Plerixafor and granulocyte-colony-stimulating factor (G-CSF) in patients with lymphoma and multiple myeloma previously failing mobilization with G-CSF with or without chemotherapy for autologous hematopoietic stem cell mobilization: the Austrian experience on a named patient program.
BACKGROUND
Plerixafor in combination with granulocyte-colony-stimulating factor (G-CSF) has been shown to enhance stem cell mobilization in patients with multiple myeloma, non-Hodgkin's lymphoma, and Hodgkin's disease who demonstrated with previous mobilization failure. In this named patient program we report the Austrian experience in insufficiently mobilizing patients.


METHODS
Twenty-seven patients from eight Austrian centers with a median (range) age of 58 (19-70) years (18 female, nine male) were included in the study. Plerixafor was limited to patients with previous stem cell mobilization failure and was given in the evening of Day 4 of G-CSF application.


RESULTS
A median increase of circulating CD34+ cells within 10 to 11 hours from administration of plerixafor by a factor of 4.7 over baseline was noted. Overall, 20 (74%) patients reached more than 10 × 10(6) CD34+ cells/L in the peripheral blood, resulting in 17 (63%) patients collecting at least 2 × 10(6) CD34+ cells/kg body weight (b.w.; median, 2.6 × 10(6) CD34+ cells/kg b.w.; range, 0.08 × 10(6) -8.07 × 10(6) ). Adverse events of plerixafor were mild to moderate and consisted of gastrointestinal side effects and local reactions at the injection site. Thirteen (48%) patients underwent autologous transplantation receiving a median of 2.93 × 10(6) CD34+ cells/kg (range, 1.46 × 10(6) -5.6 × 10(6) ) and showed a trilinear engraftment with a median neutrophil recovery on Day 12 and a platelet recovery on Day 14.


CONCLUSIONS
Our study confirms previous investigations showing that plerixafor in combination with G-CSF is an effective and well-tolerated mobilization regimen with the potential of successful stem cell collection in patients with previous mobilization failure.
Worel
Nina
N
Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria. nina.worel@meduniwien.ac.at
Rosskopf
Konrad
K
Neumeister
Peter
P
Kasparu
Hedwig
H
Nachbaur
David
D
Russ
Gudrun
G
Namberger
Konrad
K
Witt
Volker
V
Schloegl
Ernst
E
Zojer
Niklas
N
Linkesch
Werner
W
Kalhs
Peter
P
Greinix
Hildegard T
HT
D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D001317:Austria; D001596:Benzylamines; D003131:Combined Modality Therapy; D000080027:Cyclams; D004359:Drug Therapy, Combination; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000378:metabolism; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007937:Leukapheresis; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy*; D019718:Receptors, CXCR4 / Q000037:antagonists & inhibitors; D014182:Transplantation, Autologous; D055815:Young Adult
D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D007074:Immunoglobulin G; D019718:Receptors, CXCR4; C051713:antineoplastic agent K 18; D016179:Granulocyte Colony-Stimulating Factor; D008558:Melphalan; C088327:plerixafor