Approaches of stem cell mobilization in a large cohort of metastatic germ cell cancer patients

Ramin Madanchi,Winfried Alsdorf,Christoph Oing,Christian Frenzel,Christoph Seidel,Carsten Bokemeyer,Nils W Engel,Finn-Ole Paulsen

doi:10.1038/s41409-022-01614-9

Abstract

High-dose chemotherapy (HD-Cx) in refractory germ cell cancer (GCC) is effective but limited data are available concerning the optimal approach for stem cell mobilization (SCM) in these patients. In this analysis 102 patients undergoing SCM during first (n = 25) or subsequent treatment lines (n = 77) were analyzed. Subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) were given once daily (group 1) in 52 patients (51%), twice daily (group 2) in 39 patients (38%) or one injection Pegylated-G-CSF (PegG-CSF) (group 3) in eleven patients (11%) after one cycle of mobilization chemotherapy. Plerixafor was administered 13 times in group 1, seven times in group 2 and once in group 3. Overall, 77 (75%) patients achieved successful SCM defined as ≥8*106 CD34+ cells/kg body weight for three consecutive HD-Cx plus one backup dose. In group 1, 40 of 52 patients (77%) achieved successful SCM with a median of 11 G-CSF injections, in group 2, 27 of 39 patients (69%) with a median of 14 G-CSF injections and in group 3, 10 of 11 patients (91%) with one injection of PegG-CSF. SCM was more successful if conducted during first-line chemotherapy (p = 0.016) and associated with a beneficial outcome concerning overall survival (p = 0.02) if performed satisfactorily.

Highlights

Germ cell cancer (GCC) is the most common tumor type in young adults under the age of 40 with an increasing incidence over the past years [1,2,3]
For stem cell mobilization (SCM), the administration of one to two cycles of induction chemotherapy followed by repetitive administrations of human granulocyte colony-stimulating factor (GCS-F) is considered as the standard of care [8, 9]
We reviewed the SCM approaches in a large cohort of GCC patients treated at a single GCC expert center looking for individual patient characteristics to be associated with the outcome concerning SCM

Summary

Introduction

Germ cell cancer (GCC) is the most common tumor type in young adults under the age of 40 with an increasing incidence over the past years [1,2,3]. Patients undergoing chemotherapy with consecutive SCM during 1st, 2nd or subsequent treatment lines were analyzed retrospectively regarding their SCM outcome and prognosis concerning overall survival (OS). Potential correlations between successful SCM and (i) treatment line, (ii) type of growth factor used for CD34+ stem cell stimulation and (iii) patient baseline characteristics were investigated.

Results

Conclusion