherapy and stem cell transplantation. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND When selecting only leukocyte compatible donors, the requirement of ABO compatibility limits the investigation and application of granulocyte transfusion therapy by reducing the pool of potential donors. Ex vivo hetastarch (HES) sedimentation was evaluated as a method of red blood cell (RBC) reduction of granulocyte components. The objective was to determine if this procedure consistently resulted in reduction of component packed RBC (PRBC) volume to < 5 ml, the range acceptable for infusion of ABO incompatible blood components based on guidelines set forth by the American Association of Blood Banks (AABB). STUDY DESIGN AND METHODS HLA-matched, ABO-compatible sibling marrow donors were selected to donate granulocyte components, which were transfused into the allogeneic bone marrow transplant (BMT) recipient as prophylaxis against infection. Three granulocyte components were collected from each of 5 donors receiving G-CSF (daily x 5). Leukapheresis (LA) began 1 day after the first G-CSF dose (Day 1), and was repeated on Days 3 and 5. LA were performed using a continuous-flow blood cell separator, with 7L blood processed during each procedure. RBC sedimentation was facilitated by administration of a 6% HES solution to the donor line. The 5 granulocyte components collected on Day 1 were not manipulated after collection. The 10 components collected on Days 3 and 5 were manipulated by ex vivo gravity sedimentation for 60 minutes followed by transfer of the buffy coat (red cell poor [RCP] fraction) to a transfer bag with residual RBCs retained in the collection bag (red cell rich [RCR] fraction). The PRBC volume and cellular composition of the components and fractions were determined. RESULTS When data for the 10 manipulated components were combined, the fraction of the components with < 5 ml PRBC was 0.4 in the RCP and 0.1 in the RCR fractions. All unmanipulated components contained > 5 ml PRBC. The mean PRBC volume (ml) of the RCP and RCR fractions were 6.3 and 16.4, respectively (P = .06). The mean number of RBC (x10(11)) in the RCP and the RCR fractions were .41 and 1.73, respectively (P = .03). The average proportion of cells in the manipulated components lost to the RCR fraction was 19.2% of granulocytes and 18.6% of platelets. CONCLUSION Ex vivo HES sedimentation, as performed, significantly reduced the number of RBCs from granulocyte components, but did not consistently result in PRBC volumes in the RCP fraction within the range acceptable for infusion of ABO incompatible blood components based on the AABB guidelines. Moreover, significant numbers of granulocytes were lost to the RCR fraction.
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Affiliation(s)
- D Adkins
- Division of Bone Marrow Transplantation & Stem Cell Biology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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15
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Gale RP, Park RE, Dubois R, Bitran JD, Buzdar A, Hortobagyi G, Jones SE, Lazar GS, Spitzer G, Swain SM, Vaughn CB, Vogel CE, Martino S. Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer. Clin Transplant 2000; 14:32-41. [PMID: 10693633 DOI: 10.1034/j.1399-0012.2000.140107.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. OBJECTIVE Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. PANELISTS: Nine breast cancer experts from diverse geographic sites and practice settings. EVIDENCE Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. PROCESS We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. CONCLUSIONS In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with > or = 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with < or = 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.
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Affiliation(s)
- R P Gale
- Salick Health Care, Inc., Los Angeles, CA, USA.
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16
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Rowlings PA, Williams SF, Antman KH, Fields KK, Fay JW, Reed E, Pelz CJ, Klein JP, Sobocinski KA, Kennedy MJ, Freytes CO, McCarthy PL, Herzig RH, Stadtmauer EA, Lazarus HM, Pecora AL, Bitran JD, Wolff SN, Gale RP, Armitage JO, Vaughan WP, Spitzer G, Horowitz MM. Factors correlated with progression-free survival after high-dose chemotherapy and hematopoietic stem cell transplantation for metastatic breast cancer. JAMA 1999; 282:1335-43. [PMID: 10527180 DOI: 10.1001/jama.282.14.1335] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Women with breast cancer are the most frequent recipients of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (autotransplants) in North America. Despite widespread use, controversy exists about the benefits of and appropriate patients for this therapy. OBJECTIVE To determine factors associated with disease progression or death after autotransplantation in women with metastatic breast cancer. DESIGN Analysis of data collected retrospectively (January 1989 to 1992) and prospectively (1992 through January 1995) for the Autologous Blood and Marrow Transplant Registry. SETTING Sixty-three hospitals in North America, Brazil, and Russia. PARTICIPANTS A total of 1188 consecutive women aged 18 to 70 years receiving autotransplants for metastatic or locally recurrent breast cancer, with a median follow-up of 291/2 months. MAIN OUTCOME MEASURE Time to treatment failure (disease progression, disease recurrence, or death) after autotransplantation. RESULTS Factors associated with significantly (P<.05) increased risk of treatment failure in a Cox multivariate analysis included age older than 45 years (relative hazard, 1.17; 95% confidence interval [CI], 1.02-1.33), Karnofsky performance score less than 90% (1.27; 95% CI, 1.07-1.51), absence of hormone receptors (1.31; 95% CI, 1.15-1.51), prior use of adjuvant chemotherapy (1.31; 95% CI, 1.10-1.56), initial disease-free survival interval after adjuvant treatment of no more than 18 months (1.99; 95% CI, 1.62-2.43), metastases in the liver (1.47; 95% CI, 1.20-1.80) or central nervous system (1.56; 95% CI, 0.99-2.46 [approaches significance]) vs soft tissue, bone, or lung, 3 or more sites of metastatic disease (1.32; 95% CI, 1.13-1.54), and incomplete response vs complete response to standard-dose chemotherapy (1.65; 95% CI, 1.36-1.99). Receiving tamoxifen posttransplantation was associated with a reduced risk of treatment failure in women with hormone receptor-positive tumors (relative hazard, 0.60; 95% CI, 0.47-0.87). Women with no risk factors (n = 38) had a 3-year probability of progression-free survival of 43% (95% CI, 27%-61 %) vs 4% (95% CI, 2%-8%) for women with more than 3 risk factors (n = 343). CONCLUSION These data indicate that some women are unlikely to benefit from autotransplantation and should receive this treatment only after being provided with prognostic information and in the context of clinical trials attempting to improve outcome.
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Affiliation(s)
- P A Rowlings
- The Breast Cancer Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee 53226, USA
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Nester TA, Wagnon AH, Reilly WF, Spitzer G, Kjeldsberg CR, Hill HR. Effects of allogeneic peripheral stem cell transplantation in a patient with job syndrome of hyperimmunoglobulinemia E and recurrent infections. Am J Med 1998; 105:162-4. [PMID: 9727824 DOI: 10.1016/s0002-9343(98)00200-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- T A Nester
- Department of Pathology, University of Utah School of Medicine, Salt Lake City 84132, USA
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Schiller G, Vescio R, Freytes C, Spitzer G, Lee M, Wu CH, Cao J, Lee JC, Lichtenstein A, Lill M, Berenson R, Berenson J. Autologous CD34-selected blood progenitor cell transplants for patients with advanced multiple myeloma. Bone Marrow Transplant 1998; 21:141-5. [PMID: 9489630 DOI: 10.1038/sj.bmt.1701055] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fifty-five patients with advanced multiple myeloma received purified CD34-selected peripheral blood progenitor cell transplants following myeloablative chemotherapy. A median of 4.1 x 10(6) CD34 cells/kg (range 1.2-30.7) were infused after busulfan (14 mg/kg) and cyclophosphamide (120 mg/kg); granulocyte-macrophage colony-stimulating factor was used until hematopoietic recovery. Median time to neutrophils >0.5 x 10(9)/l and platelets >20 x 10(9)/l were 12 days (range 10-16 and 8-184 days, respectively). Median follow-up of survivors from the time of transplantation is 33 months (range 7 to 44 months). Thirty-one patients are alive, 19 progression-free. Median progression-free survival is 14 months. Actuarial 3-year progression-free and overall survival are 29+/-14% and 47+/-17%. CD34-selection of peripheral blood progenitor cells provides effective hematopoietic support with significant progression-free and overall survival.
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Affiliation(s)
- G Schiller
- Department of Medicine, Jonsson Comprehensive Cancer Center, UCLA School of Medicine, Los Angeles, CA 90095, USA
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Spitzer G, Adkins D, Mathews M, Velasquez W, Bowers C, Dunphy F, Kronmueller N, Niemeyer R, McIntyre W, Petruska P. Randomized comparison of G-CSF + GM-CSF vs G-CSF alone for mobilization of peripheral blood stem cells: effects on hematopoietic recovery after high-dose chemotherapy. Bone Marrow Transplant 1997; 20:921-30. [PMID: 9422470 DOI: 10.1038/sj.bmt.1700999] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fifty patients with either lymphoid or selected solid tumor malignancies were apheresed an identical number of times for PBSC collection after being randomized to receive either G-CSF 10 microg/kg/day alone (arm I), or G-CSF at the same dose with GM-CSF 5 microg/kg/day (arm II). Growth factor(s) was/were given as the stem cell mobilizing agent for 5 days before the start of PBSC collection, and were continued throughout the 4 days of apheresis. Aspiration and cryopreservation of autologous bone marrow occurred on day 3 or 4 of growth factor(s). Thirty-one of 50 patients received one cycle only at time of evaluation, and 19 patients received two cycles of HDCT, each supported with PBSC with or without autologous bone marrow. No patients received growth factors post-autologous stem cell transplant, unless the absolute neutrophils count (ANC) failed to recover to > or = 100/microl by day +18 post-transplant. The median number of days to recovery of ANC to 100/microl, 500/microl and 1000/microl, and of platelet counts to 20000/microl, 50000/microl and 100000/microl after either cycle 1 or cycle 2 of HDCT and the number of febrile days and platelet and PRBC transfusion requirements was not significantly different between the two arms of the study. The duration of hospitalization was similar between study arms for cycle 1 of HDCT, but was 3.5 days less with arm II compared to arm I (P = 0.0248) for cycle 2 of HDCT. The bone marrow buffy coat and PBSC product mononuclear cell count (x 10(8)/kg) and CD34+ cell count (x 10(6)/kg) collected by each method of stem cell mobilization was not significantly different. There is questionable clinical benefit with PBSC products mobilized with the combination of G-CSF and GM-CSF vs G-CSF alone. Perhaps different dosages, schedules, or other growth factor combinations with G-CSF might enhance these differences.
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Affiliation(s)
- G Spitzer
- Saint Louis University Health Sciences Center, Department of Internal Medicine, MO, USA
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20
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Ford C, Spitzer G, Reilly W, Adkins D. A phase II study of repetitive cycles of dose-intense carboplatin plus paclitaxel chemotherapy and peripheral blood stem cells in metastatic breast cancer. Semin Oncol 1997; 24:S17-81-S17-86. [PMID: 9374101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To assess the feasibility of administering sequential cycles of dose-intensive therapy, 14 patients without prior chemotherapy for metastatic breast cancer were registered to be treated with paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) at an initial dose of 250 mg/m2 over 24 hours (day 1), followed by carboplatin dosed to an area under the concentration-time curve of 16 (calculated according to the Calvert formula), every 3 weeks for four cycles. This combination was supported with peripheral blood stem cells collected following granulocyte colony-stimulating factor with or without cyclophosphamide and paclitaxel. One patient failed to peripheralize CD34 cells after cyclophosphamide/paclitaxel therapy and was taken off protocol. The remaining 13 patients entered the paclitaxel/carboplatin phase of the program, and nine completed all four cycles. The median duration of severe neutropenia (absolute neutrophil count < 100/microL) was 6 days, despite the absence of routine use of granulocyte colony-stimulating factor. Only five of a total of 42 chemotherapy cycles (12%) were associated with febrile neutropenia requiring hospitalization. Most patients did not require platelet transfusions. The most significant nonhematologic toxicity was gastrointestinal (grade 3 in three patients, two of whom had received local radiation for relapse before chemotherapy). Most patients developed grade 1 or 2 sensory neuropathy by the final cycle. Of the nine patients who entered the paclitaxel/carboplatin phase and were evaluable for response, five achieved a complete remission. This doublet of high-dose therapy can be given in an entirely ambulatory setting and is associated with modest hematologic toxicity. The value of this option in the treatment of metastatic breast cancer compared with more conventional approaches to high-dose therapy will require a greater number of patients evaluable for response and longer follow-up.
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Affiliation(s)
- C Ford
- LDS Hospital Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, UT, USA
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Adkins D, Spitzer G, Johnston M, Velasquez W, Dunphy F, Petruska P. Transfusions of granulocyte-colony-stimulating factor-mobilized granulocyte components to allogeneic transplant recipients: analysis of kinetics and factors determining posttransfusion neutrophil and platelet counts. Transfusion 1997; 37:737-48. [PMID: 9225939 DOI: 10.1046/j.1537-2995.1997.37797369451.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Granulocyte-colony-stimulating factor (G-CSF) is a safe and effective agent for mobilization of neutrophils in normal donors, consistently resulting in cell yields per leukapheresis (LA) procedure that are superior to those with other agents. LA components also contain platelets, whose clinical relevance is unknown. STUDY DESIGN AND METHODS This study describes the kinetics of and analyzes the factors determining the ANC and platelet count increments seen with each of three transfusions of granulocytes collected from HLA-matched sibling donors receiving G-CSF (n = 10; maximum of 3 LA procedures/donor). The transfusions were given to recipients (n = 10) on alternate days beginning. Day 1 after allogeneic bone marrow transplant (BMT). RESULTS Significant, sustained increments in the recipient ANCs were observed after the transfusion of G-CSF-mobilized LA components. The mean peak posttransfusion increments in the ANCs were 1195, 729, and 631 per microL with transfusion of donor LA components on Days 1, 3, and 5, respectively. The length of time that the mean posttransfusion ANC was at or above the baseline (pretransfusion) value was 25 to 37 hours, depending on the post-BMT day when the component was administered. No consistent relationship was observed between LA component granulocyte dose, baseline recipient ANC, or temperature elevation and post-transfusion ANC increments. Large numbers of platelets (mean, 2.55 x 10(11)) were present in LA components, and this resulted in significant increments from baseline in the mean platelet count 1 hour after LA component transfusions. Between Days 1 and 7, the duration of severe neutropenia was shorter and the percentage of patients requiring nondonor platelet transfusions was less in study patients who received LA component transfusions than in a similar historical control group who did not. CONCLUSION The transfusion of G-CSF-mobilized, HLA-matched LA components to allogeneic BMT recipients resulted in significant and sustained increments in the ANC and the platelet count. Within the range examined, a relationship between neutrophil dose and an increment in the ANC was not demonstrated.
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Affiliation(s)
- D Adkins
- Division of Bone Marrow Transplantation, Oncology and Hematology, Saint Louis University Health Sciences Center, Missouri, USA
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Antman KH, Rowlings PA, Vaughan WP, Pelz CJ, Fay JW, Fields KK, Freytes CO, Gale RP, Hillner BE, Holland HK, Kennedy MJ, Klein JP, Lazarus HM, McCarthy PL, Saez R, Spitzer G, Stadtmauer EA, Williams SF, Wolff S, Sobocinski KA, Armitage JO, Horowitz MM. High-dose chemotherapy with autologous hematopoietic stem-cell support for breast cancer in North America. J Clin Oncol 1997; 15:1870-9. [PMID: 9164197 DOI: 10.1200/jco.1997.15.5.1870] [Citation(s) in RCA: 246] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To identify trends in high-dose therapy with autologous hematopoietic stem-cell support (autotransplants) for breast cancer (1989 to 1995). PATIENTS AND METHODS Analysis of patients who received autotransplants and were reported to the Autologous Blood and Marrow Transplant Registry. Between January 1, 1989 and June 30, 1995, 19,291 autotransplants were reviewed; 5,886 were for breast cancer. Main outcomes were progression-free survival (PFS) and survival. RESULTS Between 1989 and 1995, autotransplants for breast cancer increased sixfold. After 1992, breast cancer was the most common indication for autotransplant. Significant trends included increasing use for locally advanced rather than metastatic disease (P < .00001) and use of blood-derived rather than marrow-derived stem cells (P < .00001). One-hundred-day mortality decreased from 22% to 5% (P < .0001). Three-year PFS probabilities were 65% (95% confidence intervals [Cls], 59 to 71) for stage 2 disease, and 60% (95% Cl, 53 to 67) for stage 3 disease. In metastatic breast cancer, 3-year probabilities of PFS were 7% (95% Cl, 4 to 10) for women with no response to conventional dose chemotherapy; 13% (95% Cl, 9 to 17) for those with partial response; and 32% (95% Cl, 27 to 37) for those with complete response. Eleven percent of women with stage 2/3 disease and less than 1% of those with stage 4 disease participated in national cooperative group randomized trials. CONCLUSION Autotransplants increasingly are used to treat breast cancer. One-hundred-day mortality has decreased substantially. Three-year survival is better in women with earlier stage disease and in those who respond to pretransplant chemotherapy.
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Affiliation(s)
- K H Antman
- Breast Cancer Working Committee of the Autologous Blood and Marrow Transplant Registry of North America, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA.
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Adkins D, Goodgold H, Hendershott L, Johnston M, Cravens D, Spitzer G. Indium-labeled white blood cells apheresed from donors receiving G-CSF localize to sites of inflammation when infused into allogeneic bone marrow transplant recipients. Bone Marrow Transplant 1997; 19:809-12. [PMID: 9134173 DOI: 10.1038/sj.bmt.1700749] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
G-CSF administration to normal donors results in granulocyte apheresis yields generally greater than those observed with other neutrophil mobilizing agents. In vitro, neutrophils cultured with G-CSF exhibit prolonged survival; however, the random migration of neutrophils exposed to this agent is inhibited. Although transfused neutrophils mobilized with agents other than G-CSF migrate to sites of inflammation or infection in vivo, this has yet to be demonstrated with infusion of G-CSF-mobilized neutrophils into neutropenic human subjects. Five neutropenic allogeneic bone marrow transplant (BMT) patients each received a fresh infusion of G-CSF-mobilized indium-labeled irradiated white blood cells (WBC) apheresed from HLA-matched normal donors on day +5 post-transplant. Localization of activity on delayed scintigraphic images of indium-labeled WBC scans to sites of tissue damage (oral/nasopharynx in two patients with mucositis and terminal ileum/cecum in one with diarrhea) occurred, and supports the hypothesis that G-CSF-mobilized HLA-matched donor neutrophils which have been irradiated are functional after infusion into neutropenic recipients.
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Affiliation(s)
- D Adkins
- Washington University School of Medicine, Department of Internal Medicine, St Louis, MO 63110-1093, USA
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24
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Peters BG, Adkins DR, Harrison BR, Velasquez WS, Dunphy FR, Petruska PJ, Bowers CE, Niemeyer R, McIntyre W, Vrahnos D, Auberry SE, Spitzer G. Antifungal effects of yeast-derived rhu-GM-CSF in patients receiving high-dose chemotherapy given with or without autologous stem cell transplantation: a retrospective analysis. Bone Marrow Transplant 1996; 18:93-102. [PMID: 8832001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Systemic fungal infections (SFI) in patients receiving high-dose chemotherapy (HDC) are a frequent cause of morbidity and mortality. Preclinical studies have reported augmented antifungal activity of monocytes, macrophage cells, and neutrophils exposed to certain colony-stimulating factors (CSF), including GM-CSF. We conducted a retrospective descriptive epidemiologic study to examine the characteristics of 145 consecutive patients receiving HDC administered with or without autologous stem cell transplantation (ASCT) and who subsequently received either GM-CSF and G-CSF, G-CSF alone, GM-CSF +/- IL-3 or no CSF. The analysis of this patient population sought to define the incidence of SFI and its relationship to therapy with monocyte/macrophage-stimulating (MMS group) cytokines (GM-CSF and G-CSF; GM-CSF +/- IL-3) or to cytokines which do not result in monocyte/macrophage stimulation (NMMS group, G-CSF alone or no CSF). Risk factors for the development of SFI were balanced between the MMS (n = 70) and NMMS (n = 75) groups. Two patients (2.9%) in the MMS and nine patients (12%) in the NMMS groups developed SFI. The risk ratio for developing SFI in the NMMS group compared to the MMS group was 4.20 (P = 0.023). This relationship was confounded, however, by the diagnosis of hematologic tumor or solid tumor (RR = 3.15, P = 0.082). SFI was the primary cause or major contributing factor in five of the 10 total deaths in our study population. Four SFI-related deaths occurred in the NMMS group and one SFI-related death occurred in the MMS group. Our data suggest a protective role for GM-CSF, IL-3 or other MMS cytokines in preventing SFI in patients receiving HDC. This should be further investigated as a potential complementary approach to conventional strategies in antifungal prophylaxis for patients receiving HDC.
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Affiliation(s)
- B G Peters
- Department of Pharmacy, Saint Louis University Hospital, MO 63110-0250, USA
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25
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Schiller G, Vescio R, Freytes C, Spitzer G, Sahebi F, Lee M, Wu CH, Cao J, Lee JC, Hong CH. Transplantation of CD34+ peripheral blood progenitor cells after high-dose chemotherapy for patients with advanced multiple myeloma. Blood 1995; 86:390-7. [PMID: 7540888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A major potential problem of autologous transplantation in the treatment of advanced malignancy is the infusion of tumor cells. A multi-institutional study of purified CD34-selected peripheral blood progenitor cell (PBPC) transplantation was conducted in 37 patients with advanced multiple myeloma receiving myeloablative chemotherapy. Fourteen days after intermediate-dose cyclophosphamide, prednisone, and granulocyte colony-stimulating factor (G-CSF), a median of 3 (range, 2 to 5) 10-L leukaphereses yielded 9.8 x 10(8)/kg (range, 3.7 to 28.3) mononuclear cells. The adsorbed (column-bound) fraction contained 5.9 x 10(6) cells/kg (range, 1.6 to 25.5) with 4.65 x 10(6) CD34 cells/kg (range, 1.2 to 23.3). Using Poisson distribution analysis of positive polymerase chain reactions with patient-specific complementarity-determining region 1 (CDR1) and CDR3 Ig-gene primers, tumor was detected in leukapheresis products from 8 to 14 unselected patients and ranged from 1.13 x 10(4) to 2.14 x 10(6) malignant cells/kg. After CD34 selection, residual tumor was detected in only three patients' products. Overall, a greater than 2.7- to 4.5-log reduction in contaminating multiple myeloma cells was achieved. CD34 PBPCs were infused 1 day after busulfan (14 mg/kg) and cyclophosphamide (120 mg/kg), and granulocyte-macrophage colony-stimulating factor was used until hematologic recovery. The median time to both neutrophil and platelet recovery was 12 days (range, 11 to 16 days and 9 to 52 days, respectively). The median number of erythrocyte and platelet transfusions was 7 (range, 2 to 37) and 3 (range, 0 to 85), respectively. Patients receiving fewer than 2 x 10(6) CD34 cells/kg had significantly prolonged neutropenia, thrombocytopenia, and an increased red blood cell and platelet transfusion requirement. Thus, CD34 selection of PBPCs markedly reduces tumor contamination in multiple myeloma and provides effective hematopoietic support for patients receiving myeloablative therapy.
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Affiliation(s)
- G Schiller
- Department of Medicine, UCLA School of Medicine 90024-1678, USA
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26
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Roth K, Kuhlmann D, Spitzer G, Ulfkotte J, Kruse C. Besprechungen. Sportwiss 1994. [DOI: 10.1007/bf03177945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Dimopoulos MA, Yau JC, Huan SD, Jagannath S, Spitzer G, Spinolo JA, Zagars GK, LeMaistre CF, Dicke KA, Zander AR. Allogeneic bone marrow transplantation for leukemia following piperazinedione and fractionated total body irradiation. Am J Hematol 1994; 46:82-6. [PMID: 8172200 DOI: 10.1002/ajh.2830460205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between 1980 and 1988, 126 patients with leukemia were treated with piperazinedione and fractionated total body irradiation (TBI) followed by allogeneic bone marrow transplantation from HLA matched siblings. Sixty-one patients had acute myelogenous leukemia, 46 acute lymphoblastic leukemia, and 19 chronic myelogenous leukemia. Patients with acute leukemia in first complete remission were transplanted only if perceived to have a low probability of remaining in remission with conventional therapy. The toxicity from the preparative regimen was similar to that of cyclophosphamide and TBI except that none of the patients in the study had hemorrhagic cystitis or veno-occlusive disease. After a median follow up of 114 months, 29 patients (23%) are still alive without relapse. The survival of patients with acute myelogenous or lymphoblastic leukemia transplanted in their first remission were 35% and 43%, respectively. The survival of patients transplanted in their first chronic phase of chronic myelogenous leukemia was 60%. The results of this preparative regimen are comparable to those of cyclophosphamide and TBI.
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Affiliation(s)
- M A Dimopoulos
- University of Texas M.D. Anderson Cancer Center, Houston
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28
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Abstract
We describe some issues of ongoing studies and results in metastatic and high-risk breast cancer. Caution should be used to not over interpret the outcomes of these data given the patient selection. In other tumors with lesser developed studies, such as with ovarian cancer, non seminomatous germ cell tumors (NSGC), childhood sarcoma, melanoma and limited small cell carcinoma, promising outcomes in small phase II studies are identified and proposed or potential studies comparing high-dose therapy to conventional are outlined. High-dose therapy with either peripheral blood stem cell support (PBSC) or autologous bone marrow transplantation (ABMT) in Phase II studies on a diverse array of solid tumors shows exciting promise of long-term, disease-free survival. Comparative studies in early-stage patients are urgently needed to confirm these outcomes.
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Affiliation(s)
- G Spitzer
- Division of Bone Marrow Transplantation, St. Louis University School of Medicine, Missouri 63110-0250
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29
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Dunphy FR, Spitzer G, Fornoff JE, Yau JC, Huan SD, Dicke KA, Buzdar AU, Hortobagyi GN. Factors predicting long-term survival for metastatic breast cancer patients treated with high-dose chemotherapy and bone marrow support. Cancer 1994; 73:2157-67. [PMID: 8156520 DOI: 10.1002/1097-0142(19940415)73:8<2157::aid-cncr2820730821>3.0.co;2-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Poor prognosis of Stage IV breast cancer patients have at best a 10% 3-year survival rate with conventional chemotherapy. Dose-intensive chemotherapy improved survival rates for some of these patients. METHODS All patients were Stage IV estrogen receptor-negative or estrogen receptor-positive hormonal refractory and received conventional chemotherapy (induction phase) to the point of achieving maximal response; if disease was stable or the patients responded, they entered high-dose chemotherapy (intensive phase). Seventy-six percent of the patients received two high-dose treatments with cyclophosphamide (4.5-6.0 g/m2), etoposide (750-1500 mg/m2), and cisplatin (120-180 mg/m2). Patients were randomized to receive or not receive autologous marrow. To identify prognostic factors for survival, univariate statistical analysis and multivariate models were applied to patient subsets. RESULTS Univariate analysis identified a number of factors whose presence indicates improvement in overall survival rates. These include: (1) absence of liver relapse (P = 0.001); (2) absence of soft tissue relapse (P = 0.001); (3) a smaller number of metastatic sites at the time of detecting Stage IV disease (P = 0.026); and (4) disease-free interval greater than 1 year from initial diagnosis to Stage IV disease (P = 0.011). Multivariate models were fitted to the data, and three variables were identified as independent negative predictors for overall survival: (1) liver site (P = 0.001); (2) soft tissue site (P = 0.039); and (3) prior adjuvant chemotherapy (P = 0.028). CONCLUSIONS Shorter survival after high-dose chemotherapy is predicted independently by patients pretreated with adjuvant chemotherapy, by disease distributed to the liver or the soft tissue.
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Affiliation(s)
- F R Dunphy
- Department of Internal Medicine, Saint Louis University Medical Center, Missouri 63110-0250
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30
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Spitzer G, Adkins DR, Spencer V, Dunphy FR, Petruska PJ, Velasquez WS, Bowers CE, Kronmueller N, Niemeyer R, McIntyre W. Randomized study of growth factors post-peripheral-blood stem-cell transplant: neutrophil recovery is improved with modest clinical benefit. J Clin Oncol 1994; 12:661-70. [PMID: 7512124 DOI: 10.1200/jco.1994.12.4.661] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the clinical value of growth factors (GFs) with peripheral-blood stem cells (PBSC) collected following mobilization with GFs, we randomized patients to receive or not to receive GFs following transplant. PATIENTS AND METHODS Thirty-seven patients were apheresed after receiving the combination of granulocyte colony-stimulating factor (G-CSF) with granulocyte-macrophage colony-stimulating factor (GM-CSF) at doses of 10 micrograms/kg/d and 5 micrograms/kg/d, respectively, for 6 days before apheresis and during a median of 4 days of collections. One day after the infusion of autologous marrow and PBSC, patients were randomly assigned to receive no GFs or a combination of G-CSF (7.5 micrograms/kg/d) and GM-CSF (2.5 micrograms/kg/d), both as a 2-hour intravenous (i.v.) infusion twice per day until the neutrophil count was greater than 1,500/microL. RESULTS The median days to recovery to an absolute neutrophil count (ANC) of 100/microL (9 v 11.5, P = .0005), 500/microL (10 v 16, P = .0004), or 1,000/microL (12 v 21, P = .0008) was shortened with the use of GFs, post-PBSC infusion. In addition, the duration of hospitalization was shorter (19 v 21 days, P = .0112) in the arm receiving GFs post-PBSC infusion. There was no significant difference between the two study arms in the duration of fever, documented septic episodes, or RBC or platelet transfusion requirements. CONCLUSION Despite faster neutrophil recovery and shortened duration of hospitalization with GFs administered after PBSC transplantation, the measured clinical variables of febrile days, septic episodes, and transfusion requirements were similar between the study arms. The use of GFs post-PBSC transfusion is associated with a modest clinical benefit.
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Affiliation(s)
- G Spitzer
- Department of Internal Medicine, St. Louis University Health Sciences Center, MO 63110-0250
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31
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Zimmerman S, Adkins D, Graham M, Petruska P, Bowers C, Vrahnos D, Spitzer G. Irreversible, severe congestive cardiomyopathy occurring in association with interferon alpha therapy. Cancer Biother 1994; 9:291-9. [PMID: 7719376 DOI: 10.1089/cbr.1994.9.291] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Interferon alpha is a biologic agent with demonstrated anti-tumor activity in a variety of hematologic and solid malignancies. Many patients treated with interferon experience acute toxicity manifested as a flu-like syndrome of fever, chills, myalgias, and malaise. However, fatigue, anorexia, bone marrow suppression, nausea, vomiting, dizziness, and confusion may also occur. Cardiotoxicity is a rare complication of interferon therapy that most frequently presents as transient episodes of hypotension and tachycardia, with few significant life-threatening cardiovascular effects reported. A small number of cases of suspected interferon-induced cardiomyopathy, all of which improved after discontinuing interferon, have recently been documented. We report a patient with multiple myeloma who developed severe congestive cardiomyopathy while receiving interferon alpha that did not reverse subsequent to discontinuation of interferon therapy. Although the patient had previously received doxorubicin, the presence on endomyocardial biopsy of a prominent intracellular lipid accumulation within myocytes and only grade 2 anthracycline cardiotoxicity suggested that other or additional factor(s) contributed to the severity of this patient's cardiomyopathy. Etiologies of cardiac dysfunction other than interferon and doxorubicin were excluded. While a direct cause-effect relationship between interferon alpha and irreversible congestive cardiomyopathy cannot be firmly established in this case report, patients who either concurrently or sequentially receive interferon and anthracyclines should be carefully monitored for evidence of cardiac toxicity.
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Affiliation(s)
- S Zimmerman
- Saint Louis University Health Sciences Center, Department of Internal Medicine, MO 63110, USA
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Abstract
We describe potential problems that may limit the usefulness of peripheral blood stem cells (PBSC) to facilitate the delivery of multiple cycles of high-dose chemotherapy. These include (1) cumulative myelotoxicity and (2) recurrent episodes of febrile neutropenia and a requirement for frequent platelet transfusions as a result of the stubborn persistence of a minimum of 7-9 days of absolute neutropenia and even longer durations of severe thrombocytopenia, despite utilization of PBSC. However, some of these problems may be overcome by shortening the duration of administration of the high-dose regimen with subsequent earlier reinfusion of the stem cell product. The adverse consequences of severe neutropenia could be overcome by the development of prophylactic neutrophil transfusions. These concepts are discussed with presentation of some preliminary data.
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Affiliation(s)
- G Spitzer
- Saint Louis University Health Sciences Center, Bone Marrow Transplantation and Medical Oncology and Hematology, MO 63110-0250
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Bierman PJ, Bagin RG, Jagannath S, Vose JM, Spitzer G, Kessinger A, Dicke KA, Armitage JO. High dose chemotherapy followed by autologous hematopoietic rescue in Hodgkin's disease: long-term follow-up in 128 patients. Ann Oncol 1993; 4:767-73. [PMID: 8280658 DOI: 10.1093/oxfordjournals.annonc.a058662] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is little long-term follow-up information after autologous transplantation for Hodgkin's disease. We evaluated the influence of various prognostic factors and examined the outcome in 128 such patients. PATIENTS AND METHODS Patients received high dose cyclophosphamide, carmustine, and etoposide followed by autologous hematopoietic rescue. RESULTS Patients have been observed between 50-130 months (median 77 months) following transplantation. Overall survival at four years is estimated as 45 percent, and failure-free survival as 25 percent. The best results were seen in patients with a good performance status, who had failed at most one prior chemotherapy regimen. Failure-free survival at four years is estimated as 53 percent for this group. Relapses more than 24 months after transplantation were seen in 11 patients. Five patients developed myelodysplastic syndromes. Three patients became pregnant after the transplant. CONCLUSIONS Prolonged failure-free survival may be observed following high dose chemotherapy and autologous hematopoietic rescue in patients with Hodgkin's disease. Superior results were seen in patients without extensive prior chemotherapy and in those with a good performance status. Late relapses and deaths from secondary myelodysplastic syndromes mandate prolonged follow-up after autologous transplantation for Hodgkin's disease.
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Affiliation(s)
- P J Bierman
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha
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Bowers C, Adkins D, Dunphy F, Harrison B, LeMaistre CF, Spitzer G. Dose escalation of mitoxantrone given with thiotepa and autologous bone marrow transplantation for metastatic breast cancer. Bone Marrow Transplant 1993; 12:525-30. [PMID: 8298564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
High-dose chemotherapy given with autologous bone marrow support has resulted in significant tumor responses in the majority of patients with metastatic breast cancer, a minority of which are durable. To improve on these results, we are developing high-dose preparative regimens which may be given in successive cycles, each with autologous bone marrow transplantation (ABMT), over a short duration. In this report, 44 patients with metastatic breast cancer were treated with thiotepa (total dose: 900 mg/m2) and mitoxantrone (MT), administered in a dose-escalation fashion, with ABMT. The dose-limiting non-hematologic toxicity of mitoxantrone was cardiotoxicity, with the maximum tolerated dose being 50 mg/m2 Mucositis and pneumonia were also frequent treatment-related side-effects. The overall tumor response rate was 49% in this heavily pre-treated group of patients. We are currently evaluating the toxicity and efficacy of tandem non-cross-resistant transplant regimens, using the MT combination for the second cycle of therapy, in patients with metastatic breast cancer sensitive to standard dose chemotherapy.
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Affiliation(s)
- C Bowers
- Saint Louis University Medical Center, MO 63110-0250
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35
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Spitzer G, Adkins D, Dunphy F, Petruska P, Spencer V, Velasquez W. Design of preparative regimens for stem cell transplantation in breast cancer. Breast Cancer Res Treat 1993; 26 Suppl:S3-9. [PMID: 8400330 DOI: 10.1007/bf00668354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have evaluated tandem cycles of a tri-drug combination, termed CVP (cyclophosphamide, etoposide [VP-16], and cisplatin [Platinol]), at four levels in more than 300 patients with various types of tumors. Tandem CVP appears to be at least therapeutically equivalent to alternatives. A second potentially non-cross-resistant combination of mitoxantrone and thiotepa (MT), with or without etoposide, has been used in sequence following CVP to improve long-term, disease-free survival in patients who have multiple metastatic sites, who relapse shortly after adjuvant therapy, or who show other unfavorable clinical features. A combination of MT and etoposide (MVT) achieved an overall response rate of 61% in 32 patients with metastatic or refractory breast cancer. The etoposide was then eliminated to decrease the major toxicities of this regimen. MT was subsequently given to 37 evaluable patients prior to bone marrow infusion. The overall response rate was 48.5% Thirty patients with metastatic breast cancer were then treated with induction therapy, a cycle of CVP, and then a cycle of MT. Given the low complete remission (CR) rate to induction therapy in these patients, the CR rate achieved with CVP-MT was encouraging. Further studies are ongoing.
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Affiliation(s)
- G Spitzer
- Saint Louis University Medical Center, Division of Bone Marrow Transplantation, Medical Oncology and Hematology, MO 63110-0250
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Spitzer G, Dunphy FR, Petruska PJ, Velasquez WS, Adkins DR. Tandem transplants in solid tumors: marrow versus peripheral stem cell transplant: peripheral blood cells as now practiced are not the whole answer. J Hematother 1993; 2:363-5. [PMID: 7921997 DOI: 10.1089/scd.1.1993.2.363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have performed sequential studies examining the modification of hematopoietic toxicity after the administration of high-dose cyclophosphamide, etoposide, and cisplatin (CVP). The sequential studies include a comparison of the influence of autologous bone marrow transplantation (ABMT) on hematopoietic recovery after CVP, with or without growth factors. These studies demonstrate a significant shortening of the duration of neutropenia with ABMT, but minimal impact on the number of infectious episodes, when compared to those not receiving ABMT. The addition of mobilized peripheral blood stem cells (PBSC) to ABMT followed by growth factor was found to enhance platelet recovery, but did not significantly further reduce the period of absolute neutropenia. Subsequent studies show that similar early hematopoietic recovery can be achieved by use of peripheral blood stem cells alone, pheresed following several days of subcutaneous administration of recombinant growth factors, but neutrophil recovery is more rapid with use of growth factor after PBSC infusion. Using the product of two phereses for each cycle of recovery appears to result in similar rates of hematopoietic engraftment after each cycle of CVP. In conclusion, the use of peripheral blood stem cells alone following sequential high dose CVP is associated with rapid neutrophil and platelet recovery. Caution should be exercised when using PBSC alone after high dose therapy, due to the lack of platelet recovery in some instances, which can be overcome by reinfusion of backup marrow. Thus, studies evaluating the role of PBSC after high dose therapy should continue.
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Affiliation(s)
- G Spitzer
- Division of Bone Marrow Transplantation, Oncology and Hematology, Saint Louis University Medical Center, MO 63110
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37
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Spinolo JA, Jagannath S, Velásquez W, Spitzer G, Cabanillas F, Hagemeister F, Horwitz LJ, Dicke KA. Cisplatin-CBV with autologous bone marrow transplantation for relapsed Hodgkin's disease. Leuk Lymphoma 1993; 9:71-7. [PMID: 8477204 DOI: 10.3109/10428199309148506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of high-dose cyclophosphamide, carmustine, and etoposide (CBV) with autologous bone marrow transplantation (ABMT) results in long-term disease-free survival of about 30% in patients with relapsed Hodgkin's disease. Laboratory and clinical data show that cisplatin is synergistic with etoposide and carmustine, with non-overlapping extramedullary toxicity. Twenty-one patients with relapsed Hodgkin's disease that had progressed after both MOPP-like and ABVD-like regimens were treated with CBV plus cisplatin (90 mg/m2) and ABMT. The CR rate was 55%; the three-year disease-free and overall survival were 29% and 38% respectively; these results are comparable to prior experience with CBV. Performance status was strongly correlated with achievement of CR, survival, and time to treatment failure. Nephrotoxicity was seen in 3 patients, and ototoxicity in 1 patient. Although cisplatin could be added to CBV with minimal additional toxicity, the results obtained in this small patient population were not better than those of the earlier regimen. A larger trial in patients not previously exposed to cisplatin may better define the role of its addition to CBV.
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Affiliation(s)
- J A Spinolo
- University of Texas M. D. Anderson Cancer Center, Houston
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Yau JC, LeMaistre CF, Andersson BS, Huan SD, Wallerstein RO, Woo SY, Spitzer G, Spinolo JA, Spencer V, Brunner LJ. Allogeneic bone marrow transplantation for hematological malignancies following etoposide, cyclophosphamide, and fractionated total body irradiation. Am J Hematol 1992; 41:40-4. [PMID: 1503097 DOI: 10.1002/ajh.2830410108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Forty-three patients received etoposide, cyclophosphamide, and fractionated total body irradiation before allogeneic marrow transplantation. Fifteen patients had chronic myelogenous leukemia in chronic phase or acute leukemia in first remission (standard risk) and twenty-eight patients with more advanced disease (high risk). All patients received etoposide 1,500 mg/m2 intravenously on day -8, cyclophosphamide 60 mg/kg/day intravenously on days -7 and -6, and total body irradiation at 170 cGy twice a day on days -3, -2, and -1. During the first 100 days 12 high risk patients (43%) died from causes unrelated to relapse while none of the standard risk patients died. Renal and hepatic dysfunction were also significantly increased during the first 14 days in the high risk group. The addition of 1,500 mg/m2 of etoposide to the cyclophosphamide and total body irradiation was well tolerated for patients with standard risk. However, the regimen was poorly tolerated with high mortality in patients with more advanced disease.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Bone Marrow Transplantation
- Carmustine/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Drug Therapy, Combination
- Etoposide/administration & dosage
- Etoposide/therapeutic use
- Female
- Humans
- Injections, Intravenous
- Leukemia/drug therapy
- Leukemia/radiotherapy
- Leukemia/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/radiotherapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Middle Aged
- Transplantation, Homologous
- Whole-Body Irradiation
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Affiliation(s)
- J C Yau
- Ottawa Regional Cancer Center, Ontario, Canada
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39
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Huan SD, Hester J, Spitzer G, Yau JC, Dunphy FR, Wallerstein RO, Dicke K, Spencer V, LeMaistre CF, Andersson BS. Influence of mobilized peripheral blood cells on the hematopoietic recovery by autologous marrow and recombinant human granulocyte-macrophage colony-stimulating factor after high-dose cyclophosphamide, etoposide, and cisplatin. Blood 1992; 79:3388-93. [PMID: 1596578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Peripheral blood cells (PBC) can hasten hematopoietic recovery after high-dose chemotherapy. To determine if PBC apheresed after mobilization further enhance hematopoietic recovery over that achieved with autologous bone marrow (ABM) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF), 14 patients with metastatic solid tumors were supported by ABM and rhGM-CSF during the first course of high doses of cyclophosphamide, etoposide, and cisplatin (CVP) and 11 of these 14 patients by mobilized PBC with ABM and rhGM-CSF during the second CVP. Each patient served as his or her own control. Identical doses of CVP were administered in both courses: cyclophosphamide 5.25 g/m2, etoposide 1,200 mg/m2, and cisplatin 165 to 180 mg/m2. PBC were collected on day 10 after mobilization with cyclophosphamide (3 g/m2) intravenously (IV) on day 1, doxorubicin (50 mg/m2) as a continuous IV infusion over 48 hours starting day 2, and rhGM-CSF as a daily 4-hour IV infusion starting day 4 at 0.6 mg/m2 for 14 days. Comparing recovery in the 11 patients to receive two cycles of therapy, the median days to an absolute neutrophil count of 0.1 x 10(9)/L and 0.5 x 10(9)/L were not statistically significant between the two courses; neither was there a difference in the incidence of fever and bacteremia. The median number of days to platelet count of 0.02 x 10(12)/L unmaintained by platelet transfusion was 20 from marrow infusion for course 1 and 16 for course 2 (P = .059). The median number of days to a platelet count of 0.05 x 10(12)/L was significantly shortened: 24 and 19 days for courses 1 and 2, respectively (P = .045). Patients who received PBC required fewer number of platelet transfusions. Extramedullary toxicities were not different between the groups. Our finding of enhanced early recovery of platelets and reduced platelet transfusion requirement is in concordance with other studies.
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Affiliation(s)
- S D Huan
- Division of Oncology, St Louis University Medical Center, MO 63110
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40
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Abstract
Recent studies in autologous bone marrow or peripheral blood transplantation in solid tumors are discussed. The toxicity and activity of high-dose cisplatin or carboplatin combined with etoposide and other drugs are described. The results of trials in nonseminomatous germ cell tumors, neuroblastoma, ovarian cancer, and brain tumors are detailed and discussed. The impressive antitumor activities noted in certain subgroups should lead to an early application of these strategies before drug resistance becomes prevalent.
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41
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Claxton D, Deisseroth A, Talpaz M, Reading C, Kantarjian H, Trujillo J, Stass S, Gooch G, Spitzer G. Polyclonal hematopoiesis in interferon-induced cytogenetic remissions of chronic myelogenous leukemia. Blood 1992; 79:997-1002. [PMID: 1371081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Interferon (IFN) therapy of early chronic myelogenous leukemia (CML) frequently produces partial or complete cytogenetic remission of the disease. Patients with complete cytogenetic remission often continue on therapy for several years with bone marrow showing only diploid (normal) metaphases. We studied hematopoiesis in five female patients with major cytogenetic remissions from CML during IFN therapy. Clonality analysis using the BstXI PGK gene polymorphism showed that granulocytes were nonclonal in all patients during cytogenetic remission. BCR region studies showed rearrangement only in the one patient whose remission was incomplete at the time of sampling. Granulopoiesis is nonclonal in IFN-induced remissions of CML and may be derived from normal hematopoietic stem cells.
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Affiliation(s)
- D Claxton
- University of Texas M.D. Anderson Cancer Center, Department of Hematology, Houston 77030
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42
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Abstract
Seventeen patients who had a relapse at a median of 9 months after marrow transplant (14 allogeneic and three syngeneic) received second transplants. Eight patients were in remission when transplanted. Of the nine patients with active disease at the time of transplant, six had complete remissions, and one converted from blastic to chronic phase of chronic myelogenous leukemia. The median survival was 9 months (95% confidence interval, 4 to 17 months). Four patients died within 100 days of transplantation, and three were disease-free. Ten patients died after 100 days, all except two of disease relapse. Five patients had remissions that were greater than 12 months and longer than the remission after their first transplant (inversions). Three patients remain alive and disease-free at 37+, 55+, and 61+ months, the former two despite remissions of less than 1 year after their first transplant. Second transplants with a different cytoreductive regimen can eradicate disease resistant to prior myeloablative treatment; some patients may benefit from second transplants, even if the first transplant only achieves a short remission.
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Affiliation(s)
- J A Spinolo
- M. D. Anderson Cancer Center, Houston, Texas
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43
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Dunphy FR, Spitzer G. Use of very-high-dose chemotherapy with autologous bone marrow transplantation in treatment of breast cancer. J Natl Cancer Inst 1992; 84:128-9. [PMID: 1735880 DOI: 10.1093/jnci/84.2.128] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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44
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Spitzer G, Spencer V, Dunphy FR, Kulkarni S, Johnston M. Does peripheral blood further enhance hematopoietic recovery after autologous bone narrow transplantation and post transplantation recombinant growth factor? ACTA ACUST UNITED AC 1992. [DOI: 10.1002/stem.5530100748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Yau JC, Dimopoulos MA, Huan SD, Spencer V, Woo SY, Spitzer G, Brunner LJ, Wallerstein RO, Deisseroth AB, Andersson BS. An effective acute graft-vs.-host disease prophylaxis with minidose methotrexate, cyclosporine, and single-dose methylprednisolone. Am J Hematol 1991; 38:288-92. [PMID: 1746537 DOI: 10.1002/ajh.2830380407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cyclosporine and methotrexate at standard doses (15 mg/m2 on day 1 and 10 mg/m2 on days 3, 6, and 11, total 45 mg/m2) are effective in the prophylaxis of acute graft-vs.-host disease. However, the combination has significant early toxicities with delayed engraftment, increased mucositis, and hepatotoxicity. We modified the combination by adding single-dose methylprednisolone and lowered the total dose of methotrexate to 35 mg/m2 (5 mg/m2 on days 1, 3, and 6, and then 10 mg/m2 on days 11 and 18) and then to 20 mg/m2 (5 mg/m2 on days 1, 3, 6, and 11) in an attempt to decrease these side effects in two sequential consecutive groups of patients. We demonstrated that the modified regimens maintained the efficacy with reduced toxicities. The rate of engraftment was comparable to cyclosporine alone and the hepatotoxicity was reduced with reduced doses of methotrexate. Factors such as early immunosuppression of the host, intravenous immunoglobulin, the timing of steroid administration, nucleotide free diet and germ free environment may contribute to the effectiveness of the combination and permit reduction of methotrexate dose.
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Affiliation(s)
- J C Yau
- Ottawa Regional Cancer Center, Ontario, Canada
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46
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Yau JC, Dimopoulos MA, Huan SD, Tarrand JJ, Spencer V, Spitzer G, Meneghetti CM, Wallerstein RO, Andersson BS, LeMaistre CF. Prophylaxis of cytomegalovirus infection with ganciclovir in allogeneic marrow transplantation. Eur J Haematol 1991; 47:371-6. [PMID: 1662140 DOI: 10.1111/j.1600-0609.1991.tb01863.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cytomegalovirus (CMV) infection is one of the most common causes of morbidity and mortality after allogeneic marrow transplantation. We studied 14 consecutive CMV-seropositive patients adding ganciclovir (2.5 mg/kg i.v. every 8 hours for 7 days prior to transplant and 6 mg/kg three times a week after neutrophils became greater than 0.5 x 10(9)/l and the patients were platelet transfusion-independent until d 70) to our previous prophylaxis regimen which consisted of intravenous immunoglobulin and acyclovir. The result was compared with 30 consecutive patients whom we studied with our previous regimen. The addition of ganciclovir did not cause any extra toxicities. The incidence of interstitial pneumonitis and cumulative probability of CMV excretion in the first 100 d post-transplantation was significantly reduced (p = 0.038 and p = 0.035 respectively). The result shows that addition of ganciclovir significantly decreased the incidence of CMV infection in the early post-transplantation period.
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Affiliation(s)
- J C Yau
- Department of Hematology, University of Texas, M.D. Anderson Cancer Center, Houston
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47
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Kantarjian HM, Talpaz M, LeMaistre CF, Spinolo J, Spitzer G, Yau J, Dicke K, Jagannath S, Deisseroth AB. Intensive combination chemotherapy and autologous bone marrow transplantation leads to the reappearance of Philadelphia chromosome-negative cells in chronic myelogenous leukemia. Cancer 1991; 67:2959-65. [PMID: 1675151 DOI: 10.1002/1097-0142(19910615)67:12<2959::aid-cncr2820671203>3.0.co;2-t] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Fifteen patients with Philadelphia chromosome (Ph)-positive chronic myelogenous leukemia (CML) who were ineligible for allogeneic bone marrow transplantation (BMT) or alpha-interferon therapy were included in this study. Eight patients were in the first late chronic phase, five were in the second chronic phase, one was in the accelerated phase, and one was in the blastic phase. Autologous bone marrow cells (median, 2.5 x 10(8) nucleated cells/kg) were stored at a median of 30 months after diagnosis. Patients were treated with cyclophosphamide (1.5 g/m2 daily for 4 days), carmustine (BCNU) (300 mg/m2), and etoposide (VP-16) (250 mg/m2 daily for 3 days) (CBV), followed by reinfusion of autologous bone marrow. Hematopoietic recovery was rapid, and toxicity was mild to moderate in 14 patients. One patient died of cytomegalovirus pneumonitis. Eight of 15 patients showed Ph suppression to less than 90% Ph-positive metaphases after autologous BMT. Major cytogenetic responses (Ph suppression to less than 35% Ph-positive metaphases) developed in four patients. Cytogenetic responses were observed in 4 of 11 patients infused with 100% Ph-positive marrows, and in all 4 patients infused with Ph-mosaic marrows (mixture of diploid and Ph-positive cells). Better results were observed when autologous BMT was performed in the chronic phase compared with the advanced phases. The major cytogenetic responses have lasted for 3, 4, 12, and 15+ months, whereas minor cytogenetic responses lasted for only a short time (less than 2 months). Three of seven patients (43%) in the chronic phase with previous resistance to alpha-interferon therapy became sensitive to alpha-interferon therapy after autologous BMT. The authors concluded that intensive chemotherapy followed by autologous BMT produced cytogenetic remissions in patients with Ph-positive CML and reinduced disease sensitivity to alpha-interferon therapy in patients previously resistant to it. This is particularly useful when treatment is given during the chronic phase and stem cells are collected at a time of previous cytogenetic remission.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow Transplantation/methods
- Carmustine/administration & dosage
- Cyclophosphamide/administration & dosage
- Etoposide/administration & dosage
- Female
- Follow-Up Studies
- Granulocytes/pathology
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/pathology
- Humans
- Interferon Type I/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukocytes, Mononuclear/pathology
- Macrophages/pathology
- Male
- Metaphase
- Middle Aged
- Philadelphia Chromosome
- Remission Induction
- Time Factors
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Affiliation(s)
- H M Kantarjian
- Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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48
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Abstract
Studies are described of high-dose therapy in metastatic breast cancer, early stage breast cancer, stage IV neuroblastoma, recurrent or bulky disease testicular cancer and Ewing's sarcoma. The outcome in these subgroups with conventional therapy is described for comparison. The results of these studies suggest that high-dose therapy with autologous marrow support increases the proportion of patients with long-term survival without evidence of disease. Newer supportive care and recurrent high-dose therapy cycles of non-cross resistant regimens may improve outcome further in these diseases and increase the application to more resistant tumors.
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Affiliation(s)
- G Spitzer
- St. Louis University, Division of Medical Oncology, MO 63110-0250
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49
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Abstract
To determine the incidence and clinical significance of micrometastases in the bone marrow of breast carcinoma patients, we performed an immunoalkaline phosphatase assay using anticytokeratin (AE1, AE3, MAK-6) and antiepithelial (113F1, 260F9, 317G5) antibodies on the bone marrow aspirates of 71 stage IV disease patients with either recurrent regional or distant metastases. Although we detected tumor cells within the bone marrow of 38% of these patients with this assay, no significant correlation was seen with patient's age, menopausal status, bone scan, bone marrow core histology, response to induction chemotherapy, number of metastatic sites, dominant site of metastasis, or subsequent clinical outcome. The clinical parameters that were associated with improved survival were one dominant site of metastatic disease and regional soft tissue recurrence without distant disease.
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Affiliation(s)
- S E Singletary
- Department of General Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030
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50
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Berenson RJ, Bensinger WI, Hill RS, Andrews RG, Garcia-Lopez J, Kalamasz DF, Still BJ, Spitzer G, Buckner CD, Bernstein ID. Engraftment after infusion of CD34+ marrow cells in patients with breast cancer or neuroblastoma. Blood 1991; 77:1717-22. [PMID: 1707696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The CD34 antigen is expressed by 1% to 4% of human and baboon marrow cells, including virtually all hematopoietic progenitors detectable by in vitro assays. Previous work from our laboratory has shown that CD34+ marrow cells can engraft lethally irradiated baboons. Because the CD34 antigen has not been detected on most solid tumors, positive selection of CD34+ cells may be used to provide marrow cells capable of engraftment, but depleted of tumor cells. In seven patients with stage IV breast cancer and two patients with stage IV neuroblastoma, 2.5 to 17.5 x 10(9) marrow cells were separated by immunoadsorption with the anti-CD34 antibody 12-8 and 50 to 260 x 10(6) positively selected cells were recovered that were 64 +/- 16% (range 35% to 92%) CD34+. The patients received 1.0 to 5.2 x 10(6) CD34-enriched cells/kg after marrow ablative therapy. Six patients engrafted, achieving granulocyte counts of greater than 500/mm3 at 34 +/- 10 (range 21 to 47) days and platelets counts of greater than 20,000/mm3 at 46 +/- 14 (range 28 to 66) days posttransplant. Five of these patients showed durable engraftment until the time of death 82 to 386 days posttransplant. One patient failed to sustain engraftment associated with metastatic marrow disease. Three patients died at days 14, 14, and 17 posttransplant, two of whom had evidence of early engraftment. These studies suggest that CD34+ marrow cells are capable of reconstituting hematopoiesis in humans.
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Affiliation(s)
- R J Berenson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
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