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Plerixafor added to G-CSF-supported paclitaxel-ifosfamide-cisplatin salvage chemotherapy enhances mobilization of adequate numbers of hematopoietic stem cells for subsequent autografting in hard-to-mobilize patients with relapsed/refractory germ-cell tumors : a single-center experience

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Kosmas, Christos, Athanasopoulos, Aggelos, Dimitriadis, Georgios K., Miltiadous, Constantinos, Zilakos, Minas, Lydakis, Dimitris, Magiorkinis, Emmanouel, Gekas, Christos, Daladimos, Theodoros, Mylonakis, Nikolaos and Ziras, Nikolaos (2014) Plerixafor added to G-CSF-supported paclitaxel-ifosfamide-cisplatin salvage chemotherapy enhances mobilization of adequate numbers of hematopoietic stem cells for subsequent autografting in hard-to-mobilize patients with relapsed/refractory germ-cell tumors : a single-center experience. Anti-Cancer Drugs, 25 (7). pp. 841-847. doi:10.1097/CAD.0000000000000100

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Official URL: http://dx.doi.org/10.1097/CAD.0000000000000100

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Abstract

An appreciable percentage of patients with relapsed/refractory germ-cell tumors (GCTs), candidates for high-dose chemotherapy (HDC) and autologous hematopoietic cell transplantation (HCT), fail to mobilize adequate hematopoietic stem cells (HSCs) numbers with granulocyte colony-stimulating factor (G-CSF)±salvage chemotherapy. Plerixafor has shown a potential to mobilize adequate CD34+HSCs numbers in this context. Here, we applied plerixafor in combination with G-CSF after salvage chemotherapy in 'poor' mobilizers with relapsed/refractory GCTs for HDC+HCT. Patients with relapsed/refractory GCTs (n=10) received salvage paclitaxel-ifosfamide-cisplatin (TIP) chemotherapy+G-CSF to mobilize adequate HSCs to support HDC, mainly with two courses of high-dose thiotepa-etoposide-carboplatin (TEC). Patients failing to achieve the minimum collection threshold of 2.0×10/kg CD34+ cells, to support at least one cycle of HDC, were administered plerixafor before the anticipated HSC collection during subsequent cycle(s). Overall, seven patients mobilized adequate CD34+ cells (>5.0×10/kg) aiming to support two cycles of HDC. Three patients did not mobilize adequate numbers of CD34+ cells after previous G-CSF plus salvage TIP, and plerixafor was added in subsequent cycle(s). This led to a collection of adequate CD34+ cells, able to support HDC with TEC (1-2 cycles). Hematopoietic engraftment for neutrophils (absolute neutrophil count>500/μl) and platelets (platelet count>20 000/μl) with plerixafor-mobilized HSCs occurred after a median of 9 and 14 days, respectively. Salvage TIP+G-CSF leads to successful HSC mobilization in patients with less heavily pretreated GCTs, whereas the addition of plerixafor to G-CSF+TIP led to mobilization of adequate HSCs that supported autografting after one to two TEC cycles.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Antineoplastic agents, Stem cells
Journal or Publication Title: Anti-Cancer Drugs
Publisher: Lippincott Williams & Wilkins
ISSN: 0959-4973
Official Date: August 2014
Dates:
DateEvent
August 2014Published
Volume: 25
Number: 7
Page Range: pp. 841-847
DOI: 10.1097/CAD.0000000000000100
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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