BACKGROUND: High-dose chemotherapy with tandem or triple carboplatin and etoposide course is currently the first curative choice for relapsing GCT.
The collection of an adequate amount of hematopoietic (CD34+) stem cells is a priority.
PATIENTS AND METHODS: We analyzed data of patients who underwent HDCT at 2 referral institutions. Chemotherapy followed by myeloid growth factors was applied in all cases. Uni- and multivariable models were used to evaluate the association between 2 prespecified variables and mobilization parameters. Analyses included only the first mobilizing course of chemotherapy and mobilization failures.
RESULTS: A total of 116 consecutive patients underwent a mobilization attempt from December 1995 to November 2012. Mobilizing regimens included cyclophosphamide (CTX) 7 gr/m2 (n = 39), cisplatin, etoposide, and ifosfamide (PEI) (n = 42), paclitaxel, cisplatin, and gemcitabine (TPG) (n = 11), and mixed regimens (n = 24). Thirty-seven percent were treated in first-line, 50% (n = 58) in second-line, 9.5% (n = 11) and 3.4% (n = 4) in third- and fourth-line settings, respectively. Six patients did not undergo HDCT because they were poor mobilizers, 2 in first- and second-line (1.9%), and 4 beyond the second-line (26.7%). In the multivariable model, third-line or later setting was associated with a lower CD34+ cell peak/μL (P = .028) and a lower total CD34+/kg collected (P = .008). The latter was also influenced by the type of mobilizing regimen (P < .001).
CONCLUSION: A decline in significant mobilization parameters was found, primarily depending on the pretreatment load. Results lend support to the role of CD34+ cell mobilization in the therapeutic algorithm of relapsing GCT, for whom multiple HDCT courses are still an option, and potentially a cure.
Written by:
Necchi A, Miceli R, Pedrazzoli P, Giannatempo P, Secondino S, Di Nicola M, Farè E, Raggi D, Magni M, Matteucci P, Longoni P, Milanesi M, Paternò E, Ravagnani F, Arienti F, Nicolai N, Salvioni R, Carlo-Stella C, Gianni AM. Are you the author?
Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Clinical Epidemiology and Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Immunohematology and Transfusion Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Reseach Center, Rozzano, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Reference: Clin Genitourin Cancer. 2013 Nov 13. pii: S1558-7673(13)00292-9.
doi: 10.1016/j.clgc.2013.11.021
PubMed Abstract
PMID: 24361054
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