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Dennis A Gastineau - One of the best experts on this subject based on the ideXlab platform.
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clinical impact and resource utilization after Stem Cell Mobilization failure in patients with multiple myeloma and lymphoma
Bone Marrow Transplantation, 2010Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:High-dose chemotherapy in conjunction with auto-SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 to 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was 'optimal' (> or = 5 x 10(6)) in 53%, 'low' (> or = 2-5 x 10(6)) in 25%, 'poor' (<2 x 10(6)) in 10%, and 'failed' (<10 CD34+ Cells/microl) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy Mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. This usually unappreciated resource utilization associated with Stem Cell Mobilization failure highlights the need for more effective Mobilization strategies.
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Clinical impact and resource utilization after Stem Cell Mobilization failure in patients with multiple myeloma and lymphoma.
Bone marrow transplantation, 2010Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:High-dose chemotherapy in conjunction with auto-SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 to 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was 'optimal' (> or = 5 x 10(6)) in 53%, 'low' (> or = 2-5 x 10(6)) in 25%, 'poor' (
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Clinical Impact and Resource Utilization After Stem Cell Mobilization Failure in Patients with Multiple Myeloma and Lymphoma.
Blood, 2009Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:Abstract 2142 Poster Board II-119 High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was “ optimal” (≥5×10 6 ) in 53%, “low” (≥2 to 5×10 6 ) in 25%,“ poor” ( 6 ) in 10%, and “failed” ( Disclosures: Gertz: genzyme: Research Funding.
Christof Westenfelder - One of the best experts on this subject based on the ideXlab platform.
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Hematopoietic Stem Cell Mobilization–Associated Granulocytosis Severely Worsens Acute Renal Failure
Journal of the American Society of Nephrology : JASN, 2004Co-Authors: Florian Tögel, Jorge Isaac, Christof WestenfelderAbstract:ABSTRACT. Acute renal failure (ARF), resulting from ischemic or toxic insults, remains a major health care problem because of its grave prognosis and the limited effectiveness of available treatment modalities. On the basis of the recent demonstration that hematopoietic Stem Cells can differentiate into renal Cells and the authors’ observation here that ARF results in a rise in peripheral CD34 + Cells, the authors tested whether a further increase in circulating Stem Cell numbers, induced by their Mobilization from the bone marrow, would improve renal function and outcome in mice with ischemic ARF. Unexpected, it was found that the boosting of peripheral Stem Cell numbers failed to exert any renoprotective effects but rather was associated both with greatly increased severity of renal failure and mortality. Because identical ischemic injury in neutropenic mice resulted in milder renal insufficiency and significantly reduced mortality, it was deduced that the adverse effects of pharmacologic Stem Cell Mobilization are primarily mediated by the concomitant induction of marked granulocytosis. In this manner, high numbers of activated granulocytes seem to obscure the potential renoprotective and positive survival effects of pluripotent hematopoietic Stem Cells, mediated by both their injurious renal and syStemic actions. The data strongly argue against the clinical use of granulocytosis-inducing hematopoietic Stem Cell Mobilization protocols for the prevention or treatment of ischemic ARF. Additional caution with this regimen may be warranted in patients with underlying renal insufficiency and those who develop renal insufficiency while undergoing Stem Cell Mobilization in preparation for an autologous bone marrow transplant.
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hematopoietic Stem Cell Mobilization associated granulocytosis severely worsens acute renal failure
Journal of The American Society of Nephrology, 2004Co-Authors: Florian Tögel, Jorge Isaac, Christof WestenfelderAbstract:ABSTRACT. Acute renal failure (ARF), resulting from ischemic or toxic insults, remains a major health care problem because of its grave prognosis and the limited effectiveness of available treatment modalities. On the basis of the recent demonstration that hematopoietic Stem Cells can differentiate into renal Cells and the authors’ observation here that ARF results in a rise in peripheral CD34 + Cells, the authors tested whether a further increase in circulating Stem Cell numbers, induced by their Mobilization from the bone marrow, would improve renal function and outcome in mice with ischemic ARF. Unexpected, it was found that the boosting of peripheral Stem Cell numbers failed to exert any renoprotective effects but rather was associated both with greatly increased severity of renal failure and mortality. Because identical ischemic injury in neutropenic mice resulted in milder renal insufficiency and significantly reduced mortality, it was deduced that the adverse effects of pharmacologic Stem Cell Mobilization are primarily mediated by the concomitant induction of marked granulocytosis. In this manner, high numbers of activated granulocytes seem to obscure the potential renoprotective and positive survival effects of pluripotent hematopoietic Stem Cells, mediated by both their injurious renal and syStemic actions. The data strongly argue against the clinical use of granulocytosis-inducing hematopoietic Stem Cell Mobilization protocols for the prevention or treatment of ischemic ARF. Additional caution with this regimen may be warranted in patients with underlying renal insufficiency and those who develop renal insufficiency while undergoing Stem Cell Mobilization in preparation for an autologous bone marrow transplant.
Grzegorz W. Basak - One of the best experts on this subject based on the ideXlab platform.
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European data on Stem Cell Mobilization with plerixafor in patients with nonhematologic diseases: an analysis of the European consortium of Stem Cell Mobilization
Transfusion, 2012Co-Authors: Nina Worel, Kai Hübel, Catarina Geraldes, Ozren Jakšić, Zdenek Koristek, Grzegorz W. Basak, Jane F. Apperley, Ian H Gabriel, Kenneth W. Douglas, Francesco LanzaAbstract:BACKGROUND: Plerixafor with granulocyte–colony-stimulating factor (G-CSF) has been shown to enhance Stem Cell Mobilization in patients with multiple myeloma and lymphoma with previous Mobilization failure. In this European named patient program we report the experience in insufficiently mobilizing patients diagnosed with nonhematologic diseases. STUDY DESIGN AND METHODS: Thirty-three patients with germ Cell tumor (n = 11), Ewing sarcoma (n = 6), Wiscott-Aldrich disease (n = 5), neuroblastoma (n = 4), and other nonhematologic diseases (n = 7) were included in the study. Plerixafor was limited to patients with previous or current Stem Cell Mobilization failure and given after 4 days of G-CSF (n = 21) or after chemotherapy and G-CSF (n = 12) in patients who mobilized poorly. RESULTS: Overall, 28 (85%) patients succeeded in collecting at least 2 × 106/kg body weight (b.w.) CD34+ Cells (median, 5.0 × 106/kg b.w. CD34+ Cells; range, 2.0 × 106-29.5 × 106/kg b.w. CD34+ Cells), and five (15%) patients collected a median of 1.5 × 106/kg b.w. CD34+ Cells (range, 0.9 × 106-1.8 × 106/kg b.w. CD34+ Cells). Nineteen patients proceeded to transplantation. The median dose of CD34+ Cells infused was 3.3 × 106/kg b.w. (range, 2.3 × 106-6.7 × 106/kg b.w. CD34+ Cells). The median numbers of days to neutrophil and platelet engraftment were 11 (range, 9-12) and 15 (range, 10-25) days, respectively. CONCLUSION: These data emphasize the role of plerixafor in combination with G-CSF or chemotherapy and G-CSF as an effective Mobilization regimen with the potential of successful Stem Cell collection. Accordingly, plerixafor seems to be safe and effective in patients with nonhematologic diseases. Larger prospective studies are warranted to further assess its use in these patients.
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Higher BMI is not a barrier to Stem Cell Mobilization with standard doses of plerixafor and G-CSF.
Bone marrow transplantation, 2011Co-Authors: Grzegorz W. Basak, Kai Hübel, Kw Douglas, Catarina Geraldes, Ozren Jakšić, Zdenek Koristek, Wieslaw Wiktor-jedrzejczak, Jane F. Apperley, Ian H Gabriel, F. LanzaAbstract:Higher BMI is not a barrier to Stem Cell Mobilization with standard doses of plerixafor and G-CSF
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Haematopoietic Stem Cell Mobilization with plerixafor and G-CSF in patients with multiple myeloma transplanted with autologous Stem Cells.
European journal of haematology, 2011Co-Authors: Grzegorz W. Basak, Ozren Jakšić, Zdenek Koristek, Gábor Mikala, Sandra Bašić-kinda, Jiri Mayer, Tamas Masszi, Sebastian Giebel, Boris Labar, Wieslaw Wiktor-jedrzejczakAbstract:A proportion of patients with multiple myeloma (MM) who have already undergone autologous Stem Cell transplantation (autoSCT) might benefit from a further transplantation. For this, they might need to undergo another round of Stem Cell Mobilization. We analyzed retrospectively the outcomes of Stem Cell Mobilization with plerixafor and granulocyte colony-stimulating factor (G-CSF) in a group of 30 patients who had undergone autoSCT previously, and in 46 other patients. The previously transplanted patients were significantly different from the remaining patients with respect to the intensity and number of previous therapies. We observed that the median peripheral blood concentration of CD34+ Cells after the first administration of plerixafor was lower in previously transplanted (19 Cells/μL) than in other patients (30 Cells/μL, P < 0.05). Despite a comparable number of apheresis sessions being performed, the median total yield of CD34+ Cells was significantly lower in the previously transplanted than in the remaining patients (2.8 × 10(6) Cells/kg vs. 4.2 × 10(6) Cells/kg, P < 0.05). However, successful collection of at least 2.0 × 10(6) CD34+ Cells/kg was achieved finally in a similar proportion of previously transplanted and other patients (70% vs. 82.6%). Our data suggest that Stem Cell Mobilization with plerixafor and G-CSF might overcome the negative effect of prognostic factors for poor Stem Cell Mobilization in patients with MM who have undergone autoSCT previously.
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Hematopoietic Stem Cell Mobilization with the reversible CXCR4 receptor inhibitor plerixafor (AMD3100)—Polish compassionate use experience
Annals of hematology, 2010Co-Authors: Grzegorz W. Basak, Wanda Knopinska-posluszny, Magdalena Matuszak, Elżbieta Kisiel, Dorota Hawrylecka, Anna Szmigielska-kapłon, Donata Urbaniak-kujda, Jarosław Dybko, Patrycja Zielinska, Anna Dabrowska-iwanickaAbstract:Recent developments in the field of targeted therapy have led to the discovery of a new drug, plerixafor, that is a specific inhibitor of the CXCR4 receptor. Plerixafor acts in concert with granulocyte colony-stimulating factor (G-CSF) to increase the number of Stem Cells circulating in the peripheral blood (PB). Therefore, it has been applied in the field of hematopoietic Stem Cell Mobilization. We analyzed retrospectively data regarding Stem Cell Mobilization with plerixafor in a cohort of 61 patients suffering from multiple myeloma (N = 23), non-Hodgkin’s lymphoma (N = 20), or Hodgkin’s lymphoma (N = 18). At least one previous Mobilization attempt had failed in 83.6% of these patients, whereas 16.4% were predicted to be poor mobilizers. The median number of CD34+ Cells in the PB after the first administration of plerixafor was 22/μL (range of 0–121). In total, 85.2% of the patients proceeded to Cell collection, and a median of two (range of 0–4) aphereses were performed. A minimum of 2.0 × 106 CD34+ Cells per kilogram of the patient’s body weight (Cells/kg b.w.) was collected from 65.6% of patients, and the median number of Cells collected was 2.67 × 106 CD34+ Cells/kg b.w. (0–8.0). Of the patients, 55.7% had already undergone autologous Stem Cell transplantation, and the median time to neutrophil and platelet reconstitution was 12 and 14 days, respectively. Cases of late graft failure were not observed. We identified the diagnosis of non-Hodgkin’s lymphoma and previous radiotherapy as independent factors that contributed to failure of Mobilization. The current report demonstrates the satisfactory efficacy of plerixafor plus G-CSF for Stem Cell Mobilization in heavily pre-treated poor or predicted poor mobilizers.
Morie A. Gertz - One of the best experts on this subject based on the ideXlab platform.
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Clinical impact and resource utilization after Stem Cell Mobilization failure in patients with multiple myeloma and lymphoma.
Bone marrow transplantation, 2010Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:High-dose chemotherapy in conjunction with auto-SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 to 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was 'optimal' (> or = 5 x 10(6)) in 53%, 'low' (> or = 2-5 x 10(6)) in 25%, 'poor' (
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clinical impact and resource utilization after Stem Cell Mobilization failure in patients with multiple myeloma and lymphoma
Bone Marrow Transplantation, 2010Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:High-dose chemotherapy in conjunction with auto-SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 to 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was 'optimal' (> or = 5 x 10(6)) in 53%, 'low' (> or = 2-5 x 10(6)) in 25%, 'poor' (<2 x 10(6)) in 10%, and 'failed' (<10 CD34+ Cells/microl) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy Mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. This usually unappreciated resource utilization associated with Stem Cell Mobilization failure highlights the need for more effective Mobilization strategies.
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Clinical Impact and Resource Utilization After Stem Cell Mobilization Failure in Patients with Multiple Myeloma and Lymphoma.
Blood, 2009Co-Authors: Morie A. Gertz, Robert C Wolf, Ivana M Micallef, Dennis A GastineauAbstract:Abstract 2142 Poster Board II-119 High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal Stem Cell Mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of Stem Cell Mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal Mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing Mobilization during the study period, Stem Cell collection (defined by the number of CD34+ Cells/kg) was “ optimal” (≥5×10 6 ) in 53%, “low” (≥2 to 5×10 6 ) in 25%,“ poor” ( 6 ) in 10%, and “failed” ( Disclosures: Gertz: genzyme: Research Funding.
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Thrombotic microangiopathy during peripheral blood Stem Cell Mobilization.
Journal of clinical apheresis, 2009Co-Authors: Harris V.k. Naina, Morie A. Gertz, Michelle A. ElliottAbstract:Granulocyte colony-stimulating factor (GCSF) is currently the most widely used cytokine for Stem Cell Mobilization. There are few studies suggesting GCSF administration may induce activation of both coagulation and endothelial Cells that could favor the developing of thrombotic events. We report a 58-year-old female with vasculitis and renal impairment. She was found to have an underlying monoclonal gammopathy of unknown significance (MGUS). The monoclonal protein was felt to play a role in her underlying renal disease and peripheral neuropathy. She was considered a candidate for peripheral blood Stem Cell transplantation to manage the monoclonal protein. During Stem Cell Mobilization with GCSF, she developed worsening of anemia; thrombocytopenia and worsening of renal function. She was diagnosed with thrombotic microangiopathy (TMA) which was successfully treated with therapeutic plasma exchange and rituximab. It is possible that GCSF may have directly (activating endothelial Cells) or indirectly (activation of underlying autoimmune disorder) contributed to TMA in this patient. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc.
Florian Tögel - One of the best experts on this subject based on the ideXlab platform.
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Hematopoietic Stem Cell Mobilization–Associated Granulocytosis Severely Worsens Acute Renal Failure
Journal of the American Society of Nephrology : JASN, 2004Co-Authors: Florian Tögel, Jorge Isaac, Christof WestenfelderAbstract:ABSTRACT. Acute renal failure (ARF), resulting from ischemic or toxic insults, remains a major health care problem because of its grave prognosis and the limited effectiveness of available treatment modalities. On the basis of the recent demonstration that hematopoietic Stem Cells can differentiate into renal Cells and the authors’ observation here that ARF results in a rise in peripheral CD34 + Cells, the authors tested whether a further increase in circulating Stem Cell numbers, induced by their Mobilization from the bone marrow, would improve renal function and outcome in mice with ischemic ARF. Unexpected, it was found that the boosting of peripheral Stem Cell numbers failed to exert any renoprotective effects but rather was associated both with greatly increased severity of renal failure and mortality. Because identical ischemic injury in neutropenic mice resulted in milder renal insufficiency and significantly reduced mortality, it was deduced that the adverse effects of pharmacologic Stem Cell Mobilization are primarily mediated by the concomitant induction of marked granulocytosis. In this manner, high numbers of activated granulocytes seem to obscure the potential renoprotective and positive survival effects of pluripotent hematopoietic Stem Cells, mediated by both their injurious renal and syStemic actions. The data strongly argue against the clinical use of granulocytosis-inducing hematopoietic Stem Cell Mobilization protocols for the prevention or treatment of ischemic ARF. Additional caution with this regimen may be warranted in patients with underlying renal insufficiency and those who develop renal insufficiency while undergoing Stem Cell Mobilization in preparation for an autologous bone marrow transplant.
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hematopoietic Stem Cell Mobilization associated granulocytosis severely worsens acute renal failure
Journal of The American Society of Nephrology, 2004Co-Authors: Florian Tögel, Jorge Isaac, Christof WestenfelderAbstract:ABSTRACT. Acute renal failure (ARF), resulting from ischemic or toxic insults, remains a major health care problem because of its grave prognosis and the limited effectiveness of available treatment modalities. On the basis of the recent demonstration that hematopoietic Stem Cells can differentiate into renal Cells and the authors’ observation here that ARF results in a rise in peripheral CD34 + Cells, the authors tested whether a further increase in circulating Stem Cell numbers, induced by their Mobilization from the bone marrow, would improve renal function and outcome in mice with ischemic ARF. Unexpected, it was found that the boosting of peripheral Stem Cell numbers failed to exert any renoprotective effects but rather was associated both with greatly increased severity of renal failure and mortality. Because identical ischemic injury in neutropenic mice resulted in milder renal insufficiency and significantly reduced mortality, it was deduced that the adverse effects of pharmacologic Stem Cell Mobilization are primarily mediated by the concomitant induction of marked granulocytosis. In this manner, high numbers of activated granulocytes seem to obscure the potential renoprotective and positive survival effects of pluripotent hematopoietic Stem Cells, mediated by both their injurious renal and syStemic actions. The data strongly argue against the clinical use of granulocytosis-inducing hematopoietic Stem Cell Mobilization protocols for the prevention or treatment of ischemic ARF. Additional caution with this regimen may be warranted in patients with underlying renal insufficiency and those who develop renal insufficiency while undergoing Stem Cell Mobilization in preparation for an autologous bone marrow transplant.