title: Plerixafor added to chemotherapy plus G-CSF is safe and allows adequate PBSC collection in predicted poor mobilizer patients with multiple myeloma or lymphoma.
abstract: We evaluated the safety and efficacy of plerixafor, subsequent to disease-specific chemotherapy followed by granulocyte-colony stimulating factor (G-CSF), in 37 multiple myeloma (MM) or lymphoma patients, who were candidates for autologous stem cell transplantation (ASCT) predicted as poor mobilizers (PMs). Patients were identified as predicted PMs according to the history of a previously failed mobilization attempt or the presence of ≥1 factors predicting an unsuccessful harvest, such as advanced disease, prior extensive radiotherapy, or prolonged treatment, with stem cell poisons, advanced age, or extensive bone marrow involvement. Plerixafor (0.24 mg/kg) was administered subcutaneously for up to 3 consecutive days while continuing G-CSF for 9 to 11 hours before the planned apheresis. Plerixafor administration was safe and no significant adverse events were recorded. We observed a median 4-fold increase (range: 1.4-32) in the number of circulating CD34(+) cells following plerixafor compared with baseline CD34(+) cell concentration (from a median of 5 cells/μL, range: 1-32, to a median of 32 cells/μL, range: 6-201). Twenty-seven of the 37 patients (14 of 17 with MM and 13 of 20 with lymphoma) had ≥2×10(6) CD34(+) cells/kg collected in 1-3 apheretic procedures. Of the 27 patients rescued with plerixafor, 24 (13 MM, 11 lymphoma) have been transplanted with plerixafor-mobilized peripheral blood stem cells, showing a rapid and durable hematologic recovery. Our results suggest that the addition of plerixafor to G-CSF after disease-oriented chemotherapy is safe and allows for a satisfactory harvest in order to perform a safe ASCT, in a relevant proportion of lymphoma and MM patients considered to be PMs.
authors.affiliation: Divisione di Ematologia, Ospedale San Carlo, Via Potito Petrone 1, Potenza, Italy. imma.attolico@tin.it
authors.forename: Immacolata
authors.initials: I
authors.lastname: Attolico
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pavone
authors.forename: Angelo
authors.initials: A
authors.lastname: Ostuni
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rossini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Musso
authors.forename: Alessandra
authors.initials: A
authors.lastname: Crescimanno
authors.forename: Massimo
authors.initials: M
authors.lastname: Martino
authors.forename: Pasquale
authors.initials: P
authors.lastname: Iacopino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milone
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tedeschi
authors.forename: Sabrina
authors.initials: S
authors.lastname: Coluzzi
authors.forename: Roberta
authors.initials: R
authors.lastname: Nuccorini
authors.forename: Sara
authors.initials: S
authors.lastname: Pascale
authors.forename: Elvira
authors.initials: E
authors.lastname: Di Nardo
authors.forename: Attilio
authors.initials: A
authors.lastname: Olivieri
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D019650:Hematopoietic Stem Cell Mobilization; D006412:Hematopoietic Stem Cells; D006571:Heterocyclic Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008223:Lymphoma / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D020127:Recovery of Function; 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