The successful treatment of 5-fluorouracil (5-FU) overdose in a patient with malignancy and HIV/AIDS with uridine triacetate

According to the NIH, about 275 000 patients receive treatment with 5-Fluorouracil (5-FU) and more than 1300 die from 5-FU toxicity every year from life-threatening myelosuppression, gastrointestinal complications, and neurotoxicity. Immunocompromised persons are at higher risk of developing toxicity. Recently uridine triacetate (Vistagard®) has been approved by the Food and Drug Administration (FDA) as the only specific antidote available for 5-FU poisoning. In a clinical trial (n = 135), 96% of patients with 5-FU toxicity recovered after treatment, where as in a historical control group only 10% survived. This is the first published case report of survival after 5-FU overdose who also was immunocompromised from HIV/AIDs. A 52 year old male with history of HIV/AIDS (CD4 70), CNS toxoplasmosis and anal cancer presented to the emergency department after realizing he had received an entire course of 5-FU in 24 instead of 96 h. Treatment with uridine triacetate was arranged in the emergency department. After receiving treatment the patient was asymptomatic and had an uncomplicated hospital course. 5-FU poisoning must be recognized early as uridine triacetate is approved by the FDA for use within 96 h following the end of 5-FU administration. Emergency medicine physicians should promptly recognize and treat 5-FU poisoning. However, this may be challenging as patients may not seek medical attention until many hours or several days after last administration since symptoms are often delayed with 5-FU poisoning.     

CD13 is a therapeutic target in human liver cancer stem cells

Cancer stem cells (CSCs) are generally dormant or slowly cycling tumor cells that have the ability to reconstitute tumors. They are thought to be involved in tumor resistance to chemo/radiation therapy and tumor relapse and progression. However, neither their existence nor their identity within many cancers has been well defined. Here, we have demonstrated that CD13 is a marker for semiquiescent CSCs in human liver cancer cell lines and clinical samples and that targeting these cells might provide a way to treat this disease. CD13⁺ cells predominated in the G₀ phase of the cell cycle and typically formed cellular clusters in cancer foci. Following treatment, these cells survived and were enriched along the fibrous capsule where liver cancers usually relapse. Mechanistically, CD13 reduced ROS-induced DNA damage after genotoxic chemo/radiation stress and protected cells from apoptosis. In mouse xenograft models, combination of a CD13 inhibitor and the genotoxic chemotherapeutic fluorouracil (5-FU) drastically reduced tumor volume compared with either agent alone. 5-FU inhibited CD90⁺ proliferating CSCs, some of which produce CD13⁺ semiquiescent CSCs, while CD13 inhibition suppressed the self-renewing and tumor-initiating ability of dormant CSCs. Therefore, combining a CD13 inhibitor with a ROS-inducing chemo/radiation therapy may improve the treatment of liver cancer.     

E1B-55分子缺失的腺病毒与化疗药物联合应用在食管癌细胞中产生抗肿瘤协同效应

目的 观察E1B-55分子缺失的腺病毒(E1B-55 molecule deleted adenovirus,Ad-delE1B55)在联合各种化疗药物后针对9种人食管癌细胞系所产生的协同作用.方法 采用细胞的增殖检测法(MTT)法检测Ad-delE1B55和(或)4种化疗药物在9种食管癌细胞中的细胞毒性,并根据所得数据计算50%抑制浓度(IC50);使用流式细胞学方法检测表达绿色荧光蛋白基因的腺病毒(Ad-GFP)对各种细胞的感染率;细胞经过处理后,通过流式细胞学方法检测细胞的凋亡和细胞周期;用蛋白印迹western blot法检测腺病毒在细胞内产生的蛋白,以检验病毒复制与细胞毒性的关系;通过使用裸鼠的动物实验,验证体外实验的联合效应.结果 聚合酶链反应(PCR)结果显示,Ad-delE1B55在所感染的细胞中能够复制,针对E1B55的PCR结果证明了其缺失.MTT结果说明Ad-delE1B55在9种食管癌细胞中均产生细胞毒性,但敏感性并不相同;通过细胞毒性结果计算了Ad-delE1B55对9种食管癌细胞株的IC50.通过Ad-GFP感染细胞,计算出病毒感染率,将其与Ad-delE1B55对细胞的IC50作对比,发现两者之间无明显相关性;将9种食管癌细胞株的p53基因型与Ad-delE1B55对细胞的IC50作对比,发现两者之间也无明显相关性.Western blot结果显示Ad-delE1B55感染细胞后48小时,其复制水平达到峰值.在讨论化疗药物与Ad-delE1B55联合给药时的顺序时,不论是western blot结果还是细胞周期结果均显示同时给药效果最好.所以,Ad-delE1B55分别与5-氟尿嘧啶(5-FU),丝裂霉素(MMC),足叶乙甙(VP-16)或顺铂(CDDP)4种化疗药物以同时给药形式联合应用于食管癌细胞株,MTT结果显示腺病毒与5-FU、MMC、VP-16联合能够产生抗肿瘤的协同作用,但与CDDP联合应用不能产生协同作用;动物实验中联合应用Ad-delE1B55与5-FU产生的抗肿瘤作用均好于单独应用任意一种,与体外实验一致,证明了抗肿瘤的协同作用.结论 在食管癌细胞中腺病毒的感染率和内源性p53基因型与Ad-delE1B55的IC50没有相关性,不能预测其细胞毒性.联合应用Ad-delE1B55与5-FU、MMC、VP-16能够产生抗肿瘤的协同作用,但与CDDP联合应用不能产生协同作用.Ad-delE1B55与化疗药物的联合应用为临床失去手术机会的食管癌患者提供了一个新的治疗方案.两种药物的协同作用能够提高疗效,并降低不良反应.     

奥沙利铂与常用化疗药物对胃癌细胞株相互作用的研究

目的　利用胃癌细胞株探讨奥沙利铂与常用化疗药物的相互作用。方法　测定奥沙利铂与 4种常用化疗药的单药和联合用药对胃癌细胞株的抑制率 ,将测得的数据输入电脑 ,用CalcuSyn(Biosoft)软件处理 ,推算出有关数据 :斜率(m )、截距 ( y int)、IC50 、联合指数 (CI)和剂量减少指数 (DRI)。结果　胃癌细胞株单药化疗敏感性顺序 :OXA >MMC >5 Fu >FUDR >CDDP ;联合用药的敏感性顺序 :CDDP +OXA >FUDR +OXA >5 Fu +OXA >MMC +OXA。联合用药协同作用的大小依次为 :FUDR +OXA >5 Fu +OXA >MMC +OXA。根据这 4组两种药物联合用药的CI和DRI综合分析 ,以FUDR +OXA和 5 Fu +OXA组较佳 ;此外 ,三种药物联用的CI和DRI也十分理想。结论　OXA与常用化疗药物联合 ,对胃癌细胞株有良好的抑制率     

An analysis of the therapeutic efficacy of protracted infusion of low-dose 5-fluorouracil and cisplatin in advanced gastric cancer

To analyze the clinical efficacy of a protracted infusion of low-dose 5-fluorouracil (5-FU) and cisplatin (CDDP), a phase II study was performed in 36 patients with advanced gastric cancer. The treatment schedule of the low-dose administration of 5-FU and CDDP (FP) was a continuous infusion of 5-FU (250 mg/m²) for 28 consecu-tive days and a drip infusion of CDDP (3.5 mg/m²) for 5 consecutive days, followed by a 2-day interval each week in one cycle. The overall response rate was 47.2%. Of importance, the improvement in quality of life assessed by performance status (PS) and oral intake was 13.9% and 33.3%, respectively. The toxicity in low-dose FP treatment was less than grade 2, including gastrointestinal toxicities and bone marrow suppression, and this was tolerable during the treatment. The median survival time (MST) and 1-year survival rate were 8 months and 36.2%, respectively. In a pharmacokinetic analysis following the protracted infusion of low-dose FP, the plasma concentrations of 5-FU and CDDP were increased to about 120–130 ng/ml and 0.3–0.5 μg/ml on day 21 after the treatment, respectively. The plasma concentrations of 5-FU and CDDP were not significantly different between responders and non-responders. The tumor response to low-dose FP treatment was associated with the induction of apoptotic cell death and with the overexpression of apoptosis-related genes, such as Bax and Bcl-Xs, in cancer cells. These results indicate that the protracted infusion of low-dose FP could be a useful regimen for patients with advanced gastric cancer, in terms of the high response rate and low toxi-city, possibly leading to the prolongation of survival and improvement in the quality of life. Received: June 5, 2000 / Accepted: August 7, 2000     

Investigation of a new in-line leukocyte reduction filter for packed red blood cells

Background and objectivesOccasionally there are adverse transfusion reactions in the therapeutic use of packed red blood cells. Some of those reactions are caused by the presence of white blood cells (WBCs). Both immunogenic and infectious transfusion reactions are significantly influenced by the level of white blood cell contamination.Materials and methodsThe flexible in-line red cell filtration system Leucoflex LCR Diamond (Macopharma) was investigated. According to manufacturer information the system has a smaller filter surface (46 cm²) than the previous filter LCR-5 (53 cm²). Main difference with the previous model is the rhomboid design. The filter tube connections are not at the level of the centre edge, but at two opposite corners. Eighteen red cell concentrates were produced under Good Manufacturing Practice conditions in routine operation. To ensure the quality of the filter system every 7 days metabolic parametres such as WBC count, haemoglobin content, haemolysis rate, potassium load, pH and ATP content were analysed over a storage period of 49 days.ResultsThe mean product volume was 260.7 mL after filtration. Average haemoglobin content was 51.8 g per unit and WBC contamination was 0.02 × 10⁶ per unit. Haemolysis rate was 0.05% directly after filtration and 0.20% at the end of storage. Immediately after filtration the potassium concentration was 1.3 mmol/L and the pH was 7.37. During whole storage time the ATP level was maintained above 2.0 μmol per g haemoglobin.ConclusionThe tested filtration system is suitable for quality-assured production of red blood cell concentrates meeting national and international guidelines.     

Assessment of stability of CD34+ cell products enriched by immunoselection from peripheral blood mononuclear cells during refrigerated storage

Durable engraftment of transplanted CD34+ cells largely depends on the quality of the cell product. Limited data are currently available about extended storage of immunoselected CD34+ cells. The aim of our study was to assess the stability of CD34+ cell product with the cells stored in high concentration (80 × 10⁶ in 6 mL) in small bags intended for cell implantation. Cell products were prepared by leukapheresis and immunoselection (Clinimacs^plus procedure) from 13 patients with chronic dilated cardiomyopathy. CD34+ cell products were stored at 2–8 °C and analyzed at time 0 (fresh products), 24, 48 h, 4 and 6 days. Product viability, absolute number of viable CD34+ cells and apoptosis were determined by flow cytometry. Microbiological contamination of the cell products was tested by BACTEC system. The mean viability of CD34+ cells decreased by 2.7% within 24 h, by 13.4% within 48 h and by 37.5% within 6 days. The mean recovery of viable CD34+ cells was 91.1%, 74.8%, 66.3% and 56.2% at 24, 48 h, 4 and 6 days, respectively. The mean fraction of early apoptotic cells in fresh and stored products was 4.9 ± 3.5% at 0 h, 5.9 ± 3.8% at 24 h, 4.2 ± 3.1% at 48 h, 6.3 ± 2.6% at 4 days and 9.3 ± 4.6% at 6 days. All products were negative for microbial contamination.     

Vitamin E (α-tocopherol) enhances the PDT action of hematoporphyrin derivatives on cervical cancer cells

ObjectiveThe effect of antioxidant vitamin E (VE) on PDT (a mainly reactive oxygen species-driven process) has in the past shown contradicting results. Hence, we studied the effect of different concentrations and different incubation periods of VE on the PDT cytotoxicity of the cervical adenocarcinoma HeLa cell line.Materials and methodsHeLa cells were incubated with 25 μg/ml of hematoporphyrin derivatives (HpD) for 25 min (1st PDT regimen) or 24 h (2nd PDT regimen), then irradiated with visible light (total light dose of 10 J/cm²) either with or without different concentrations of VE (1–1000 μM) which had been incubated with the cells for 1 h or 24 h prior to PDT. After irradiation, viability was measured using MTT assay.ResultsThe results obtained showed that PDT is effective against cervical cancer cells. Incubation of HpD for 24 h leads to improved PDT action. Higher concentrations of VE incubated in HeLa cells for 1 h before the 2nd PDT regimen significantly enhanced cytotoxicity of PDT and the maximal enhancement was at 1000 μM of VE. The cytotoxic effect of VE on HeLa cells after incubation for 24 h before PDT is enhanced by the PDT action.ConclusionIn conclusion 1000 μM of VE can be used 1 h before PDT to enhance its effect on cervical adenocarcinoma, a disease which is steadily increasing in young women. It is well-known that the cervical adenocarcinoma is resistant to anticancer agents and radiotherapy and it was previously considered to be HpD-PDT resistant.     

Biodegradable polymersomes as carriers and release systems for paclitaxel using Oregon Green® 488 labeled paclitaxel as a model compound

Oregon Green® 488 labeled paclitaxel (Flutax) loaded biodegradable polymersomes (Flutax-Ps) based on methoxy poly(ethylene glycol)-b-poly(d,l-lactide) (mPEG-PDLLA), methoxy poly(ethylene glycol)-b-poly(ε-caprolactone) (mPEG-PCL) or a mixture of the block copolymers (50:50, w/w) were prepared (abbreviated as Flutax-Ps (L), Flutax-Ps (C) and Flutax-Ps (LC), respectively). For the formation of the Ps, the corresponding block copolymers and Flutax were dissolved in THF and the THF solution was injected into an aqueous phase. Flutax-Ps with a size less than 150 nm were obtained, which had Flutax entrapment efficiencies higher than 55% (polymer concentration: 1 mg/ml; Flutax concentration up to 100 μg/ml). A sustained and complete release of Flutax was observed for Flutax-Ps (L) over one month with no initial burst. Flutax was released much slower from Ps (C) than from Ps (L) (49.9% after one month), which is probably due to differences in the crystallinity and rate of degradation of the consisting copolymers. The release rate of Flutax from Ps (LC) was in between those of Ps (L) and Ps (C). The in vitro cytotoxicity of Flutax-Ps (L) using cultured SKBR3 breast cancer cells was compared with that of empty Ps (L) and a Cremophor® EL/ethanol formulation (50:50, v/v) with Flutax (FCE) or without Flutax (CE). At a Flutax concentration of 5 μg/ml, about 67% reduction in the viability of SKBR3 cells was observed for Flutax-Ps (L) after 3 days exposure, while the FCE formulation reduced the cell viability for more than 90% under the same conditions. Empty Ps (L) showed a low toxicity of about 10% and the CE formulation exhibited a cytotoxicity higher than 54% without Flutax, indicating that the high reduction in SKBR3 cell viability for FCE is associated with the toxicity of the Cremophor® EL formulation.     

Smoothened activates breast cancer stem-like cell and promotes tumorigenesis and metastasis of breast cancer

Smoothened (Smo) is a G protein-coupled receptor protein encoded by the Smo gene of the hedgehog signalling pathway, which is thought to play an important role in maintaining organ patterning, cell differentiation and self-renewal. The possible role of Smo in the process of tumorigenesis and metastasis of breast cancer still remains unclear. The present experiments were to investigate the effect of Smo on activating breast cancer stem-like CD44⁺CD24⁻ cells and the tumorigenesis and metastasis of breast cancer. By injected CD44⁺CD24⁻ cells (1 × 10⁴) into the cleared fat pad of NOD/SCID mice, it was observed that CD44⁺CD24⁻ cells possess higher tumor-initiating capacity and metastasis properties than equal numbers of non-CD44⁺CD24⁻ cells. The mRNA and protein expressions of Smo in CD44⁺CD24⁻ cells were higher than those in non-CD44⁺CD24⁻ cells, indicating that Smo may play a role in maintaining breast cancer stem cell features. qRT–PCR results revealed that expressions of STAT3, Bcl-2 and cyclinD1 mRNA in MCF-7 cells were decreased after transfected by Smo siRNA. In addition, the expressions of MMP-2 and MMP-9 were downregulated in MCF-7 cells after Smo expression was inhibited. Smo inhibition may be a possible therapeutic target that potentially suppresses breast tumor formation and development.     

How to manage poor mobilizers for high dose chemotherapy and autologous stem cell transplantation?

Today, peripheral blood stem cells are the preferred source of stem cells over bone marrow. Therefore, mobilization plays a crutial role in successful autologous stem cell transplantation. Poor mobilization is generally defined as failure to achieve the target level of at least 2 × 10⁶ CD34⁺ cells/kg body weight. There are several strategies to overcome poor mobilization: 1) Larger volume Leukapheresis (LVL) 2) Re-mobilization 3) Plerixafor 4) CM + Plerixafor (P) + G-CSF and 5) Bone Marrow Harvest. In this review, the definitions of successful and poor mobilization are discussed. Management strategies for poor mobilization are defined. The recent research on new agents are included.     

Formation and characterization of β-cyclodextrin (β-CD) – polyethyleneglycol (PEG) – polyethyleneimine (PEI) coated Fe3O4 nanoparticles for loading and releasing 5-Fluorouracil drug

In this work, β-cyclodextrin (β-CD) – polyethyleneglycol (PEG) – polyethyleneimine (PEI) coated iron oxide nanoparticles (Fe₃O₄-β-CD-PEG-PEI) were developed as drug carriers for drug delivery applications. The 5- Fluorouracil (5-FU) was chosen as model drug molecule. The developed nanoparticles (Fe₃O₄-β-CD-PEG-PEI) were characterized by various techniques such as Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), Scanning electron microscopy (SEM), transmission electron microscopy (TEM) and vibrating sample magnetometry (VSM). The average particles size range of 5-FU loaded Fe₃O₄-β-CD, Fe₃O₄-β-CD-PEG and Fe₃O₄-β-CD-PEG-PEI nanoparticles were from 151 to 300 nm and zeta potential value of nanoparticles were from −43 mV to −20 mV as measured using Malvern Zetasizer.Finally, encapsulation efficiency (EE), loading capacity (LC) and in-vitro drug release performance of 5-FU drug loaded Fe₃O₄-β-CD, Fe₃O₄-β-CD-PEG and Fe₃O₄-β-CD-PEG-PEI nanoparticles was evaluated by UV–vis spectroscopy. In-vitro cytotoxicity tests investigated by MTT assay indicate that 5-FU loaded Fe₃O₄-β-CD-PEG-PEI nanoparticles were toxic to cancer cells and non-toxic to normal cells. The in-vitro release behavior of 5-FU from drug (5-FU) loaded Fe₃O₄-β-CD-PEG-PEI composite at different pH values and temperature was studied. It was found that 5-FU was released faster in pH 6.8 than in the acidic mediums (pH 1.2), and the released quantity was higher. Therefore, the newly prepared Fe₃O₄-β-CD-PEG-PEI carrier exhibits a promising potential capability for anticancer drug delivery in tumor therapy.     

Salinomycin can effectively kill ALDH stem-like cells on gastric cancer

Salinomycin is a novel identified cancer stem cells (CSCs) killer. Higher ALDH activity represents CSCs characterization. Here, we screened ALDH activities on several gastric cancer cell lines and divided them into ALDH^high and ALDH^low gastric cancer groups. ALDH^high cancer cells (NCI-N87 and SNU-1) disclosed more CSCs characteristics, such as higher levels of Sox2, Nanog and Nestin, more floating spheroid bodies, more colony formation and more resistance to conventional chemotherapeutic drugs 5-Fu and CDDP, compared to these parameters observed in ALDH^low cancer cells (P < 0.01). Importantly, ALDH^high cancer cells are relatively sensitive to salinomycin when compared to ALDH^low cancer cells (P < 0.01). Our results confirmed ALDH as functional marker of CSCs population on gastric cancer. Salinomycin might be selective therapy for CSCs fraction, which is resistant to conventional anticancer drugs 5-Fu and CDDP.     

Factors associated with peripheral blood stem cell yield in healthy pediatric donors

Background and Objectives

Although several studies have reported on the use of children as donors for peripheral blood stem cells (PBSC), data on the predictive factors of CD34+ stem cell yield in healthy pediatric donors are very limited.

FK228 augmented temozolomide sensitivity in human glioma cells by blocking PI3K/AKT/mTOR signal pathways

Temozolomide is a novel cytotoxic agent currently used as first-line chemotherapy for glioblastoma multiforme (GBM). Romidepsin (FK228), a histone deacetylase inhibitor, is a promising new class of antineoplastic agent with the capacity to induce growth arrest and/or apoptosis of cancer cells. However, combination of the two drugs in glioma remains largely unknown. In the present study, we evaluated the combinatory effects of FK228 with TMZ in glioma, and its molecular mechanisms responsible for these effects. Glioma cell lines were treated with TMZ, FK228 or the combination of drugs. The resistance effect including cytotoxicity and apoptosis was determined in glioma cells, respectively. We further evaluated the effects of FK228 in the PI3K/Akt-signaling pathway in vitro. Mice engrafted with 5 × 10⁶ LN382 cells were treated with TMZ, FK228 or the combination of two drugs, and tumor weights and volumes were measured, respectively. FK228 enhanced the cytotoxic effects of TMZ in glioma cells compared to vehicle-treated controls or each drug alone. The combination of FK228 and TMZ-induced apoptosis was demonstrated by increased expression of cleaved-Caspase 3, Bax, cleaved-PARP, and decreased Bcl-2 expression. Furthermore, the expression of key components of the PI3K/Akt-signaling pathway showed that combination of FK228 and TMZ block PI3K/Akt pathways in vitro. This block effect was also confirmed in vivo in mice models. Mice treated with both FK228 and TMZ drugs showed significantly reduced tumor weights and volumes, compared to each drug alone. Our results suggested that FK228 augmented temozolomide sensitivity in human glioma cells partially by blocking PI3K/AKT/mTOR signal pathways. It thus may provide a promising target for improving the therapeutic outcome of TMZ-resistant gliomas, although further studies will be needed.     

Improved measurement of LINE-1 sequence methylation for cancer detection

BackgroundMethylation of long interspersed nuclear element-1 (LINE-1) sequences varies among normal cells and it is often decreased in cancer genomes and white blood cells (WBC) of cancer patients. Current measurement techniques of genome-wide level are inadequate because LINE-1 methylation is distinctive at each locus. Here, we improved the detection of cancer by combining information of LINE-1 methylation pattern and level.MethodsCombined bisulfite restriction analysis (COBRA) of LINE-1, COBRA LINE-1, was used to test cancer cell lines, two oral rinse cohorts, and WBC from normal and cancer patients. COBRA LINE-1 separated LINE-1 sequences into 4 products depending on the methylation statuses of 2 CpG dinucleotides, as follows: 2 unmethylated CpGs (^uC^uC), partial methylation (^mC^uC), 1 methylated CpG (^mC), and 1 unmethylated CpG (^uC).ResultsThe association between ^mC^uC and ^uC^uC was directly correlated in normal cells (r = 0.4895, p = 0.0009) but inversely correlated in cancer (r = ? 0.8979, p = 0.0002). Oral rinse AUC values of ^uC^uC were 0.763 and 0.926 and methylation levels were 0.707 and 0.621, respectively. ^uC^uC, but not overall methylation level, differentiated cancer WBC from normal (p = 0.0082 and p = 0.4830, respectively).ConclusionLINE-1 partial methylation represents hypomethylation in normal cells but hypermethylation in cancer cells. This information improves LINE-1 methylation detection in cancer.     

MRP8/ABCC11 directly confers resistance to 5-fluorouracil

Multidrug-resistance-associated protein, MRP8/ABCC11 (ABCC11), is an efflux pump for nucleotide analogues and 5-fluoro-2'-deoxyuridine 5'-monophosphate (FdUMP). To test whether ABCC11 directly confers 5-fluorouracil (5-FU) resistance, we used the 5-FU-resistant subline PC-6/FU23-26 selected from PC-6 human small-cell lung cancer cells by 5-FU and found that it increases the resistance by approximately 25-fold. The intracellular FdUMP accumulation was reduced in PC-6/FU23-26 cells concomitant with the overexpression of the ABCC11 gene. These findings suggest that ABCC11 confers 5-FU resistance in the sublines by enhancing the efflux for the active metabolite FdUMP. Previously, methotrexate also increased the efflux by ABCC11, and we found cross-resistance to methotrexate in PC-6/FU23-26 cells. To confirm our hypothesis, we examined whether decreasing the expression of ABCC11 in PC-6/FU23-26 cells by small interfering RNA altered the cytotoxicity to 5-FU and methotrexate and found that this enhanced 5-FU and methotrexate cytotoxicity in PC-6/FU23-26 cells. These data indicate that expression of the ABCC11 gene is induced by 5-FU, and that ABCC11 is directly involved in 5-FU resistance by the efflux transport of the active metabolite FdUMP.     

Current status of art mobilization in Myeloma

Multiple myeloma is the leading indication of autologous hematopoietic cell transplantation (AHCT) worldwide. Hematopoietic progenitor cell mobilization (HPCM) is the first step of a successful AHCT. A minimum of 2 × 10⁶ CD34⁺ cells/kg are needed for successful engraftment. Growth factors have been used both alone or in combination with chemotherapy for HPCM of patients with myeloma. Mobilization failures result in delays in AHCT and increased cost and resource utility. Strategies to mobilize progenitor cells were mainly chemotherapy and growth factor or growth factor-only mobilization until the advent of plerixafor. Plerixafor is successfully integrated into both growth factor-only and cyclophosphamide and growth factor mobilization strategies with significantly reducing the mobilization failure rate in myeloma patients. The best strategy to mobilize progenitor cells with the highest yield and lowest toxicity and cost in patients with multiple myeloma has not yet been determined. This review aims to summarize the current status of art mobilization in myeloma comparing the pros and cons of different mobilization strategies.     

Peripheral blood progenitor cell collection without close monitoring of peripheral blood CD34+ cells: A feasible strategy for multiple myeloma or pre-treated Non-Hodgkin’s Lymphoma patients mobilized with low-dose cyclophosphamide plus G-CSF

BackgroundDaily monitoring of peripheral blood CD34+ cells may not be necessary for all patients with hematologic malignancies for adequate peripheral blood progenitor cells (PBPC) mobilization and harvesting. We therefore designed a regimen for PBPC mobilization in patients with multiple myeloma or pre-treated Non-Hodgkin’s lymphoma based on a combination of low-dose cyclophosphamide (Cy) plus granulocyte colony-stimulating factor (G-CSF) without daily monitoring of peripheral blood CD34+ cells.Study design and methodsA prospective study was performed on patients with multiple myeloma (n = 22) or pre-treated Non-Hodgkin’s lymphoma (n = 17) whose PBPC were harvested according to the following regimen: 1.5 g/m² Cy at day 1, 12 μg/kg/day G-CSF from day +7 to +11 avoiding daily monitoring of peripheral blood CD34+ cells and two consecutive leukapheresis at days +12 and +13. The optimum threshold of 2 × 10⁶ CD34+ cells per kg was established.ResultsThe proportion of patients with higher CD34+ cell yield after two leukapheresis was similar: multiple myeloma (16/22–72.7%) and Non-Hodgkin’s lymphoma (12/17–70.6%). Exposure to radiotherapy and greater than two prior chemotherapy regimens were significantly associated with lower yield in multiple myeloma (p = 0.002) and Non-Hodgkin’s lymphoma patients (p = 0.002), respectively.ConclusionOur data suggested that adequate yields of CD34+ cells may be achieved in multiple myeloma or pre-treated Non-Hodgkin’s lymphoma mobilized with low-dose Cy plus G-CSF regardless of the daily monitoring of peripheral blood CD34+ cells.