Second time a charm? Remobilization of peripheral blood stem cells with plerixafor in patients who previously mobilized poorly despite using plerixafor as a salvage agent. Issue 12 (22nd April 2013)

• Record Type: Journal Article
• Authors: Yuan, Shan; Nademanee, Auayporn; Krishnan, Amrita; Kogut, Neil; Shayani, Sepideh; Wang, Shirong
• Is Part Of: Transfusion. Volume 53:Issue 12(2013)
• Page Start: 3244
• Page End: 3250
• Publication Date: 2013-04-22
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.12198
• Languages: English
• ISSNs: 0041-1132

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="trf12198-sec-1001" sec-type="section"> <title>Background</title> <p>Plerixafor is a recently introduced agent used to improve peripheral blood stem cell (PBSC) mobilization in patients with hematologic malignancies. However, some patients still cannot mobilize adequately even with plerixafor.</p> </sec> <sec id="trf12198-sec-1002" sec-type="section"> <title>Study Design and Methods</title> <p>We retrospectively reviewed the PBSC collections of 18 consecutive lymphoma and multiple myeloma patients, who had previously mobilized poorly despite the use of plerixafor and received plerixafor again during remobilization.</p> </sec> <sec id="trf12198-sec-1003" sec-type="section"> <title>Results</title> <p>During the first mobilization attempt, all 18 recombinant granulocyte–colony‐stimulating factor (G‐CSF; two) or G‐CSF plus chemotherapy–mobilized patients (16) had poor response to plerixafor, with peripheral blood (PB) CD34+ counts ranging from 0 to 7.48 × 10<sup>6</sup>/L after the first dose. They collected only 0.15 × 10<sup>6</sup> to 1.63 × 10<sup>6</sup> (median, 0.40 × 10<sup>6</sup>) CD34+ cells/kg after one to four collections. The median average daily yield was 0.24 × 10<sup>6</sup> CD34+ cells/kg. Remobilization began 1 to 4 weeks later with G‐CSF, plerixafor, and with (three) or without (15) cyclophosphamide. The PB CD34+ cell counts after the first dose of plerixafor were 3.04 × 10<sup>6</sup> to 127.54 × 10<sup>6</sup>/L (median, 14.58 × 10<sup>6</sup>/L). After one to four doses of plerixafor, each patient collected an additional 0.39 × 10<sup>6</sup> to 14.02 × 10<sup>6</sup> (median, 1.89 × 10<sup>6</sup>) CD34+ cells/kg, and the median daily average was 0.78 × 10<sup>6</sup> CD34+ cells/kg. Cumulatively, after two rounds of collections, 15 collected more than 2.0 × 10<sup>6</sup> CD34+ cells/kg. Thirteen have proceeded to autologous stem cell transplantation (ASCT) and successfully engrafted.</p> </sec> <sec id="trf12198-sec-1004" sec-type="section"> <title>Conclusion</title> <p>In patients who had responded poorly to the use of plerixafor as a mobilization salvage agent, response to remobilization with plerixafor for the second time was variable, but most (83.3%) patients were able to collect enough PBSCs to proceed to ASCT.</p> </sec> </abstract>