title: Efficacy of pre-emptively used plerixafor in patients mobilizing poorly after chemomobilization: a single centre experience.
abstract: A significant proportion of patients with lymphoid malignancies are hard-to-mobilize with a combination of chemotherapy plus granulocyte colony-stimulating factor (G-CSF) (chemomobilization). Plerixafor is a novel drug used to improve mobilization of blood stem cells. However, it has been studied mainly in association with G-CSF mobilization. We evaluated the efficacy of 'pre-emptive' use of plerixafor after chemomobilization in patients who seem to mobilize poorly. During a 15 month period, altogether 63 patients with lymphoid malignancies were admitted to our department for blood stem cell collection. Sixteen patients (25%) received plerixafor after the first mobilization due to the low blood (B) CD34(+) cell counts (n = 12) or poor yield of the first collection (n = 4). The median number of plerixafor injections was 1 (1-3). The median B-CD34(+) count after the first plerixafor dose was 39 × 10(6) /L (<1-81) with the median increase of fivefold. Stem cell aphaereses were performed in 14/16 patients (88%) receiving plerixafor and a median of 2.9 × 10(6) /kg (1.6-6.1) CD34(+) cells were collected with a median of one aphaeresis (1-3). Altogether 13/16 patients mobilized with a combination of chemomobilization and plerixafor received high-dose therapy with stem cell support and all engrafted. Pre-emptive use of plerixafor after chemomobilization is efficient and safe and should be considered in poor mobilizers to avoid collection failure. In patients with low but rising B-CD34(+) counts, the use of plerixafor might be delayed as late mobilization may occur. Further studies are needed to optimize patient selection and timing of plerixafor.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland University of Eastern Finland/Institute of Clinical Medicine, Kuopio, Finland. esa.jantunen@kuh.fi
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Taru
authors.initials: T
authors.lastname: Kuittinen
authors.forename: Eija
authors.initials: E
authors.lastname: Mahlamäki
authors.forename: Marja
authors.initials: M
authors.lastname: Pyörälä
authors.forename: Pentti
authors.initials: P
authors.lastname: Mäntymaa
authors.forename: Tapio
authors.initials: T
authors.lastname: Nousiainen
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D000069585:Filgrastim; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006571:Heterocyclic Compounds / Q000627:therapeutic use*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy; D011092:Polyethylene Glycols; D019718:Receptors, CXCR4 / Q000037:antagonists & inhibitors; D011994:Recombinant Proteins; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D019718:Receptors, CXCR4; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim; C088327:plerixafor