Successful Mobilization Research Articles

Strategic Framing Work(s): How Microcredit Loans Facilitate Anti-Witch-Hunt Movements

This article shows how a social movement organization focused on microcredit loans is able to mobilize a community against its own cultural practice of witch-hunts. Successful mobilization against witch-hunts are possible when two conditions are met: first, when activists are able to tap into microcredit groups' social capacity for collective mobilization (defined by ties of mutual dependence, reciprocity, and friendship); and second, when activists are able to use strategic framing to present a coherent argument about the congruence of microcredit and anti-witch-hunt goals. In this context a master frame (women's development) emerged that effectively forged the seemingly disparate goals of microcredit loans and anti-witch-hunt campaigns into one synthetic movement. In contrast, successful mobilization against witch-hunts was difficult in areas where the activists did not have access to the microcredit networks or were not able to strategically frame the campaign.

A feasible shortcut for the mobilization outcome: Steady state CD34 positive hematopoietic stem cells

Predicting success of hematopoietic cell mobilization is an important issue for transplant physicians. We examined the steady state peripheral blood CD34+ cell count to predict ability to mobilize adequate hematopoietic progenitor cells in 63 myeloma and lymphoma patients. The median steady state CD34+ cell number was 1.56/μL (0.03–5.76). Although counting steady state CD34+ is definitely cost effective to predict the successful mobilization, we could not find a threshold steady state CD34 count of any value predicting successful mobilization.

Abstract 239: Stem Cell Therapy Improves Critical Limb Ischemia

Introduction: The journey from single cell to complex being is attributable to stem cells role. Adult stem cells originate during ontogeny & persist in specialized niches within organs. Asymmetric division of each stem cell during differentiation produces : one daughter stem cell & one daughter transit amplifying/intermediate cell having migratory properties. Forced migration of hematopoietic stem/progenitor cells (HSPC) from bone marrow into peripheral blood is called mobilization. Accumulating evidence suggests that attenuation of the chemokine stromal derived factor-1(SDF-1)-CXCR4 axis that plays a pivotal role in retention of HSPC in bone marrow (BM) results in the release of these cells from the BM into peripheral blood. Recently, adult cells have been genetically reprogrammed to an embryonic stem cell like state. Induced pluripotent stem cells (IPSCs) were similar to human embryonic stem cells in morphology, proliferative capacity, expression of cell surface antigens, & gene expression. Treatment of ischemic vascular disease of lower limbs remains a significant challenge. Unfortunately, if medical & surgical salvage procedures fail, amputation is an unavoidable result for those patients. Aim of Work: (Hypothesis) To assess the application of implantation of autologous stem/progenitor cell in the treatment of chronic limb ischemia & to evaluate the safety, efficacy & feasibility of this novel therapeutic approach. Methods: A total of 24 patients with chronic limb ischemia not eligible for arterial reconstruction or endovascular procedures were enrolled & randomized (1:1) to either the implanted group or the control group. Control group: Conventional medical therapy in the form of anti platelet therapy & vasodilators. Implanted group: Subcutaneous injection of 300μ g/day of recombinant human granulocyte colony stimulating factor (G-CSF) for 5 days to mobilize stem/progenitor cells from BM. Total leucocytic count is measured daily to follow up successful mobilization of bone marrow mononuclear cells (BMMNCs). Stem cell Harvesting After 5 days peripheral blood mononuclear cells (PBMNCs) were harvested using a cell separator. Samples from apheresis products are subjected to TLC measurement & immunophenotypic characterization of CD34+ cells by flow cytometry. The collected PBMNCs were implanted by multiple intramuscular injections into ischemic limbs. Results: There was significant increase in pain free walking distance & ankle/brachial index (ABI) & significant decreased rest pain. Effectiveness was documented by : reduced number of amputation, increase ABI & improvement of the quality of life in therapeutic group compared to control group. Conclusion: The novel therapeutic approach of PBMNCs implantation in patients with chronic limb ischemia is safe, feasible & effective in decreasing co-morbidity & rate of amputation. Safety was manifested by absence of complications during G-CSF therapy or during harvesting & injection of the stem cells. Recommendations: 1- Future studies on larger number of patients & longer follow up. 2- Controlled studies using different methods & different cell population (PBMNCs, BMMNCs or MSCs) to compare the outcome of each. 3-Studing the role of endothelial progenitor cell dysfunction in different ischemic diseases to develop successful gene therapy.

Two cycles of the PS-341/bortezomib, adriamycin, and dexamethasone combination followed by autologous hematopoietic cell transplantation in newly diagnosed multiple myeloma patients

Treatment with 3-6 cycles of PS-341/bortezomib, adriamycin, and dexamethasone (PAD) has been explored in terms of induction therapy prior to autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). We evaluated the effects of two cycles of PAD given before ASCT. Patients received two 21-d cycles of PAD (bortezomib 1.3 mg/m(2) × 4 d, adriamycin 9 mg/m(2) × 4 d, and dexamethasone 40 mg × 4 d × 2). Starting on day 12 of cycle 2, patients were given subcutaneous granulocyte-colony stimulating factor to mobilize peripheral blood stem cells (PBSCs). Following PBSC harvesting, ASCT was performed using high-dose melphalan, followed by thalidomide. A total of 32 patients were enrolled. Of 31 who completed two cycles of PAD, 25 (81%) achieved a partial response (PR) or better. Major adverse events were cytopenia, with grade I/II neurotoxicity evident during 4.8% of PAD cycles. Two patients were withdrawn from the study prior to PBSC collection. Thirty patients showed successful mobilization of PBSCs and underwent ASCT, with all 30 showing adequate neutrophil and platelet recovery. Following ASCT, 14 patients (47%) achieved a complete response (CR), 8 (27%) a very good partial response (VGPR), and 6 (20%) PR. Thalidomide was given to 25 patients after ASCT, as maintenance therapy. Twelve patients showed better responses after administration of thalidomide, and a total of 21 patients (70%) achieved CR. The 5-yr probabilities of overall and progression-free survival were 71.1% and 23.5%, respectively. A short course of PAD was effective as an induction treatment before ASCT in patients newly diagnosed with MM. Prospective comparisons with longer courses of such treatment are needed.

Are You Still with Us? A Study of the Post-Adoption Determinants of Sustained Use of Mobile-Banking Services

This research develops and empirically tests a theoretical model that explains sustained use of mobile banking services. While an extensive array of research has examined various theoretical antecedents of the intention to adopt and use new technologies, only a handful of studies have examined the extent of current usage of a system. Moreover, despite the huge market potential of and recent technological advancements seen in the mobile-commerce market, little is known about the factors that can influence sustained use of integrated mobile financial services after adoption. The present research examines the extent of mobile banking service usage of 370 Korean mobile-baking users in the post-adoption stage. The results of the study indicate that perceived usability, channel preference, and perceived value are three major determinants of sustained mobile banking use. The model further extends and explains that good menu design is a dominant factor in perceived usability of m-banking services, while low monetary costs (i.e., charges and fees) and provision of various banking functions can improve m-banking users' perception of the value of m-banking services. Along with the suggested model, the presented case of factors promoting successful m-banking services will help many mobile industries around the world envisage a successful and stable mobile–financial services market and accelerate their development. Implications of the findings and future research directions are also discussed.

Double high-dose therapy with dose-intensive cyclophosphamide, etoposide, cisplatin (DICEP) followed by high-dose melphalan and autologous stem cell transplantation for relapsed/refractory Hodgkin lymphoma

The purpose of the present study was to review retrospectively our results of double high-dose therapy with DICEP (dose-intensified cyclophosphamide 5.25 g/m2, etoposide 1.05 g/m2, and cisplatin 105 mg/m2) re-induction followed by high dose melphalan 200 mg/m2 (HDM) and autologous stem cell transplantation (ASCT) for 73 consecutive patients with relapsed (n = 43) or refractory (n = 30) classical Hodgkin lymphoma (HL) treated between June 1995 and November 2009. DICEP chemotherapy resulted in successful stem cell mobilization in 71 patients (97%), with a median CD34 + cell collection of 15.6 × 106/kg. With a median follow-up of 56 months post-DICEP, the 5-year progression free survival (PFS) and overall survival (OS) rates were 61% [95%CI = 49–72%] and 80% [95%CI = 69–89%], respectively. The 5-year PFS was 65% vs. 30% for DICEP responders vs. nonresponders (logrank p = 0.003) and 89% for International Prognostic Score (IPS) = 0–1, 56% for IPS = 2–3, and 24% for IPS = 4–7 (logrank p < 0.001). Response to DICEP and IPS at relapse were the only two factors that independently predicted PFS and OS in multivariate analyses. Treatment-related mortality was 1%. In conclusion, DICEP-HDM/ASCT is well tolerated double high-dose therapy associated with excellent stem cell mobilization and favorable PFS and OS outcomes for relapsed as well as primary refractory HL.

Next-Generation Applications on Cellular Networks: Trends, Challenges, and Solutions

Applications over cellular networks now range from operator–consumer applications (e.g., mobile television, voice-over-ip, video conferencing), peer-to-peer applications (e.g., instant messaging), machine-to-machine applications (e.g., data telemetry and automotive applications), mobile web services (e.g., music and video streaming), and social networking applications. The current approach for developing mobile applications appears to focus on utilizing template-based application-development kits provided by platform developers (e.g., Google's Android, Apple's iOS, or Nokia's Symbian) to capture application designs and install them on the runtime platforms through use of code generators tied to particular versions of the platform. It is still unclear as to how an application developer (or network operator) conceptualizes the features of a mobile application in a platform-independent way, identifies its utility and explores its impact on the user, or further refines the choice of technology, platform, and mobility/interactivity requirements. This paper attempts to offer some guidelines, based on recent research in the industry and academia in these areas, toward the design and development of successful mobile applications that can utilize the capabilities of the next generation of cellular networks. We provide an overview of the growing trends of the rich multimedia and real-time mobile applications, including the diversity of application types, their impact on the enterprise and consumer, their traffic volumes, and their load and communication patterns. In addition to the overall trend analysis, we also study the design choices that are to be made, and how they are realized, and also describe how the platforms (client and server) may be implemented. Additionally, we focus on mobile video applications according to their communication characteristics and their distinct demands on the cellular network. We also present an analysis of device and network application programming interfaces (API) that form the basic building blocks for efficient and secure mobile application development of the future.

Successful mobilization using a combination of plerixafor and G-CSF in pediatric patients who failed previous chemomobilization with G-CSF alone and possible complications of the treatment

Peripheral blood stem cell (PBSC) mobilization, which uses plerixafor (AMD 3100), a newly developed specific inhibitor of the CXCR4 receptor, in combination with granulocyte-colony stimulating factor(G-CSF), has been shown to enhance the stem cell mobilization in adult patients, but pediatric data are scarce. We documented our experience with this drug in 6 Korean pediatric patients who had failed in chemomobilization, using G-CSF, alone. All patients were mobilized CD34+ cells (median, 11.08 × 106/kg: range, 6.34-28.97 × 106/kg) successfully within 2 to 3 cycles of apheresis, without complications. A total of 7 autologous transplantations were performed, including 1 tandem transplantation. However, 2 patients with brain tumors showed severe pulmonary complications, including spontaneous pneumomediastinum. This is the first study of PBSC mobilization with plerixafor in Asian pediatric patients. Furthermore our study suggests that mobilization with plerixafor may be effective in Korean pediatric patients, who have previously been heavily treated and have failed PBSC mobilization with classical chemomobilization, using G-CSF. However, further studies are needed to examine the possible complications of autologous transplantation, using a mobilized plerixafor product in children.

TIM Lecture Series: The Business of Mobile Apps

OverviewThe first TIM Lecture Series of 2012 was presented by Brian Hurley, President and CEO of Purple Forge, who generously shared his experiences and insights gained from running a successful mobile applications company. The presentation was targeted at individuals interested in starting their own mobile apps company, particularly those with a background in computer

TIM Lecture Series: The Business of Mobile Apps

OverviewThe first TIM Lecture Series of 2012 was presented by Brian Hurley, President and CEO of Purple Forge, who generously shared his experiences and insights gained from running a successful mobile applications company. The presentation was targeted at individuals interested in starting their own mobile apps company, particularly those with a background in computer

Successful Stem Cell Mobilization and Engraftment in Heavily Pretreated Multiple Myeloma Patients with Prior High Dose Melphalan and Autologous Stem Cell Transplantation

Salvage second autologous transplantation for patients with relapsed multiple myeloma (MM) after prior autologous transplantation has shown to be beneficial in particular if the first remission is longer than 12-18 months. In addition second salvage autologous transplant may be used in the contest of progressive refractory myeloma for temporarily disease control or for hematopoietic reconstitution after prior extensive therapy. Customarily, patients with multiple myeloma who received prior alkylating agents or autologous transplantation with high dose Melphalan are considered non transplant candidate because of the deleterious effects on stem cell collection. Plerixafor is a chemokine receptor -4- antagonist which is approved by FDA for use in combination with G-CSF for mobilization of CD34+ stem cells in patients with NHL and multiple myeloma. We have explored the feasibility of Plerixafor and G-CSF in stem cell collection for second salvage autologous transplantation in 4 consecutive patients with multiple myeloma who underwent prior extensive therapy including prior autologous transplantation with Melphalan-200. Patient characteristics, chemotherapy used and interval between first and second salvage transplant are shown in Table 1. All Patients received GCSF at dose of 10 mcg/KG for 4 days in AM, Plerixafor on the evening of the 4th night and subsequent nights prior to apheresis at a dose of 0.24 mg/kg. The number of apheresis procedures were 2 in two patients and 3 in two patients. The number of CD34 + cells collected were 4.25, 3.06, 3.63, 3.78 million cells/Kg. All the patients engrafted successfully after the second transplant. Neutrophils engraftement were at day 10, 12, 12 and 11 while platelet engraftment were at day 10, 15, 32 and 19 respectivlely for the four patients. Our Data shows the feasibility of stem cell collection in heavily pretreated MM patients including high dose Melphalan and autologous stem cell transplantation. Prospective studies are needed to confirm such feasibility. Such approach may have future clinical application in eliminating minimal residual disease after the first autologous transplant when used in MM patients with planned upfront tandem autologous transplant.Table 1Patient #AGEInduction pre 1st TransplantMobilization RegimenFirst Transplant TypeMaintenance/Relapse treatmentRe-InductionInterval between transplants (Years)146VAD X4 then Thalidomide for 1 yearCytoxan/G-CSFSingleThalidomid then Lenalidomide maintenanceRVD × 38.57266VAD X4Cytoxan/G-CSFPlanned TandemDex/Thal followed by Bro/DoxilMPV-Rituximab4.77356Thal/Dex then Bro/Dex then MPCytoxan/G-CSFSingleDex/Thal then RVD×3 then VD-PACEMPV-Rituximab ×24.43467Lenalidomide/Dex × 4G-CSFSingleLenalidomide maintennace for 15 monthsRVD × 4,VD-PACE ×21.75X indicates number of cycles; RVD, lenalidomide, Bortezomib, Dex.; Thal, Thalidomide; MPV, Melphalan, Prednisone , Bortezomib; PACE, Cisplatin, Doxorubicin, Cytoxan, Etoposide; Bro, Brotezomib. Open table in a new tab X indicates number of cycles; RVD, lenalidomide, Bortezomib, Dex.; Thal, Thalidomide; MPV, Melphalan, Prednisone , Bortezomib; PACE, Cisplatin, Doxorubicin, Cytoxan, Etoposide; Bro, Brotezomib.

Pharmacoeconomic Impact of Upfront Use Plerixafor for Autologous Stem Cell Mobilization in Multiple Myeloma Patients

Abstract 2075 The most commonly employed agent for upfront stem cell mobilization is granulocyte-colony-stimulating factor (G-CSF), which is associated with about 25% of unsuccessful mobilization. Plerixafor was granted FDA approval based on improved rate of successful mobilization as an upfront mobilizing agent. However, because of its cost, it is often reserved for patients who failed previous standard mobilization. This strategy can increase the number of apheresis and potentially delay treatment. This retrospective study, performed between January 2008 and April 2011, included 50 adult patients with multiple myeloma (MM) who underwent ASCT. Twenty-five patients received plerixafor, in combination with G-CSF, and 25 patients received G-CSF alone as an upfront mobilization therapy. Plerixafor was given as 0.24mg/kg/day SC in the evening for up to 4 days, starting on day 4 of G-CSF. For stem cell collection, G-CSF was given as 10mcg/kg/day SC in the morning for 5 days. Targets of collection were minimal 5 x106 and optimal 107 CD34+ cells/kg. After ASCT, G-CSF was given as 5mcg/kg/day IV from day 0 until engrafted. In April 2010, a practice change was instituted to delay initiation of G-CSF from day 0 to day +5 following ASCT. Simultaneously, plerixafor was used, in combination with G-CSF, as an upfront mobilization therapy for autologous stem cell mobilization in MM patients. The primary objective of this study was to assess pharmacoeconomic impact of using plerixafor as an upfront mobilization therapy in patients with MM. There were no differences in age (mean, 57.4±8.7 yrs vs. 56.4±6.3 yrs; p=NS), weight (mean, 74.6±15.9kg vs. 75±19.7kg; p=NS), number of previous SCT (mean, 0±0.2 vs. 0.1±0.3; p=NS), patients with relapsed disease (16% vs. 16%; p=NS) or melphalan dose (mean, 192.8±19.9mg vs. 192.8 ±19.9mg; p=NS) between plerixafor group and the control. Compared with the control, plerixafor mobilizations yielded higher CD34+ cell content [mean (x106 CD34+ cells/kg), 16.1±9.7 vs. 8.4±4.6; p=0.0007], higher number of CD 34+cells infused [mean (x106 CD34+ cells/kg), 7.6±4.6 vs. 4.4±1.7; p=0.0017], required fewer number of G-CSF doses for both stem cell collection (mean, 5.9±1.1 vs. 7.1±1; p=0.0001) and for neutrophil recovery (mean, 8±1.8 vs. 11.8±1.1; p<0.0001), and required fewer number of apheresis (mean, 1.9±1.1 vs. 3.1±1; p=0.0001). The plerixafor group had a longer time to neutrophil engraftment compared with the control (mean, 10.8±0.9 days vs. 9.8±0.9 days; p<0.0001); however, this did not translated to longer days of hospitalization post-ASCT (mean, 15.2±2.7 days vs. 14.1±3.1 days; p=NS). The plerixafor group required fewer G-CSF doses for both mobilization and neutrophil recovery, and fewer apheresis sessions. Therefore, this group had a lower cost of G-CSF per patient for both stem cell collection (mean, $2,212±572 vs. $2,765±487, p=0.0006) and for stem cell recovery (mean, $1,677±521 vs. $2,653±1,125, p=0.0003), and also lower cost of apheresis per patient (mean, $889±517 vs. $1,476±479; p=0.0001). The mean number of plerixafor doses per patient was 1.8±1, with a cost per patient of $9,081.6±5,220. Based on our interim data for overall cost analysis, the plerixafor group had similar cost for blood products per patient (mean, $2,803±3,049 vs. $2,332±1,160, p=0.49), overall cost of medications (mean, $19,461±5,307 vs. $22,442±5,451, p=0.13), overall cost of hospitalization (mean, $60,646±13,981 vs. $61,474±10,464, p=0.84), and cost of hospitalization and apheresis combined per patient (mean, $61,632±14,163 vs. $62,949±10,298, p=0.75). This data suggests that using plerixafor for upfront autologous stem cell mobilization in patients with MM significantly improves success rate of mobilization, decreases the number of apheresis sessions, and does not have a substantial pharmacoeconomic impact. Disclosures: No relevant conflicts of interest to declare.

An Exploration of the Leadership Attributes and Methods Associated With Successful Lean System Deployments in Acute Care Hospitals

The lean system has been shown to be a viable and sustainable solution for the growing number of cost, quality, and efficiency issues in the health care industry. While there is a growing body of evidence to support the outcomes that can be achieved as a result of the successful application of the lean system in hospital organizations, there is not a complete understanding of the leadership attributes and methods that are necessary to achieve successful widespread mobilization and sustainment. This study was an exploration of leadership and its relevant association with successful lean system deployments in acute care hospitals. This research employed an exploratory qualitative research design encompassing a research questionnaire and telephonic interviews of 25 health care leaders in 8 hospital organizations across the United States. The results from this study identified the need to have a strong combination of personal characteristics, learned behaviors, strategies, tools, and tactics that evolved into a starting adaptable framework for health care leaders to leverage when starting their own transformational change journeys using the lean system. Health care leaders could utilize the outcomes reported in this study as a conduit to enhance the effective deployment, widespread adoption, and sustainment of the lean system in practice.

Predictive factors for inadequate stem cell mobilization in Chinese patients with NHL and HL: 14‐year experience of a single‐center study

Factors affecting progenitor cell mobilization in patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) are incompletely understood. The aim of this retrospective study was to determine which factors are crucial for effective mobilization and collection of autologous peripheral blood stem cells (PBSC) prior to transplantation in Chinese patients. A total of 239 patients with lymphoma (198 NHL and 41 HL patients) underwent PBSC collection after mobilization with granulocyte-colony-stimulating factor (G-CSF) or G-CSF plus chemotherapy priming. Patient characteristics at diagnosis and transplant, including low Eastern Cooperative Oncology Group score (P = 0.013), lack of extranodal invasion (P = 0.034), previously administered radiotherapy regimens (P = 0.040), treatment with platinum prior to mobilization (P = 0.042), previous chemotherapy regimens (P = 0.001) and cycles (P < 0.001), and chemotherapy regimens (P < 0.001) were statistically significant for successful mobilization in multivariate analysis. Premobilization factors, including previous radiotherapy (P = 0.009), previous chemotherapy regimens (P = 0.043) and cycles (P = 0.039), low platelet count prior to mobilization (P = 0.042), and lower CD34+ cells in peripheral blood (PB) (P = 0.050) or bone marrow (BM) (P = 0.007) were considered possibly predictive of poor mobilization. We found the patients who had chemosensitive lymphoma had worse progress-free survival (PFS) than the patients with initial treatment and high risks (P = 0.017). Our analysis showed that high amounts of chemotherapy, radiotherapy, low platelet count, chemosensitive recurrent patients, combination chemotherapy plus G-CSF and low CD34+ cells in BM prior to mobilization could emerged as important predictive factors for mobilization failure in Chinese patients with NHL and HL.

Influence of Genetic Polymorphisms in CYP2C8 and ABCB1 on the Mobilization Ability and Toxicity of Paclitaxel,

Abstract 4050 Introduction.We and others have described the efficacy of paclitaxel-based chemotherapy in mobilizing large amounts of hematopoietic progenitors (HP) both in patients with solid tumors,(Bone Marrow Transplant 2000;25:231–5), and with hematological malignancies (Haematologica 2008; 93:161–3). Like most drugs, the taxanes are not controlled by the actions of one gene, but believed to be dependent on several polymorphic proteins. Single nucleotide polymorphisms (SNPs) in the ABCB1 gene, which encodes the transport protein P-glycoprotein, or in in metabolic enzymes, such as CYP2C8, have been suggested to influence the pharmacokinetics and clinical response to paclitaxel. Aim. To retrospectively evaluate the effects of five known allelic variants in the CYP2C8, and ABCB1genes on the mobilization ability and toxicity of the anticancer agent paclitaxel. Patients and Methods. 107 patients with hematological malignancies (43 lymphoma, 41 myeloma, 23 acute leukemia) received paclitaxel 170 mg/m2 i.v. by continuous infusion for 24 hours (day 1) followed by 8 mg/kg s.c G-CSF daily until the last apheresis. 77% received this treatment after failure of mobilization with G-CSF, and the rest as first line therapy because of risk factors for failure to achieve successful mobilization. The genetic variants (ABCB1 rs1045642 A >G, ABCB1 rs2032582 C>A, ABCB1 rs2032582 C>T, CYP2C8 rs10509681 C>T, and CYP2C8 rs11572080 A>G), were genotyped by allelic discrimination polymerase chain reaction (PCR) assays using TaqMan®Genotyping Assays (Applied Biosystems). The effect of genotypes on mobilization efficacy and on maximal hematological toxicity (according to the NCI version 3) was retrospectively assessed. Results. Allelic frequencies for rs1045642 A>G, rs2032582 C>A, rs2032582 C>T, rs10509681 C>T, and rs11572080 A>G variants, were 0.46, 0.40, 0.8, 0.13, and 0.13, respectively. Successful mobilization (>2 106/kg CD34+ cells) was achieved in 57% of patients. No reproducible significant associations between genotype and outcome (evaluated as number of CD34+ cells/kg in the first and total apheresis, number of collections performed, and on the mobilization success [p>0.05]), nor on myeloid or platelet toxicity (p>0.05) were found for any of the SNPs analyzed. Discussion. This study on a well-defined patient population suggests that the presently evaluated variant alleles in CYP2C8 and ABCB1 genes do not explain the substantial interindividual variability in the outcome or hematological toxicity of the mobilization schedule using paclitaxel and G-CSF. Funding. This study was supported in part by a research grants 04515/GERM/06; RECAVA RD06/0014/0039, and FIS 10/02594. Disclosures:No relevant conflicts of interest to declare.

Successful Mobilization with the Combination of Plerixafor and G-CSF in Korean Pediatric Patients Who Failed in Previous Chemomobilization with G-CSF Alone

Abstract 4397 Introduction:The classical peripheral blood stem cell mobilization (PBSCM) relies on granulocyte colony-stimulating factor (G-CSF) either as a single agent or in conjunction with chemotherapeutic agents (chemomobilization). This method however, sometimes fails in patients who have previously been heavily treated with chemotherapy or radiotherapy. PBSCM with plerixafor (AMD3100), a newly developed specific inhibitor of the CXCR4 receptor, in combination with G-CSF has been shown to enhance stem cell mobilization in adult patients, but pediatric data is scarce. We document our experiences with this drug in five pediatric patients. Patients & Methods:Five patients (three males, two females) with a median age of 9.6 years (range 6–11 years) who have failed in chemomobilization with G-CSF alone, received plerixafor. The diagnosis of patients was medulloblastoma in 2, osteosarcoma in 2, and neuroblastoma in 1. All the patients had previously been heavily treated with chemotherapy (median 15.4 months) and two of them with medulloblastoma underwent craniospinal irradiation. Patients received G-CSF (10mcg/kg) for 4 days at 10 AM before the first plerixafor (240ug/kg) administration, which was given subcutaneously 10 hours before apheresis. Apheresis was performed thereafter on the fifth day of G-CSF administration. Patients received G-CSF at 8AM and apheresis was started at 10AM. Each apheresis was performed with plerixafor and G-CSF in the same manner. Results:All the patients mobilized targeted numbers of CD34+ cells (median 12.86×10^6/kg, range 6.34–28.97×10^6/kg) successfully with two to three cycles of apheresis, without complications (Per each apheresis: median 3.8×10^6/kg, range 1.55–14.49×10^6/kg). A total of four autologous transplantations were performed in 3 patients including one tandem transplantation in a neuroblastoma patient. Neutrophil and platelet were successfully engrafted in four transplantations within a median of 9.7 days (range 9–10 days) and 68.3 days (range 15–197 days), respectively. Conclusion:Our study suggests that mobilization with plerixafor is safe and effective in Korean pediatric patients who have previously been heavily treated and have failed PBSC mobilization with classical chemomobilization with G-CSF. This is the first results of PBSCM with plerixafor in Asian pediatric patients. Disclosures:No relevant conflicts of interest to declare.

Pharmacoeconomic Impact of Upfront Use Plerixafor for Autologous Stem Cell Mobilization in Multiple Myeloma Patients

Abstract 2075The most commonly employed agent for upfront stem cell mobilization is granulocyte-colony-stimulating factor (G-CSF), which is associated with about 25% of unsuccessful mobilization. Plerixafor was granted FDA approval based on improved rate of successful mobilization as an upfront mobilizing agent. However, because of its cost, it is often reserved for patients who failed previous standard mobilization. This strategy can increase the number of apheresis and potentially delay treatment.This retrospective study, performed between January 2008 and April 2011, included 50 adult patients with multiple myeloma (MM) who underwent ASCT. Twenty-five patients received plerixafor, in combination with G-CSF, and 25 patients received G-CSF alone as an upfront mobilization therapy. Plerixafor was given as 0.24mg/kg/day SC in the evening for up to 4 days, starting on day 4 of G-CSF. For stem cell collection, G-CSF was given as 10mcg/kg/day SC in the morning for 5 days. Targets of collection were minimal 5 x106 and optimal 107 CD34+ cells/kg. After ASCT, G-CSF was given as 5mcg/kg/day IV from day 0 until engrafted. In April 2010, a practice change was instituted to delay initiation of G-CSF from day 0 to day +5 following ASCT. Simultaneously, plerixafor was used, in combination with G-CSF, as an upfront mobilization therapy for autologous stem cell mobilization in MM patients. The primary objective of this study was to assess pharmacoeconomic impact of using plerixafor as an upfront mobilization therapy in patients with MM. There were no differences in age (mean, 57.4±8.7 yrs vs. 56.4±6.3 yrs; p=NS), weight (mean, 74.6±15.9kg vs. 75±19.7kg; p=NS), number of previous SCT (mean, 0±0.2 vs. 0.1±0.3; p=NS), patients with relapsed disease (16% vs. 16%; p=NS) or melphalan dose (mean, 192.8±19.9mg vs. 192.8 ±19.9mg; p=NS) between plerixafor group and the control. Compared with the control, plerixafor mobilizations yielded higher CD34+ cell content [mean (x106 CD34+ cells/kg), 16.1±9.7 vs. 8.4±4.6; p=0.0007], higher number of CD 34+cells infused [mean (x106 CD34+ cells/kg), 7.6±4.6 vs. 4.4±1.7; p=0.0017], required fewer number of G-CSF doses for both stem cell collection (mean, 5.9±1.1 vs. 7.1±1; p=0.0001) and for neutrophil recovery (mean, 8±1.8 vs. 11.8±1.1; p<0.0001), and required fewer number of apheresis (mean, 1.9±1.1 vs. 3.1±1; p=0.0001). The plerixafor group had a longer time to neutrophil engraftment compared with the control (mean, 10.8±0.9 days vs. 9.8±0.9 days; p<0.0001); however, this did not translated to longer days of hospitalization post-ASCT (mean, 15.2±2.7 days vs. 14.1±3.1 days; p=NS). The plerixafor group required fewer G-CSF doses for both mobilization and neutrophil recovery, and fewer apheresis sessions. Therefore, this group had a lower cost of G-CSF per patient for both stem cell collection (mean, $2,212±572 vs. $2,765±487, p=0.0006) and for stem cell recovery (mean, $1,677±521 vs. $2,653±1,125, p=0.0003), and also lower cost of apheresis per patient (mean, $889±517 vs. $1,476±479; p=0.0001). The mean number of plerixafor doses per patient was 1.8±1, with a cost per patient of $9,081.6±5,220. Based on our interim data for overall cost analysis, the plerixafor group had similar cost for blood products per patient (mean, $2,803±3,049 vs. $2,332±1,160, p=0.49), overall cost of medications (mean, $19,461±5,307 vs. $22,442±5,451, p=0.13), overall cost of hospitalization (mean, $60,646±13,981 vs. $61,474±10,464, p=0.84), and cost of hospitalization and apheresis combined per patient (mean, $61,632±14,163 vs. $62,949±10,298, p=0.75).This data suggests that using plerixafor for upfront autologous stem cell mobilization in patients with MM significantly improves success rate of mobilization, decreases the number of apheresis sessions, and does not have a substantial pharmacoeconomic impact. Disclosures:No relevant conflicts of interest to declare.

Plerixafor for Autologous Peripheral Blood Stem Cell Mobilization in Patients Previously Treated with Fludarabine or Lenalidomide

Fludarabine and lenalidomide are essential drugs in the front-line treatment of non-Hodgkin lymphoma (NHL) and multiple myeloma (MM), respectively. Data suggests that fludarabine and lenalidomide therapy may have a deleterious effect on stem cell mobilization. In the European compassionate use program, 48 patients (median age 57 years) previously treated with fludarabine (median 5 cycles; range: 1-7 cycles) were given plerixafor plus granulocyte colony-stimulating factor (G-CSF) for remobilization following a primary mobilization attempt. The overall median number of CD34+ cells collected was 2.3 × 10(6)/kg (range: 0.3-13.4). The minimum required number of CD34+ cells (≥2.0 × 10(6)/kg) was collected from 58% of patients in a median of 2 days. Thirty-five patients (median age = 57 years) previously treated with lenalidomide (median 5 cycles; range: 1-10 cycles) were given plerixafor plus G-CSF for remobilization. The overall median number of CD34+ cells collected was 3.4 × 10(6)/kg (range: 1.1-14.8). The minimum required number of CD34+ cells (≥2.0 × 10(6) per kg) was collected from 69% of patients in a median of 2 days. In conclusion, salvage mobilization with plerixafor plus G-CSF is successful in the majority of patients with MM previously treated with lenalidomide. In fludarabine-exposed patients, only 58% of patients will achieve successful salvage mobilization with plerixafor plus G-CSF, suggesting the need for novel mobilization regimens algorithms in this subgroup of patients.

Grassroots unionism in the context of economic crisis in Greece

This article draws on empirical evidence from a trade union in the centre of Athens to explore the impact of a politically active membership and its dialectical relationship with union renewal. The examined union is considered as an exemplar for the Greek accounts of unionism in the sense that it has achieved considerable collective bargaining gains and it has organized successful membership mobilization stories. It is argued in the analysis that the success of this union stems from a strategy of making rank-and-file activists the very fabric of union's organizing and mobilization activities. Further, trust issues between leaders, activists and ordinary members are significant in the increase of the likelihood of collective action.

Successful mobilization of peripheral blood stem cells in children with cancer using plerixafor (Mozobil&amp;trade;) and granulocyte-colony stimulating factor

This paper describes the successful mobilization of peripheral blood stem cells for autologous transplantation in three children with malignant diseases by using plerixafor (Mozobil™; Genzyme Corporation, Cambridge, MA) and granulocyte-colony stimulating factor (G-CSF) after failed previous mobilizations. A median sixfold increase in the number of circulating CD34+ cells after plerixafor treatment as compared with the baseline level was observed. An optimal CD34+ cell count for transplantation with one or two leukapheresis sessions was achieved. Mobilization using plerixafor was found to be safe with no adverse events. Therefore, the combination of G-CSF and plerixafor in children results in effective increases in peripheral CD34+ cell counts and reduces the risk of mobilization failure.