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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
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 |
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| 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: |
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| 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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