Dexamethasone, paclitaxel, etoposide, cyclophosphamide (d-TEC) and G-CSF for stem cell mobilisation in multiple myeloma

Bilgrami, S; Bona, Robert; Edwards, R. Lawrence; Li, Z; Naqvi, Bilal; Shaikh, Attiya; Furlong, Fiona; Fox, Judee M; Clive, Jonathan; Tutschka, Peter J.

doi:10.1038/sj.bmt.1703126

Cited by 10 publications

(6 citation statements)

References 41 publications

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“…Clinical activity in MM was nevertheless demonstrated, a concept supported by the use of paclitaxel in the combination d-TEC (dexamethasone, paclitaxel, etoposide, cyclophosphamide), which was successfully used in MM for stem cell mobilization. 43 In 2003, ECOG reported a clinical study of docetaxel given at 75 mg/m 2 intravenously over 1 hour every 3 weeks in patients with relapsing or refractory MM, who had received no more than 2 prior combination chemotherapy regimens. Eighty percent of patients developed grade 3 to 4 granulocytopenia, 23% experienced grade 3 to 4 thrombocytopenia, and the median survival was 9.9 months.…”

Section: Discussionmentioning

confidence: 99%

Patupilone (epothilone B) inhibits growth and survival of multiple myeloma cells in vitro and in vivo

Lin

Catley

LeBlanc

et al. 2005

Blood

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Section: Discussionmentioning

confidence: 99%

Patupilone (epothilone B) inhibits growth and survival of multiple myeloma cells in vitro and in vivo

Lin

Catley

LeBlanc

et al. 2005

Blood

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“…It is widely known that cyclophosphamide is not merely a cytotoxic drug but also has an immunomodulatory activity. It induces abortive mobilization of CD34 hematopoietic progenitors [ 26 – 28 ], it stimulates proliferation of dendritic cell progenitors in the bone marrow, which results in the increased dendritic cell counts in peripheral blood and is coincident with the unfolding adaptive immune response [ 29 ]. It generally increases the immune response by maintaining the balance of dendritic cell subpopulations [ 30 ], and finally it either abrogates or inhibits the functionality of T-regs [ 31 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

Five-year disease-free survival among stage II-IV breast cancer patients receiving FAC and AC chemotherapy in phase II clinical trials of Panagen

et al. 2016

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BackgroundWe report on the results of a phase II clinical trial of Panagen (tablet form of fragmented human DNA preparation) in breast cancer patients (placebo group n = 23, Panagen n = 57). Panagen was administered as an adjuvant leukoprotective agent in FAC and AC chemotherapy regimens. Pre-clinical studies clearly indicate that Panagen acts by activating dendritic cells and induces the development of adaptive anticancer immune response.MethodsWe analyzed 5-year disease-free survival of patients recruited into the trial.ResultsFive-year disease-free survival in the placebo group was 40 % (n = 15), compared with the Panagen arm – 53 % (n = 51). Among stage III patients, disease-free survival was 25 and 52 % for placebo (n = 8) and Panagen (n = 25) groups, respectively. Disease-free survival of patients with IIIB + C stage was as follows: placebo (n = 6)–17 % vs Panagen (n = 18)–50 %.ConclusionsDisease-free survival rate (17 %) of patients with IIIB + C stage breast cancer receiving standard of care therapy is within the global range. Patients who additionally received Panagen demonstrate a significantly improved disease-free survival rate of 50 %. This confirms anticancer activity of Panagen.Trial registrationClinicalTrials.gov NCT02115984 from 04/07/2014.

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“…The choice of starting the apheretic sessions at low WBC and CD34þ counts, and performing multiple sessions if necessary, may have contributed towards the above results. Furthermore, although not ideal, similar policies are still used: Stewart et al [13] selected the same CD34þ value, Lie et al [16] the same WBC level, and Bilgrami et al [17] started apheresis on the basis of a crude rate of 1% CD34þ cells.…”

Section: Discussionmentioning

confidence: 98%

“…Although there is no conclusive evidence of the superiority of one G-CSF dose over the others, we chose 10 mg/kg because it has been used by authors administering lower G-CSF doses [4,15] and is also commonly used in other settings [16,17]; furthermore, there are some suggestions that an increase in the G-CSF dose may reduce the failure rate [16]. A high yield of CD34þ cells (more than 6 £ 10 6 /kg) was obtained from over 75% of our patients, thus allowing a double transplant if indicated; furthermore, the yield was at least sufficient for a single transplant in almost all cases.…”

Section: Discussionmentioning

confidence: 99%

Harvesting of Autologous Blood Stem Cells after a Mobilising Regimen with Low-dose Cyclophosphamide

Deliliers

Annaloro

Marconi

et al. 2002

Leukemia & Lymphoma

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Although high-dose cyclophosphamide (HD-CTX) is commonly used as a mobilising regimen for autologous peripheral blood stem cell (PBSC) collection, significant morbidity and insufficient harvesting may complicate the procedure. Alternative regimens and lower doses of cyclophosphamide (CTX) have been investigated as possible ways of overcoming these difficulties. Low-dose CTX (1.5 g/m2) was administered to 102 lymphoma patients as an autologous PBSC mobilising regimen. The collection of 6 x 10(6) CD34+ cells/kg was chosen as the target of the apheresis sessions, whereas 3 x 10(6)/kg were considered the minimum necessary to perform autologous stem cell transplantation (ASCT) safely. The apheretic sessions were started a median of eight days after CTX administration; a median of two aphereses was required. More than 6 x 10(6) CD34+ cells/kg were collected from 78 patients, between 3 and 6 x 10(6)/kg from 19, and fewer than 3 x 10(6)/kg from 5, two of whom underwent bone marrow harvesting and one a successful second PBSC harvesting session using the same mobilising regimen. Eighty-two patients underwent autografting, six of whom received a second transplant after relapse (five using autologous PBSCs coming from the first apheretic course). Low-dose CTX proved to be a safe and effective regimen for autologous PBSC mobilization and also compared favourably with alternative regimens in terms of the rate of harvesting insufficiency. This does not imply that low-dose CTX is the best mobilising regimen for all patients, and the identification of prognostic factors predicting mobilising potential may help in choosing the best individualised regimen.

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Dexamethasone, paclitaxel, etoposide, cyclophosphamide (d-TEC) and G-CSF for stem cell mobilisation in multiple myeloma

Cited by 10 publications

References 41 publications

Patupilone (epothilone B) inhibits growth and survival of multiple myeloma cells in vitro and in vivo

Patupilone (epothilone B) inhibits growth and survival of multiple myeloma cells in vitro and in vivo

Five-year disease-free survival among stage II-IV breast cancer patients receiving FAC and AC chemotherapy in phase II clinical trials of Panagen

Harvesting of Autologous Blood Stem Cells after a Mobilising Regimen with Low-dose Cyclophosphamide

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