title: A risk-based approach to optimize autologous hematopoietic stem cell (HSC) collection with the use of plerixafor.
abstract: Autologous hematopoietic stem cell (HSC) transplant is an effective treatment for patients with hematological malignancies. Unfortunately, 15-30% of patients fail to mobilize a sufficient number of HSCs for the transplant. Plerixafor is now used as a salvage mobilization regimen, with good success. We describe here a risk-based approach for the use of plerixafor, based on the circulating CD34(+) cell count and the CD34(+) cell dose collected after 4 days of G-CSF, that identifies potential poor HSC mobilizers upfront. A total of 159 patients underwent HSC collections using this approach. Of these, 55 (35%) were identified as high risk owing to low CD34(+) cell number or low yield on day 1 of collection, and received plerixafor on the subsequent days of collection. Of the 159 patients, 151 (95%) were able to provide adequate collections with the first mobilization attempt in a median of 1.7 days using this approach. Of the eight who failed initial mobilization, 5 successfully underwent re-mobilization with plerixafor and G-CSF and 3 (1.9%) were mobilization failures. This approach helped to control the overall cost of HSC collections for our BMT program by decreasing the need for remobilization, reducing the number of collection days and avoiding the use of plerixafor in all patients.
authors: Blood and Marrow Transplant Program, The University of Kansas Medical Center, Shawnee Mission Parkway, Westwood, KS 66205, USA. sabhyankar@kumc.edu
authors: S
authors: S
authors: Abhyankar
authors: S
authors: S
authors: DeJarnette
authors: O
authors: O
authors: Aljitawi
authors: S
authors: S
authors: Ganguly
authors: D
authors: D
authors: Merkel
authors: J
authors: J
authors: McGuirk
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018952:Antigens, CD34; D001596:Benzylamines; D002469:Cell Separation / Q000379:methods*; D000080027:Cyclams; 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*; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014182:Transplantation, Autologous
chemical_list: D019380:Anti-HIV Agents; D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor