Prophylactic peripheral blood stem cell collection in patients with extensive bone-marrow infiltration of neuroendocrine tumours prior to peptide receptor radionuclide therapy with 177Lu-DOTATATE

  • Peptide receptor radionuclide therapy (PRRT) of metastatic neuroendocrine tumors (NET) can be successfully repeated but may eventually be dose-limited. Since 177Lu-DOTATATE dose limitation may come from hematological rather than renal function, hematological peripheral blood stem cell backup might be desirable. Here, we report our initial experience of peripheral blood stem-cell collection (PBSC) in patients with treatment-related cytopenia and therefore high risk of bone-marrow failure. Five patients with diffuse bone-marrow infiltration of NET and relevant myelosuppression (≥grade 2) received PBSC before one PRRT cycle with 177Lu-DOTATATE (7.6 ± 0.8 GBq/cycle). Standard stem-cell mobilization with Granulocyte-colony stimulating factor (G-CSF) was applied, and successful PBSC was defined as a collection of >2 × 106/kg CD34+ cells. In case of initial failure, Plerixafor was administered in addition to G-CSF prior to apheresis. PBSC was successfully performed in all patients with no adverse events. Median cumulative activity was 44.8 GBq (range, 21.3–62.4). Three patients had been previously treated with PRRT, two of which needed the addition of Plerixafor for stem-cell mobilization. Only one of five patients required autologous peripheral blood stem-cell transplantation during the median follow up time of 28 months. PBSC collection seems to be feasible in NET with bone-marrow involvement and might be worth considering as a backup strategy prior to PRRT, in order to overcome dose-limiting bone-marrow toxicity.

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Author:Amir SabetORCiDGND, Nicolai Mader, Jörg Thomas Bittenbring, Fadi Khreish, Frank GrünwaldGND, Hans-Jürgen Biersack, Samer Ezziddin
Parent Title (English):Pharmaceuticals
Place of publication:Basel
Document Type:Article
Date of Publication (online):2021/10/05
Date of first Publication:2021/10/05
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/01/25
Tag:NET; PBSC; PRRT; hematotoxicity; neuroendocrine tumor; peptide receptor radionuclide therapy; peripheral blood stem cell collection
Issue:10, art. 1022
Page Number:7
First Page:1
Last Page:7
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0