Predictors of CD34+ cell mobilization and collection in adult men with germ cell tumors: Implications for the salvage treatment strategy

Andrea Necchi, Rosalba Miceli, Paolo Pedrazzoli, Patrizia Giannatempo, Simona Secondino, Massimo Di Nicola, Elena Farè, Daniele Raggi, Michele Magni, Paola Matteucci, Paolo Longoni, Marco Milanesi, Emanuela Paternò, Fernando Ravagnani, Flavio Arienti, Nicola Nicolai, Roberto Salvioni, Carmelo Carlo-Stella, Alessandro M. Gianni

Research output: Contribution to journalArticlepeer-review

Abstract

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 + cell mobilization in the therapeutic algorithm of relapsing GCT, for whom multiple HDCT courses are still an option, and potentially a cure.

Original languageEnglish
JournalClinical Genitourinary Cancer
Volume12
Issue number3
DOIs
Publication statusPublished - 2014

Keywords

  • Hematopoietic stem cell transplantation
  • High-dose chemotherapy
  • Male germ cell tumor
  • Testicular neoplasms

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Medicine(all)

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