title: Plerixafor added to G-CSF-supported paclitaxel-ifosfamide-cisplatin salvage chemotherapy enhances mobilization of adequate numbers of hematopoietic stem cells for subsequent autografting in hard-to-mobilize patients with relapsed/refractory germ-cell tumors: a single-center experience.
abstract: An appreciable percentage of patients with relapsed/refractory germ-cell tumors (GCTs), candidates for high-dose chemotherapy (HDC) and autologous hematopoietic cell transplantation (HCT), fail to mobilize adequate hematopoietic stem cells (HSCs) numbers with granulocyte colony-stimulating factor (G-CSF)±salvage chemotherapy. Plerixafor has shown a potential to mobilize adequate CD34+HSCs numbers in this context. Here, we applied plerixafor in combination with G-CSF after salvage chemotherapy in 'poor' mobilizers with relapsed/refractory GCTs for HDC+HCT. Patients with relapsed/refractory GCTs (n=10) received salvage paclitaxel-ifosfamide-cisplatin (TIP) chemotherapy+G-CSF to mobilize adequate HSCs to support HDC, mainly with two courses of high-dose thiotepa-etoposide-carboplatin (TEC). Patients failing to achieve the minimum collection threshold of 2.0×10/kg CD34+ cells, to support at least one cycle of HDC, were administered plerixafor before the anticipated HSC collection during subsequent cycle(s). Overall, seven patients mobilized adequate CD34+ cells (>5.0×10/kg) aiming to support two cycles of HDC. Three patients did not mobilize adequate numbers of CD34+ cells after previous G-CSF plus salvage TIP, and plerixafor was added in subsequent cycle(s). This led to a collection of adequate CD34+ cells, able to support HDC with TEC (1-2 cycles). Hematopoietic engraftment for neutrophils (absolute neutrophil count>500/μl) and platelets (platelet count>20 000/μl) with plerixafor-mobilized HSCs occurred after a median of 9 and 14 days, respectively. Salvage TIP+G-CSF leads to successful HSC mobilization in patients with less heavily pretreated GCTs, whereas the addition of plerixafor to G-CSF+TIP led to mobilization of adequate HSCs that supported autografting after one to two TEC cycles.
authors.affiliation: aDepartment of Medicine, Second Division of Medical Oncology and Hematopoietic Cell Transplant Program bDepartment of Transfusion Medicine and Cell Processing Laboratory, 'Metaxa' Cancer Hospital, Piraeus, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Kosmas
authors.forename: Aggelos
authors.initials: A
authors.lastname: Athanasopoulos
authors.forename: George
authors.initials: G
authors.lastname: Dimitriadis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Miltiadous
authors.forename: Minas
authors.initials: M
authors.lastname: Zilakos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Lydakis
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Magiorkinis
authors.forename: Christos
authors.initials: C
authors.lastname: Gekas
authors.forename: Theodoros
authors.initials: T
authors.lastname: Daladimos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mylonakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Ziras
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001596:Benzylamines; D002945:Cisplatin / Q000008:administration & dosage; D000080027:Cyclams; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006571:Heterocyclic Compounds / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D009364:Neoplasm Recurrence, Local; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D017239:Paclitaxel; D002945:Cisplatin; C088327:plerixafor; D007069:Ifosfamide