title: Growth factor and patient-adapted use of plerixafor is superior to CY and growth factor for autologous hematopoietic stem cells mobilization.
abstract: The ideal method to mobilize autologous hematopoietic stem cells (AHSCs) in patients with lymphoma or multiple myeloma remains to be determined. The use of plerixafor, added to growth factor, may overcome the limitations to the use of growth factor mobilization without chemotherapy. We developed and validated a cost-based decision-making algorithm that uses the CD34+ cell count in the peripheral blood on the fourth day of G-CSF administration and the target CD34+ cell count for the specific patient to decide on the use of plerixafor (MUSC algorithm). We compared this approach (MA cohort) with a historical cohort of patients undergoing mobilization with CY 2000 mg/m(2) followed by G-CSF and GM-CSF (CY cohort). Fifty individuals are included in the MA cohort and 81 in the CY cohort. The mobilization failure rate was 2% in the MA cohort vs 22% in the CY cohort (P=0.01). Fewer patients in the MA cohort than in the CY cohort had infectious complications during mobilization requiring hospitalization (2 vs 30% P<0.01). There was significant shortening in the median number of days between starting mobilization and undergoing transplantation in the MA cohort (14 vs 43 days, P<0.01). In conclusion, growth factor and patient-adapted use of plerixafor provides safer hematopoietic stem cell mobilization and faster access to AHSC transplantation.
authors.affiliation: Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC 29425-6350, USA. costalj@musc.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Costa
authors.forename: A N
authors.initials: AN
authors.lastname: Miller
authors.forename: E T
authors.initials: ET
authors.lastname: Alexander
authors.forename: K R
authors.initials: KR
authors.lastname: Hogan
authors.forename: M
authors.initials: M
authors.lastname: Shabbir
authors.forename: C
authors.initials: C
authors.lastname: Schaub
authors.forename: R K
authors.initials: RK
authors.lastname: Stuart
mesh_terms: D000465:Algorithms; D019380:Anti-HIV Agents; D018952:Antigens, CD34 / Q000032:analysis; D001596:Benzylamines; D002452:Cell Count; D000080027:Cyclams; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage; D016298:Hematopoietic Cell Growth Factors / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects / Q000379:methods*; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods; D012189:Retrospective Studies; D014182:Transplantation, Autologous
chemical_list: D019380:Anti-HIV Agents; D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D016298:Hematopoietic Cell Growth Factors; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; C088327:plerixafor