title: Plerixafor and autologous stem cell transplantation: impressive result in a chemoresistant testicular cancer patient treated with high-dose chemotherapy.
abstract: Plerixafor, a CXCR4 antagonist, induces the rapid release of hematopoietic progenitor stem cells from the bone marrow into peripheral blood; it is approved for autologous hematopoietic progenitor stem cell mobilization in multiple myeloma and non-Hodgkin's lymphoma patients. We report the case of a 34-year-old patient with metastatic testicular embryonal carcinoma who was extensively and in vain pretreated with chemotherapy and failed to mobilize an adequate number of hematopoietic progenitor stem cells following high-dose chemotherapy, with the support of granulocyte colony-stimulating factors. After a cycle of high-dose cyclophosphamide associated with granulocyte colony-stimulating factors, plerixafor was administered to the patient, with the clinical evidence of an increase in hematopoietic progenitor stem cells in the peripheral blood. The patient achieved a complete engraftment following two cycles of high-dose chemotherapy (paclitaxel, ifosfamide, carboplatin, etoposide), with the support of hematopoietic progenitor stem cells; the patient showed discrete tolerability to the treatment. At biochemical control, the β-human chorionic gonadotropin value decreased from 86 to less than 1.2 mUI/ml and total body PET-CT scan showed a complete response to chemotherapy. According to this experience, we believe that in patients with advanced germ cell cancer, it is essential to explore the possibility of the use of high-dose chemotherapy to induce a stable and permanent response; in this context, plerixafor, with the support of granulocyte colony-stimulating factors, may be an innovative option for satisfactory mobilization during high-dose chemotherapy protocols.
authors.affiliation: Department of Hematology and Oncology, Hematology Unit with Bone Marrow Transplantation, Santa Maria Goretti Hospital, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: De Blasio
authors.forename: Luigi
authors.initials: L
authors.lastname: Rossi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Zappone
authors.forename: Elettra
authors.initials: E
authors.lastname: Ortu La Barbera
authors.forename: Rita
authors.initials: R
authors.lastname: Salvatori
authors.forename: Matteo
authors.initials: M
authors.lastname: Pacilli
authors.forename: Antonio
authors.initials: A
authors.lastname: Carbone
authors.forename: Eleonora
authors.initials: E
authors.lastname: Zaccarelli
authors.forename: Anselmo
authors.initials: A
authors.lastname: Papa
authors.forename: Silverio
authors.initials: S
authors.lastname: Tomao
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001596:Benzylamines; D000080027:Cyclams; D003520:Cyclophosphamide / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006412:Hematopoietic Stem Cells / Q000187:drug effects; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D019718:Receptors, CXCR4 / Q000037:antagonists & inhibitors*; D033581:Stem Cell Transplantation / Q000379:methods*; D013736:Testicular Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D007166:Immunosuppressive Agents; D019718:Receptors, CXCR4; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; C088327:plerixafor