Impact of preleukapheresis cell counts on collection results and correlation of progenitor-cell dose with engraftment after high-dose chemotherapy in patients with germ cell cancer.

Schwella, N.; Beyer, Jörg; Schwaner, Ingo; Heuft, H G; Rick, Oliver; Huhn, D.; Serke, Stefan; Siegert, W.

doi:10.1200/jco.1996.14.4.1114

Cited by 84 publications

(65 citation statements)

References 14 publications

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“…For germ cell cancer patients, the mobilization of peripheral blood stem cells with chemotherapy and G-CSF has not been well established and the amount of harvested PBSC has varied with chemotherapy regimens. One report on PBSC harvesting with chemotherapy (VIP) and G-CSF for germ cell cancer patients 10 obtained an almost equal amount as in our study. In another report, refractory or relapsed germ cell cancer patients underwent three cycles of chemotherapy of taxol, cisplatin and ifosfamide (TIP) before high-dose chemotherapy; however, progenitor cells were poorly mobilized after TIP chemotherapy.…”

Section: Discussionsupporting

confidence: 76%

Collection of peripheral blood stem cells with granulocyte‐colony‐stimulating factor alone in testicular cancer patients

et al. 2000

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Background: High-dose chemotherapy with the transplantation of peripheral blood stem cells (PBSC) has been performed for the treatment of advanced testicular cancer patients. Recently, it has been reported that, in healthy donors, a large quantity of stem cells can be transferred to peripheral blood using granulocyte-colony-stimulating factor (G-CSF) alone. Therefore, it was decided to try to harvest PBSC from three patients having testicular cancers with G-CSF alone. Methods:The three patients with testicular cancer were 26, 56 and 62-years-old. They had undergone five, two and three cycles of chemotherapy, respectively, but no radiation therapy. Granulocyte colony-stimulating factor was subcutaneously injected (250 mg) into each patient twice per day for 6 days. Peripheral blood stem cells were harvested for 3 days (days 4-6) and mononuclear cells (MNC), CD34-positive cells and colony-forming units of granulocyte-macrophage (CFU-GM) in PBSC collected by apheresis were measured. Results: Apheresis showed that the total MNC count was 20.2 ¥ 10 8 /kg (range, 10.6-25.9 ¥ 10 8 /kg), the CD34-positive cell count was 0.98 ¥ 10 6 /kg (range, 0.75-1.4 ¥ 10 6 /kg) and the total CFU-GM count was 1.36 ¥ 10 5 /kg (range, 0.25-3.0 ¥ 10 5 /kg). Conclusion: After mobilization of peripheral blood stem cells with G-CSF alone, sufficient amounts of MNC were obtained from testicular cancer patients who had undergone chemotherapy several times. However, sufficient amounts of CD34-positive cells and CFU-GM could not be obtained. These results suggested that the G-CSF dose was not adequate for harvesting sufficient amounts of CD34-positive cells and CFU-GM.

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Section: Discussionsupporting

confidence: 76%

Collection of peripheral blood stem cells with granulocyte‐colony‐stimulating factor alone in testicular cancer patients

et al. 2000

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“…[26][27][28] We and others, however, have shown that disease-specific cytotoxic chemotherapy plus growth factor efficiently mobilized PBPC from bone marrow into PB in patients with solid tumors and hematologic malignancies. [29][30][31] Knowledge about PBPC mobilization by chemotherapy and/or growth factor in patients suffering from STS is poor. Bokemeyer et al 20 demonstrated the feasibility of PBPC mobilization and collection in nine previously untreated STS patients following ADM/IFO plus G-CSF or G-CSF alone.…”

Section: Discussionmentioning

confidence: 99%

“…The patient received a cell dose of 1.6 ϫ 10 6 CD34 + cells/kg for hematopoietic rescue, which was below the threshold considered to be sufficient for rapid and safe hematopoietic recovery. 29,33 Unfortunately, in this patient no CFU-GM assays were available from frozen/thawed PBPC samples, which could have contributed to more information on the quality of the autograft. In conclusion, in STS patients with cytotoxic pretreatment PBPC mobilization is feasible by a further course of disease-specific chemotherapy plus G-CSF.…”

Section: Discussionmentioning

confidence: 99%

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Mobilization of peripheral blood progenitor cells by disease-specific chemotherapy in patients with soft tissue sarcoma

Schwella

Rick

Meyer

et al. 1998

Bone Marrow Transplant

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Summary:We investigated peripheral blood progenitor cell (PBPC) mobilization by disease-specific chemotherapy in patients with metastatic soft tissue sarcoma (STS). Nine patients, five females and four males, aged 12-51 years, pretreated by one to nine courses of cytotoxic chemotherapy, underwent STS-specific mobilization followed by G-CSF at 5 g/kg/day. PBPC were collected by 19 conventional-volume aphereses (8-12 l) with one to four procedures in individual patients. Leukaphereses started on median day 15 (range 13-18) from the first day of mobilization chemotherapy at medians of 25.8 ؋ 10 3 WBC/ l (6.8-46.9), 3.5 ؋ 10 3 MNC/ l (1.1-8.8), 122 ؋ 10 3 platelets/ l (72-293) and 30.7 CD34 ؉ cells/ l (6.7-207.8). Cumulative harvests resulted in medians of 4.6 ؋ 10 8 MNC/kg (3.0-6.4), 2.9 ؋ 10 6 CD34 ؉ cells/kg (1.1-11.1) and 12.0 ؋ 10 4 CFU-GM/kg (2.0-37.8). Eight patients underwent high-dose chemotherapy (HDCT) followed by PBPC rescue. Seven patients recovered hematopoiesis at medians of 12 days (8-15) for ANC Ͼ0.5 ؋ 10 3 / l and 14 days (8-27) for platelets Ͼ20 ؋ 10 3 / l. One patient, who received 1.6 ؋ 10 6 CD34 ؉ cells/kg, exhibited delayed ANC recovery on day ؉37 and failed to recover platelets until hospital discharge on day +55. We conclude that in patients with metastatic STS, who are pretreated by standard chemotherapy, PBPC can be mobilized by a further course of STS-specific chemotherapy plus G-CSF. One to four conventional-volume aphereses result in PBPC autografts that can serve as hematopoietic rescue for patients scheduled for HDCT. Keywords: soft tissue sarcoma; blood progenitor cells; disease-specific mobilization Soft tissue sarcomas (STS), arising from the extraskeletal connective tissue of the body, occur at a rate of 0.7% of all adult cancers. 1 Radical surgery, often combined with radiotherapy, can be curative in up to 60% of patients. However, prognosis of patients with metastatic or recurrent STS is poor, and most of them will die from progressive Treatment of patients who do not respond to these drugs is very difficult because only few salvage regimens exist. 6,7 There is strong evidence for a dose-response relationship for doxorubicin and ifosfamide. 8,9 For optimal response rates it seems essential to achieve a dose intensity of greater than 65 mg/m 2 for doxorubicin and greater than 5 g/m 2 for ifosfamide. 10,11 In the last decade, hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) have entered clinical trials in an attempt to administer escalated-dose chemotherapy regimens without inducing fatal neutropenia. 12,13 More recently, the use of hematopoietic stem/progenitor cells has circumvented myelotoxicity as the dose-limiting toxicity in clinical trials. 14,15 The aim of this study was to demonstrate peripheral blood progenitor cell (PBPC) mobilization by diseasespecific chemotherapy in pretreated patients with metastatic STS scheduled for high-dose chemotherapy (HDCT). Patients and methods Pa...

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“…This is especially important in those conditions, e.g. advanced breast cancer, in which transplantation is performed mainly in patients who have shown optimal response to first-line induction chemotherapy.Despite the controversy over the number of autologous CPCs required to support myeloablative regimens, an amount greater than 2.5 x 106 kg-' body weight CD34+ cells is considered by many authors to be sufficient for a safe haematopoietic reconstitution (Bender et al, 1992;Bensinger et al, 1995;Schwella et al, 1996). The tempo of platelet engraftment has been reported to be delayed in some patients when less than 5 x 106 CD34+ cells kg-' body weight are reinfused (Bensinger et al, 1995).…”

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Collection of circulating progenitor cells after epirubicin, paclitaxel and filgrastim in patients with metastatic breast cancer

Pedrazzoli

Perotti²,

Prada³

et al. 1997

Br J Cancer

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Summary The efficacy of high-dose chemotherapy (HDC) and circulating progenitor cell (CPC) transplantation in metastatic breast cancer (MBC) relies mainly on giving this treatment after a response to conventional induction chemotherapy has been achieved. For this reason an optimal mobilization regimen should be therapeutically effective while minimizing the number of leucaphereses required to support the myeloablative therapy. The combination of an anthracycline and paclitaxel in chemotherapy-untreated MBC has produced impressive response rates. We evaluated the CPC-mobilizing capacity of the combination epirubicin (90 mg m-2) and paclitaxel (135 mg m-2) followed by filgrastim (5 Ag kg-1 day-1) starting 48 h after chemotherapy administration in ten patients with MBC who were eligible for an HDC and CPC transplantation programme. Leucaphereses were performed by processing at least two blood volumes per procedure at recovery from neutrophil nadir when CD34+ cells in the peripheral blood exceeded 20 [I-. In most patients (six out of 10) more than 2.5 x 106 CD34+ cells kg-', a threshold considered to be sufficient for haematopoietic reconstitution, were collected with a single apheresis. In the remaining four patients an additional procedure, performed the following day, was enough to reach the required number of progenitors. These data suggest that the epirubicin-paclitaxel combination, besides being a very active regimen in MBC, is effective in releasing large amounts of progenitor cells into circulation.Keywords: progenitor cell; mobilization; breast cancer; chemotherapyThe autologous transfusion of circulating progenitor cells (CPCs) collected from the peripheral blood by leucapheresis is rapidly replacing autologous bone marrow transplantation to support haematopoiesis after high-dose chemotherapy (HDC) for lymphoma and solid tumours (Gianni AM, 1994;Holoyake, 1994). The main reason for the success of this procedure is the capability of CPCs to produce a much faster haematopoietic recovery than bone marrow cells (Siena et al, 1989;Sheridan et al, 1992;Chao et al, 1993;Schmitz et al, 1996).An adequate number of progenitor cells capable of guaranteeing short-and long-term haematopoiesis can be harvested from the peripheral blood after treatment with haematopoietic growth factors administered as single agents or, more frequently, following myelosuppressive chemotherapy (Bensinger et al, 1993;Siena et al, 1994). Moreover, mobilization with disease-oriented chemotherapy in addition to cytokines is particularly recommended in patients with chemosensitive neoplasms as the greater efficacy of mobilization is combined with the anti-tumour effect of the drug. In fact, in most CPC transplantation programmes the mobilizing regimens include agents (often at high doses) with proven efficacy against the underlying disease (Brugger et al, 1992;Shimazaki et al, 1992;Gianni AM et al, 1995 Controversy still surrounds the use of HDC with CPC support in stage IV breast cancer (Shpall et al, 1994;Hortobagyi, 1995;Kennedy, 1995), mai...

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Impact of preleukapheresis cell counts on collection results and correlation of progenitor-cell dose with engraftment after high-dose chemotherapy in patients with germ cell cancer.

Cited by 84 publications

References 14 publications

Collection of peripheral blood stem cells with granulocyte‐colony‐stimulating factor alone in testicular cancer patients

Collection of peripheral blood stem cells with granulocyte‐colony‐stimulating factor alone in testicular cancer patients

Mobilization of peripheral blood progenitor cells by disease-specific chemotherapy in patients with soft tissue sarcoma

Collection of circulating progenitor cells after epirubicin, paclitaxel and filgrastim in patients with metastatic breast cancer

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