CLINICAL APPLICATIONS OF CYTOKINES AND GROWTH FACTORS CLINICAL APPLICATIONS OF CYTOKINES AND GROWTH FACT ORS edited by JOHN R. WINGARD University of Florida College of Medicine, USA and GEORGE D. DEMETRI Dana Farber Cancer Institute, Harvard Medical School, USA ~. " Library of Congress Cataloging-in-Publication Data Clinical applications of cytokines and growth factors / edited by John R. Wingard and George D. Demetri. p. cm. -- (Developments in oncology ; 80) Includes index. ISBN 978-1-4613-7277-6 ISBN 978-1-4615-5013-6 (eBook) DOI 10.1007/978-1-4615-5013-6 1. Blood--Diseases--Immunotherapy. 2. Hematopoietic growth factors--Therapeutic use. 3. Growth factors--Therapeutic use. 1. Wingard, John R., 1947- . II. Demetri, George D., 1956- III. Series. [DNLM: 1. Cytokines--pharmacology. 2. Cytokines--therapeutic use. 3. Growth Substances--pharmacology. 4. Growth Substances- -therapeutic use. Wl DE998N v.80 1999] RC636.C54 1999 616.07'9--dc21 DNLMlDLC for Library of Congress 99-22740 CIP Copyright © 1999 by Springer Science+Business Media New York OriginalIy published by Kluwer Academic Publishers in 1999 Softcover reprint of the hardcover 1s t edition 1999 AII rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photo copying, recording, or otherwise, without the prior written permission of the publisher, Springer Science+Business Media, LLC. Printed on acid-free paper. TABLE OF CONTENTS List of Contributors ................................................ viii Introduetion ....................................................... xi I. Biology of Hematopoietic and Lymphopoietic Cytokines 1. Cytokines, Growth Faetors, and Hematopoiesis G. BAGBY and M. HEINRICH ................................ 2 2. The Interaetion of Cytokines with Stern Cell and Stromal Cell Physiology P. SIMMONS, D.N. HA YLOCK, J-P LEVESQUE, and A.C.W. ZANNETTINO ...................................... 56 3. The Interaetion ofCytokines with T-eell and Natural Killer Cell Physiology R.A. CARTER and E.K. WALLER ............................ 74 4. Improving on Nature by Re-Engineering Hematopoietie Growth Faetors Y.FENG and 1 MCKEARN ................................... 90 11. Management of Neutropenia and Neutropenie Fever 5. The Influenee ofColony Stimulating Faetors on Neutrophil Produetion, Distribution, and Funetion 1M. GA VIRIA, W.c. LlLES, and D.C. DALE ................... 118 6. Evidenee-Based Use ofHematopoietie Cytokines in Clinieal Oneology G.D. DEMETRI ........................................... 137 7. Eeonomie, Publie Health, and Poliey Implieations of Hematopoietie Growth Faetors, High-Dose Chemotherapy, and Stern Cell Reseue C.L. BENNETT and T.1 STINSON ........................... 150 8. Outpatient Management ofNeutropenie Fever: Antibioties, Growth Faetors or Both? E.B. RUBINSTEIN, L.S. ELTING, C.C. SUN, and K.V.1. ROLSTON .......................................... 159 9. The Use ofHematopoietie Growth Faetors for Recruitment of Leukoeytes for Transfusion D.B. JENDIROBA, B. LICHTIGER, and E. J FREIREICH ......... 178 111. Management of Anemia 10. Pathophysiology ofthe Anemia ofMalignancy I.W. ADAMSON ......................................... 187 11. The Use ofRecombinant Erythropoietin in the Treatment and Prevention of Cancer and Chemotherapy Related Anemia J. L. SPIVAK ............................................ 198 IV Management of Thrombocytopenia 12. Regulation ofHuman Megakaryocytopoiesis R. HOFFMAN and M.W. LONG ............................. 218 13. The Effects of Multilineage Cytokines on Platelet Recovery R. VII and J. DIPERSIO .................................... 237 14. Clinical Studies ofThrombopoietin R. BASSER .............................................. 269 V. The Rofe of Cytokines to Enhance Cancer Chemotherapy 15. Dose Intensification in Solid Tumor Chemotherapy H. V AN DEVENTER and T. SHEA .......................... 279 16. Conventional and High Dose Chemotherapy for Lymphomas K.W. V AN BESIEN ....................................... 300 17. Hematopoietic Growth Factors in Acute Leukemia R. STONE ......................................... , ..... 313 VI. Management of Marrow Failure States 18. Cytokines for the Treatment of Myelodysplastic Syndromes and Other Bone Marrow Failure States R. S. NEGRIN ........................................... 326 VII The Use of Cytokines in Blood and Marrow Transplantation 19. Stern Cell Collection for Hematopoietic Transplantation: Stern Cell Sources, Mobilization Strategies, and Factors that Influence Yield lR. WINGARD and F.M. WEEKS ........................... 341 20. Mechanisms ofGrowth Factor Mobilization ofHematopoietic Progenitors D. LINK ................................................. 357 vi 21. The Use ofCytokines to Enhance Collection ofStem Cells for Marrow and Blood Transplantation S. ROMAN-UNFER and E.J. SHPALL ........................ 369 22. The Use of Cytokines During Blood and Marrow Transplantation J. NEMUNAITIS ......................................... 381 Index .......................................................... 403 vii List of Contributors JOHN w. ADAMSON, M.D., Director of Research, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10021 GROVER BAGBY, M.D., Professor of Medicine and Molecular Medical Genetics, Director, Oregon Cancer Center, Oregon Health Sciences University, Portland, OR 97201 RUSSELL BASSER, MBBS., Centre for Developmental Cancer Therapeutics, Royal Melboume Hospital, Victoria, Australia, 3050 CHARLES L. BENNETT, M.D., Ph.D., Associate Professor, Northwestem University, VA Chicago Health Care Systems, Lakeside Division, Medical Science Building, Chicago, IL 60611 RICHARD A. CARTER, M.D., Assistant Professor of Medicine, Emory University School ofMedicine, Atlanta, GA 30322 DAVID C. DALE, M.D., Professor ofMedicine, Department ofMedicine, University of Washington, Seattle, W A 98195 GEORGE D. DEMETRI, M.D., Assistant Professor ofMedicine, Department of Adult Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115 JOHN DIPERSIO, M.D., Professor of Medicine, Pathology, and Pediatrics, Chief, Division ofBMT and Stern Cell Biology, Washington University School ofMedicine, St. Louis, MO 63110 LINDA S. ELTING, Dr.P.H., Associate Professor ofEpidemiology, MD Anderson Cancer Center, Houston, TX 77030 YIQING FEN, Ph.D., Senior Research Investigator, SEARLE/A Monsanto Company, st. Louis, MO 63198 EMIL J FREIREICH, M.D., D.Sc. (Hon), Professor ofMedicine, University ofTexas MD Anderson Cancer Center, Houston, TX 77030 J. MILTON GAVIRIA, M.D., Senior Fellow, Division of Infectious Disease, Department ofMedicine, University ofWashington, Seattle, WA 98195 DAV ID N. HA YLOCK, B.App.Sci.,Hanson Centre for Cancer Research, Division of Haematology, Institute of Medical and Veterinary Science, Adelaide, Australia, SA5000 MICHAEL HEINRICH, M.D., Associate Professor of Medicine, Oregon Health Sciences University, Portland, OR 97201 RONALD HOFFMAN, M.D., Eileen Heidrick Professor of Oncology, Chief, Hematology/Oncology Section, Molecular Biology Research Laboratory, University of Illinois College of Medicine, Chicago, IL 60607 DA VID B. JENDIROBA, M.D., Graduate Research Assistant, University of Texas MD Anderson Cancer Center, Houston, TX 77030 JEAN-PIERRE LEVESQUE, PH.D, Hanson Centre for Cancer Research, Division of Haematology, Institute of Medical and Veterinary Science, Adelaide, Australia, SA5000 BENJAMIN LICHTIGER, M.D., Ph.D., Professor ofMedicine, University ofTexas MD Anderson Cancer Center, Houston, TX 77030 W. CONRAD LILES, M.D., Ph.D., Assistant Professor, Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195 DANIEL LINK, M.D., Assistant Professor, Washington University School of Medicine, St. Louis, MO 53110 MICHAEL W. LONG, M.D., Associate Professor, Pediatric Hematology/Oncology Section, University ofMichigan School ofMedicine, Ann Arbor, MI JOHN MCKEARN, Ph.D., Executive Director ofDiscovery Research, SEARLE/A Monsanto Company, St. Louis, MO 63198 ROBERT S. NEGRIN, M.D., Associate Professor ofMedicine, Stanford University Hospital, Stanford, CA 94305 JOHN NEMUNAITIS, M.D., Regional Director, PRN Research, Inc.; Director, TOPA Research, Physician Reliance Network, Dallas, TX 75246 KENNETH V.I. ROLSTON, M.D., Professor of Medicine, MD Anderson Cancer Center, Houston, TX 77030 SUSAN ROMAN-UNFER, M.D., Bone Marrow Transplant Fellow, University of Colorado Health Science Center, Bone Marrow Transplant Program, Denver, CO 80262 EDWARD B. RUBENSTEIN, M.D., Associate Professor, University of Texas MD Anderson Cancer Center, Houston, TX 77030 ix THOMAS SHEA, M.D., Professor ofMedicine, Department ofMedicine, Division of Hematology/Oncology, University ofNorth Carolina, Chapel Hill, NC 27599 ELIZABETH J. SHPALL, M.D., Professor ofMedicine, University ofColorado Health Science Center Bone Marrow Transplant Program, Denver, CO 80262 PAUL SIMMONS, M.D., Matthew Roberts Laboratory, Division of Hematology, Hanson Centre for Cancer Research, Adelaide, Australia, SA5000. JERRY L. SPIV AK, M.D., Professor of Medicine and Oncology, Johns Hopkins University School ofMedicine, Baltimore, MD 21205 TAMMY 1. STINSON, M.S., Research Analyst, VA Chicago Health-Care Systems, Lakeside Division, Medical Science Building, Chicago, IL 60611 RICHARD STONE, M.D., Associate Professor of Medicine, Harvard University, Dana Farber Cancer Institute, Boston, MA 02114 CHARLOTIE C. SUN, M.P.H., Graduate Research Assistant, University ofTexas MD Anderson Cancer Center, Houston, TX 77030 KOEN B. VA N BESIEN, M.D., Associate Professor ofMedicine, Director, Stern Cell Transplantation, University ofIllinois-Chicago, Chicago, IL 60612 HENRIK VA N DEVENTER, M.D., Research Fellow, Department of Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hili, NC 27599 RA VI VIJ, M.D., Fellow, Division ofBone Marrow Transplantation and Stern Cell Biology, Washington University School ofMedicine, st. Louis, MO 63110 EDMUND K. WALLER, M.D., Ph.D., Assistant Professor of Medicine, Emory University School ofMedicine, Atlanta, GA 30322 FREDERICK M. WEEKS, M.D., Assistant Professor of Medicine, Division of Hematology/Oncology, University ofFlorida College ofMedicine, Shands Hospital, Gainesville, FL 32610 JOHN R. WINGARD, M.D., Professor of Medicine, Director, Bone Marrow Transplant Program, Division ofHematology/Oncology, University ofFlorida College ofMedicine, Shands Hospital, Gainesville, FL 32610 ANDREW C.W. ZANETTINO, Ph.D., Hanson Centre for Cancer Research, Division of Haematology, Institute of Medical and Veterinary Science, Adelaide, Australia, SA5000 x Introduction The hematopoietic system plays roles that are crucial for survival of the host: delivery of oxygen to tissues, arrest of accidental blood leaking from blood vessels, and fending off of invading microbes by humoral, cell-mediated, and phagocytic immunity. The activity of the hematopoietic system is staggering: daily, a normal adult produces approximately 2.5 billion erythrocytes, 2.5 billion platelets, and 1 billion granulocytes per kilogram of body weight. This production is adjusted in a timely fashion to changes in actual needs and can vary from nearly none to many times the normal rate depending on needs which vary from day to day, or even minute to minute. In response to a variety of stimuli, the cellular components of the blood are promptly increased or decreased in production to maintain appropriate numbers to optimally protect the host from hypoxia, infection, and hemorrhage. How does this all happen and happen without over or under responding? There has been extraordinary growth in our understanding ofhematopoiesis over the last two decades. Occupying center stage is the pluripotent stern cell and its progeny. Hematopoietic stern cells have been characterized by their capacity for self renewal and their ability to proliferate and differentiate along multiple lineages. Few in number, the stern cell gives rise to all circulating neutrophils, erythrocytes, lymphoid cells, and platelets. In hematopoietic transplantation, the stern cell is capable of restoring long-term hematopoiesis in a lethally irradiated host. Expansion of the numbers of progeny of stern cells provides the host with an enormous capacity for hematopoietic homeostasis. As important as stern cells are, however, it is now recognized that it is only through very complex interactions with other cells in the stromal microenvironment, physical contact with matrix proteins in the bone marrow, and exposure to soluble proteins which have growth stimulatory and growth inhibitory properties, such as hematopoietic growth factors and various adhesion molecules, that stern cells can do their jobs. Thus, these "supporting actors" are every bit as important as stern cells in the regulation ofhematopoiesis. The growth factors, their actions, and their clinical roles, are the subject of this volume. Hematopoietic growth factors are a family of glycoproteins that regulate proliferation, differentiation, and function of hematopoietic cells. The specific function ofthese molecules are complex and redundant. Their activity may be lineage specific or affect cells of multiple lineages. These moleeules are synthesized by lymphocytes, monocytes, stromal cells, and a host of other cell types as weIl. The identification and isolation of their genes has led to mass production of recombinant hematopoietic growth factor molecules. The availability of these molecules, in turn, have made possible in vitro studies on progenitor cell proliferation and function to achieve better understanding of hematopoiesis and, subsequently, clinical trials. Today, several growth factors are available to the clinician as treatments for various pathologicpertubations of hematopoiesis. Their use has also advanced our capacity to safely deliver cancer chemotherapy. Hematopoietic growth factors have become an everyday tool for the practicing oncologist. In this volume, recognized experts review the biological interactions between