***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT AMD-3100 , a bicyclam , is a novel agent that uniquely inhibits the entry of human immunodeficiency virus type 1 ( HIV-1 ) into CD4 + T cells via selective blockade of the chemokine CXCR-4 receptor . Twelve healthy volunteers were given AMD-3100 as a single 15-min intravenous infusion at 10 , 20 , 40 , or 80 μg/kg . Five subjects also received a single subcutaneous injection of AMD-3100 ( 40 or 80 μg/kg ) . Three subjects received two escalating oral doses each ( 80 and 160 μg/kg ) . All subjects tolerated their dose(s ) well without any grade 2 toxicity or dose adjustment . Six subjects experienced mild , transient symptoms , primarily gastrointestinal in nature and not dose related . All subjects experienced a dose-related elevation of the white blood cell count , from 1.5 to 3.1 times the baseline , which returned to the baseline 24 h after dosing . AMD-3100 demonstrated dose proportionality for the maximum drug concentration in serum ( Cmax ) and the area under the concentration-time curve from 0 h to ∞ ( AUC0–∞ ) over the entire dose range . At the highest intravenous dose ( 80 μg/kg ) , the medianCmax was 515 ( range , 470 to 521 ) ng/ml and the AUC0–∞ was 1,044 ( range , 980 to 1,403 ) ng-h/ml . The median systemic absorption after subcutaneous dosing was 87 % ( range , 67 to 106 % ) . No drug was detectable in the blood following oral dosing . Using a two-compartment model , the median pharmacokinetic parameter estimates ( ranges ) were as follows : volume of distribution , 0.34 ( 0.27 to 0.36 ) liter/kg ; clearance , 1.30 ( 0.97 to 1.34 ) liters/h ; elimination half-life , 3.6 ( 3.5 to 4.9 ) h. After a single , well-tolerated intravenous dose of AMD-3100 , concentrations were sustained for 12 h above the in vitro antiretroviral 90 % inhibitory concentrations and for 8 h above antiviral concentrations identified in the SCID-hu Thy/Liv mouse model of HIV infection PURPOSE The purpose of this study was to compare the effects of filgrastim , sargramostim , or sequential sargramostim and filgrastim on CD34(+ ) cell yields and morbidity after myelosuppressive mobilization chemotherapy ( MC ) . PATIENTS AND METHODS One hundred fifty-six patients were r and omized to receive filgrastim ( n = 51 ) , sargramostim ( n = 52 ) , or sargramostim for 5 days followed by filgrastim ( n = 53 ) after MC with either cyclophosphamide and etoposide ( n = 75 ) or paclitaxel and cyclophosphamide ( n = 81 ) . RESULTS Compared with those who received sargramostim , patients who received filgrastim had faster recovery of an absolute neutrophil count of 0.5 x 10(9)/L or greater ( a median of 11 v 14 days ; P = . 0001 ) , with fewer patients requiring RBC transfusions ( P = .008 ) , fewer patients with fever ( 18 % v 52 % ; P = 0.001 ) , fewer hospital admissions ( 20 % v 42 % ; P = .013 ) , and less intravenous antibiotic therapy ( 24 % v 69 % ; P = .001 ) . Patients who received filgrastim yielded more CD34(+ ) cells ( median , 7.1 v 2.0 x 10(6)/kg/apheresis ; P = .0001 ) , and a higher fraction achieved 2.5 x 10(6 ) ( 94 % v 78 % ; P = .021 ) and 5 x 10(6 ) ( 88 % v 53 % ; P = .001 ) or more CD34(+ ) cells/kg with fewer aphereses ( median , 2 v 3 ; P = .002 ) and fewer days of growth-factor treatment ( median , 12 v 14 ; P = .0001 ) . There were no major differences in outcomes between the filgrastim alone and the sequential regimens . After high-dose chemotherapy , patients who had peripheral-blood stem cells ( PBSCs ) mobilized with filgrastim or the sequential regimen received higher numbers of CD34(+ ) cells and had faster platelet recovery ( P = .015 ) , with fewer patients ( P = .014 ) receiving fewer platelet transfusions ( P = .001 ) than patients receiving sargramostim-mobilized PBSCs . CONCLUSION It was concluded that filgrastim alone or sequential sargramostim and filgrastim were superior to sargramostim alone for the mobilization of CD34(+ ) cells and reduction of toxicities after MC Summary : We performed a r and omized study to compare ‘ G-CSF alone ’ ( administered at dose of 10 mcg/kg/day ) and ‘ cyclophosphamide plus G-CSF ’ ( cyclophosphamide at dose of 4 g/m2 and G-CSF at dose of 10 μg/kg/day ) , as PBPC mobilization schedules in 52 patients with NHL or HD . R and omization was stratified according to the amount of previous chemotherapy ( ⩽2 and > 2 lines of previous chemotherapy ) . Mean CD34 + cell peak in P.B. , mean ‘ Total CD34 + cells ’ harvested and percentage of patients successfully mobilized , in the group mobilized with ‘ G-CSF alone ’ vs the group mobilized with ‘ cyclophosphamide plus G-CSF ’ , were : 35.3 × 106 vs 45.8 × 106/l ( P=0.3 ) , 5.4 × 106 vs 6.8 × 106/kg ( P>0.9 ) and 50 vs 61 % ( P=0.4 ) . No differences were observed in the stratum of less pretreated patients . However , in the stratum of patients who had previously received more than two lines of  chemotherapy , CD34+cell peak ( P=0.05 ) and percentage of successful mobilization ( P=0.01 ) were higher when ‘ cyclophosphamide plus G-CSF ’ was used . Using logistic regression , both age and mobilization with ‘ G-CSF alone ’ were significantly associated with a low CD34 + cell peak in P.B. However , in the stratum of less pretreated patients , only age was significantly associated with this risk While initial therapies have become highly effective with introduction of lenalidomide and bortezomib and patients may opt for delayed stem cell transplantation , it is important to collect stem cells for future transplant . Given its increasing use as initial therapy , we examined if lenalidomide had any impact on the ability to collect peripheral blood stem cells ( PBSC ) . We studied the entire cohort of patients with myeloma undergoing PBSC mobilization at our institution during a 5-year period , comparing the results between patients receiving different initial therapies . Among those mobilized with granulocyte-colony stimulating factor ( G-CSF ) alone , there was a significant decrease in total CD34 + cells collected ( P<0.001 ) , average daily collection ( P<0.001 ) , day 1 collection ( P<0.001 ) and increased number of aphereses ( P=0.004 ) in patients treated with lenalidomide compared to those receiving dexamethasone , thalidomide-dexamethasone or VAD . A similar trend was seen in those mobilized with chemotherapy and G-CSF . A trend was seen towards decreased PBSC yield with increasing duration of lenalidomide therapy as well as increasing age ( P=0.002 ) . There was no effect on quality of PBSC collected based on similar engraftment across all groups . We recommend collection of PBSC within 6 months of initiation of therapy with lenalidomide containing regimens to minimize the risk of mobilization failures We investigated the efficacy and toxicity of combining granulocyte-colony stimulating factor ( G-CSF ) at st and ard doses with plerixafor , a CXCR4 inhibitor , to mobilize stem cells in patients with non-Hodgkin 's lymphoma ( NHL ) and multiple myeloma ( MM ) . Patients with NHL and MM underwent mobilization with G-CSF ( 10 microg/kg/day ) for up to 9 days and plerixafor ( 240 microg/kg/day ) , which started on the evening of day 4 . Apheresis began on day 5 and continued daily until either > or= 5 x 10(6 ) CD34/kg were collected or to a maximum of 5 aphereses . Toxicities , increase in circulating CD34 cells/microL before and after the first dose of plerixafor , percentage of patients collecting > or= 5 x 10(6 ) CD34/kg , total CD34 cells/kg collected , engraftment , and exploratory efficacy analyses in heavily pretreated patients were examined . Six sites enrolled 49 patients ( NHL , 23 ; MM , 26 ) . All completed mobilization and 47 of 49 ( 96 % ) underwent transplant . Circulating CD34 cells/microL increased by 2.5-fold ( 1.3 - 6.0-fold ) after the first plerixafor dose . The median CD34 cells/kg collected was 5.9 x 10(6 ) ( 1.5 - 22.5 ) in 2 ( 1 - 5 ) days of aphereses . Median days to neutrophil and platelet engraftment were 11 ( 8 - 16 ) and 14.5 ( 7 - 39 ) days , respectively . Adverse events primarily were mild nausea and diarrhea ( n=24 ) . Twenty-eight ( 57 % ) were identified as heavily pretreated patients . Their median fold increase in circulating CD34 cells/microL was 2.5 ( 1.4 - 5.0 ) after plerixafor , similar to minimally pretreated patients .  Plerixafor and G-CSF increased circulating CD34 cells/microL and led to the adequate collection of stem cells for autotransplant in 96 % of the patients . This combination may have particular value in heavily pretreated patients BACKGROUND High-dose chemotherapy followed by autologous bone marrow transplantation is a therapeutic option for patients with chemotherapy-sensitive non-Hodgkin 's lymphoma who have relapses . In this report we describe a prospect i ve r and omized study of such treatment . METHOD A total of 215 patients with relapses of non-Hodgkin 's lymphoma were treated between July 1987 and June 1994 . All patients received two courses of conventional chemotherapy . The 109 patients who had a response to chemotherapy were r and omly assigned to receive four courses of chemotherapy plus radiotherapy ( 54 patients ) or radiotherapy plus intensive chemotherapy and autologous bone marrow transplantation ( 55 patients ) . RESULTS The overall rate of response to conventional chemotherapy was 58 percent ; among patients with relapses after chemotherapy , the response rate was 64 percent , and among those with relapses during chemotherapy , the response rate was 21 percent . There were three deaths from toxic effects among the patients in the transplantation group , and none among those in the group receiving chemotherapy without transplantation . The two groups did not differ in terms of prognostic factors . The median follow-up time was 63 months . The response rate was 84 percent after bone marrow transplantation and 44 percent after chemotherapy without transplantation . At five years , the rate of event-free survival was 46 percent in the transplantation group and 12 percent in the group receiving chemotherapy without transplantation ( P = 0.001 ) , and the rate of overall survival was 53 and 32 percent , respectively ( P = 0.038 ) . CONCLUSIONS As compared with conventional chemotherapy , treatment with high-dose chemotherapy and autologous bone marrow transplantation increases event-free and overall survival in patients with chemotherapy-sensitive non-Hodgkin 's lymphoma in relapse We assessed the mobilization capacity of taxol with rhG-CSF , both as a single chemotherapeutic agent and in the presence of cyclophosphamide ( CY ) , and compared the effect with yields achieved when mobilization was performed solely with rhG-CSF . Fifteen patients with breast cancer received taxol 170 mg/m2 ( continuous infusion , day 1 ) and rhG-CSF ( 8 μg/kg/day , from day 2 until the end of apheresis ) ( T-G group ) , while seven breast cancer patients were additionally treated with CY ( 4 g/m2 ) on day 2 , followed by rhG-CSF starting at similar doses on day 3 ( T-CY-G group ) . The PBSC collection s after taxol with/without CY were compared with those of 30 breast cancer patients who had received rhG-CSF ( 8 μg/kg/day ) for mobilization . No differences were found in the characteristics of patients included in any of the three mobilization groups . The median yield of CD34 + cells from all patients included in taxol containing sched 
    Output:
    
Currently , chemotherapy or plerixafor in combination with G-CSF is a reasonable option in heavily pretreated and hard-to-mobilize patients with non-Hodgkin 's lymphoma and multiple myeloma