title: Growth factor plus preemptive ('just-in-time') plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure.
abstract: Lenalidomide is associated with suboptimal autologous hematopoietic stem cell (AHSC) mobilization. We hypothesized that growth factor plus preemptive plerixafor is an effective strategy for AHSC mobilization in multiple myeloma (MM) despite prior exposure to lenalidomide. We retrospectively reviewed patient characteristics and mobilization outcomes of 89 consecutive MM patients undergoing first mobilization with filgrastim or pegfilgrastim +/- preemptive plerixafor using a previously validated algorithm based on day 4 peripheral blood CD34+ cell count (PB-CD34+) and mobilization target. Outcomes were analyzed according to the extent of prior exposure to lenalidomide: no prior exposure (group A, n=40), 1- 4 cycles (group B, n=30) and >4 cycles (group C, n=19). Multivariate analysis yielded only age and number of cycles of lenalidomide as negatively associated, and mobilization with pegfilgrastim as positively associated with higher PB-CD34+. Only 45% of patients in group A required plerixafor vs 63% in groups B and 84% in C, P=0.01. A higher proportion of patients in group A (100%) met the mobilization target than in groups B (90%) or C (79%), P=0.008. All patients yielded at least 2 × 10(6) CD34+/kg. Growth factor mobilization with preemptive plerixafor is an adequate upfront mobilization strategy for MM patients regardless of prior exposure to lenalidomide.
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: J
authors.initials: J
authors.lastname: Abbas
authors.forename: K R
authors.initials: KR
authors.lastname: Hogan
authors.forename: C
authors.initials: C
authors.lastname: Kramer
authors.forename: K
authors.initials: K
authors.lastname: McDonald
authors.forename: C D
authors.initials: CD
authors.lastname: Butcher
authors.forename: A
authors.initials: A
authors.lastname: Littleton
authors.forename: K
authors.initials: K
authors.lastname: Shoptaw
authors.forename: Y
authors.initials: Y
authors.lastname: Kang
authors.forename: R K
authors.initials: RK
authors.lastname: Stuart
mesh_terms: D000368:Aged; D000465:Algorithms; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000473:pathology*; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011092:Polyethylene Glycols; D011994:Recombinant Proteins / Q000008:administration & dosage; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; C455861:pegfilgrastim; D011092:Polyethylene Glycols; D013792:Thalidomide; D000077269:Lenalidomide; D000069585:Filgrastim; C088327:plerixafor