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Motllo C.,Autonomous University of Barcelona | Sancho J.-M.,Autonomous University of Barcelona | Grifols J.-R.,Banc de Sang I Teixits | Junca J.,Autonomous University of Barcelona | And 11 more authors.
Cytotherapy | Year: 2014

Background aims: The increasing scarcity of young related donors has led to the use of older donors for related allogeneic hematopoietic stem cell transplantation (HSCT). This study analyzed the influence of age on the results of mobilization of peripheral blood stem cells (PBSCs) in healthy donors as well as on the engraftment and outcome of HSCT. Methods: A retrospective analysis from a single center was performed comparing the results of PBSC mobilization from related healthy donors according to their age. Results: The study included 133 consecutive related donors. The median age was 50 years (range, 4-77 years); 70 (53%) donors were males, and 44 (33%) were >55 years old. All donors were mobilized with granulocyte colony-stimulating factor for 5 days. The peak CD34+ cell count in peripheral blood was higher in younger than in older donors (median, 90.5 CD34+ cells/μL [range, 18-240 CD34+ cells/μL] versus 72 CD34+ cells/μL [range, 20-172.5 CD34+ cells/μL], P= 0.008). The volume processed was lower in younger than in older donors (16,131 mL [range, 4424-36,906 mL] versus 18,653 mL [range, 10,003-26,261 mL], P= 0.002) with similar CD34+ cells collected (579.3× 106 cells [range, 135.14× 106-1557.24× 106 cells] versus 513.69× 106 cells [range, 149.81× 106-1290× 106 cells], P= 0.844). There were no differences in time to recovery of neutrophils and platelets or in the incidences of acute and chronic graft-versus-host disease, overall survival, non-relapse mortality and relapse incidence. Conclusions: Donors >55 years old mobilized fewer CD34+ cells and required a greater volume to collect a similar number of CD34+ cells. The outcome of HSCT was not influenced by donor age. Donor age should not be a limitation for related allogeneic HSCT. © 2014 International Society for Cellular Therapy.

Vives S.,ICO Hospital Germans Trias i Pujol | Vives S.,University of Barcelona | Oriol A.,ICO Hospital Germans Trias i Pujol | Oriol A.,University of Barcelona | And 8 more authors.
European Journal of Haematology | Year: 2015

Objectives: A multicentre prospective non-randomised study of de novo acute myeloid leukaemia (AML) in patients aged ≥70 yr was designed to reduce toxicity and achieve acceptable complete remission (CR) rates. Methods: The outpatient treatment included induction with oral fludarabine, subcutaneous cytarabine and subcutaneous filgrastim (FAG). The patients received more induction cycles according to the response achieved. If there was no response to induction with FAG, the following induction cycle included oral idarubicin, subcutaneous cytarabine and subcutaneous filgrastim (IAG). Patients achieving CR received one intensification (FAG on response to previous FAG or alternatively IAG) and one consolidation cycle (IAG). Results: Thirty patients were enrolled from April 2004 to June 2007. The median age was 73 yr (range 70-77). Fifteen patients (50%) achieved CR. The 2-yr DFS was 29% (95% CI, 5-47%), and the 2-yr OS was 23% (95% CI, 12-35%). Twenty-five of 69 cycles (36%) were managed on a completely outpatient basis. The median hospital stay per cycle was 10 d (95% CI, 3-25). Conclusions: This study demonstrates the tolerability and efficacy of a semi-intensive treatment in elderly de novo patients with AML managed on an outpatient basis, without substantial toxicity. © 2015 John Wiley & Sons A/S.

Gil-Gil M.J.,Institute Catala dOncologia ICO | Martinez-Garcia M.,Parc de Salut Mar Hospital del Mar | Sierra A.,Bellvitge Biomedical Research Institute | Conesa G.,Parc de Salut Hospital del Mar | And 3 more authors.
Clinical and Translational Oncology | Year: 2014

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation. © 2013 Federación de Sociedades Españolas de Oncología (FESEO).

Guerrero A.,Instituto Valenciano Of Oncologia | Servitja S.,Hospital Del Mar | Rodriguez-Lescure A.,Hospital General Universitario Of Elche | Calvo L.,Complejo Hospitalario Universitario Juan Canalejo | And 6 more authors.
Anti-Cancer Drugs | Year: 2011

The objective of this phase I/II study was to establish the recommended dose of biweekly vinorelbine and oxaliplatin in patients with metastatic breast cancer and to evaluate the efficacy and safety profile of this schedule as first-line treatment. Four different dose levels of vinorelbine and oxaliplatin were selected for the phase I study: (i) 25 and 80 mg/m2; (ii) 25 and 90 mg/m2; (iii) 25 and 100 mg/m2; and (iv) 30 and 90 mg/m2; respectively. At least three patients were treated at each dose level. Overall, 12 patients were included in the phase I trial. No dose-limiting toxicities occurred at any dose level. Therefore, the fourth dose level (30 mg/m of vinorelbine and 90 mg/m2 of oxaliplatin) every 2 weeks was selected for the phase II trial. In this part, 44 patients were included and 61% completed the eight 2-week cycles of study treatment. On an intention-to-treat basis, overall response rate was 59%, and median progression-free survival and overall survival were 9.2 months (95% confidence interval: 7.6-10.9) and 18.6 months (95% confidence interval: 14.4-22.9), respectively. The main severe toxicities were neutropenia (46%) and fatigue (14%). We conclude that the biweekly combination of vinorelbine and oxaliplatin at doses of 30 mg/m and 90 mg/m2, respectively, is highly active and well tolerated as first-line treatment for patients with metastatic breast cancer. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sancho J.-M.,Autonomous University of Barcelona | Morgades M.,Autonomous University of Barcelona | Grifols J.-R.,Banc de Sang I Teixits | Junca J.,Autonomous University of Barcelona | And 9 more authors.
Cytotherapy | Year: 2012

Background aims. Failure in mobilization of peripheral blood (PB) stem cells is a frequent reason for not performing hematopoietic stem cell transplantation (HSCT). Early identification of poor mobilizers could avoid repeated attempts at mobilization, with the administration of pre-emptive rescue mobilization. Methods. Data from the first mobilization schedule of 397 patients referred consecutively for autologous HSCT between 2000 and 2010 were collected. Poor mobilization was defined as the collection of < 2 × 106 CD34+cells/kg body weight (BW). Results. The median age was 53 years (range 4-70) and 228 (57%) were males. Diagnoses were multiple myeloma in 133 cases, non-Hodgkin's lymphoma in 114, acute myeloid leukemia or myelodysplastic syndrome in 81, Hodgkin's lymphoma in 42, solid tumors in 17 and acute lymphoblastic leukemia in 10. The mobilization regimen consisted of recombinant human granulocytecolony-stimulating factor (G-CSF) in 346 patients (87%) and chemotherapy followed by G-CSF (C G-CSF) in 51 (13%). Poor mobilization occurred in 105 patients (29%), without differences according to mobilization schedule. Diagnosis, previous therapy with purine analogs and three or more previous chemotherapy lines were predictive factors for poor mobilization. A CD34+cell count in PB > 13.8/μL was enough to ensure ≥ 2 × 106 CD34+cells/kg, with high sensitivity (90%) and specificity (91%). Conclusions. The prevalence of poor mobilization was high, being associated with disease type, therapy with purine analogs and multiple chemotherapy regimens. The threshold of CD34+ cell count in PB identified poor mobilizers, in whom the administration of immediate or pre-emptive plerixafor could be useful to avoid a second mobilization. © 2012 Informa Healthcare.

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