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@ARTICLE{Lisenko:131062,
      author       = {K. Lisenko and P. Wuchter and M. Hansberg and A. Mangatter
                      and A. Benner$^*$ and A. D. Ho and H. Goldschmidt and U.
                      Hegenbart and S. Schönland},
      title        = {{C}omparison of {D}ifferent {S}tem {C}ell {M}obilization
                      {R}egimens in {AL} {A}myloidosis {P}atients.},
      journal      = {Biology of blood and marrow transplantation},
      volume       = {23},
      number       = {11},
      issn         = {1083-8791},
      address      = {[S.l.]},
      publisher    = {Elsevier Health Sciences},
      reportid     = {DKFZ-2017-06129},
      pages        = {1870 - 1878},
      year         = {2017},
      abstract     = {High-dose melphalan (HDM) and autologous blood stem cell
                      transplantation (ABSCT) is an effective treatment for
                      transplantation-eligible patients with systemic light chain
                      (AL) amyloidosis. Whereas most centers use granulocyte
                      colony-stimulating factor (G-CSF) alone for mobilization of
                      peripheral blood stem cells (PBSC), the application of
                      mobilization chemotherapy might offer specific advantages.
                      We retrospectively analyzed 110 patients with AL amyloidosis
                      who underwent PBSC collection. Major eligibility criteria
                      included age <70 years and cardiac insufficiency New York
                      Heart Association ≤III°. Before mobilization, 67 patients
                      $(61\%)$ had been pretreated with induction therapy,
                      including 17 $(15\%)$ patients who had received melphalan.
                      Chemo-mobilization was performed with either
                      cyclophosphamide, doxorubicin, dexamethasone (CAD)/G-CSF
                      (n = 78, $71\%);$ ifosfamide/G-CSF (n = 14, $13\%);$
                      or other regimens (n = 8, $7\%).$ AL amyloidosis
                      patients with predominant heart involvement and/or status
                      post heart transplantation were mobilized with G-CSF only
                      (n = 10, $9\%).$ PBSC collection was successful in 101
                      patients $(92\%)$ at first attempt. The median number of
                      CD34+ cells was 8.7 (range, 2.1 to 45.5) × 106 CD34+/kg
                      collected in a median of 1 leukapheresis (LP) session.
                      Compared with G-CSF-only mobilization, a chemo-mobilization
                      with CAD/G-CSF or ifosfamide/G-CSF had a positive impact on
                      the number of collected CD34+ cell number/kg per LP
                      (P <.001, multivariate). Melphalan-containing previous
                      therapy and higher age had a significant negative impact on
                      quantity of collected CD34+ cells. Median common toxicity
                      criteria (CTC) grade of nonhematologic toxicity was II
                      (range, 0 to IV). Life-threatening CTC grade IV adverse
                      events were observed in 3 patients with no fatalities.
                      Cardiovascular events were observed in 17 patients $(22\%)$
                      upon CAD/G-CSF mobilization (median CTC: grade 3; range, 1
                      to 4). Toxicity in patients undergoing ifosfamide/G-CSF
                      mobilization was higher than in with those who received
                      G-CSF-only mobilization. HDM and ABSCT were performed in 100
                      patients. Compared with >6.5 × 106 transplanted CD34+
                      cells/kg, an ABSCT with <3 × 106 CD34+ cells/kg was
                      associated with a longer duration to leukocyte
                      reconstitution >1 × 109/L and a reduced platelet count <150
                      × 109/L 1 year after ASCT. Our results show that CAD
                      chemotherapy is very effective in PBSC mobilization and has
                      a tolerable toxicity profile in AL amyloidosis patients. A
                      further toxicity reduction by omission of doxorubicin might
                      be considered. Because of advanced nonhematologic toxicity,
                      ifosfamide administration cannot be recommended. However,
                      G-CSF mobilization alone is also safe and effective.
                      Considering the hematopoietic reconstitution and long-term
                      stem cell function, our results provide a rationale to
                      collect and transplant as many as >6.5 × 106 CD34+
                      cells/kg, if feasible with reasonable effort.},
      cin          = {C060},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28754546},
      doi          = {10.1016/j.bbmt.2017.07.015},
      url          = {https://inrepo02.dkfz.de/record/131062},
}