title: Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization.
abstract: Plerixafor augments PBSC collection, but the optimal approach for incorporating it into mobilization is uncertain. Forty-nine consecutive patients mobilized with G-CSF alone were analyzed, and a day 4 peripheral blood CD34(+) cell count of 0.015/ml was found to predict for a day 5 apheresis yield of 2 × 10(6) CD34(+) progenitors/kg, our institutional minimum necessary for a single autologous transplant. On the basis of this relationship, a clinical guideline was developed which recommended pre-emptive use of plerixafor if the day 4 peripheral blood CD34(+) cell count was between 0.005 and 0.015/ml. A total of 166 consecutive subjects with lymphoma or plasma cell dyscrasias underwent G-CSF mobilization after adoption of this care pathway, and the mobilization failure rate was only 7% in patients managed per guideline. The median PBSC yield was 6.3 × 10(6) CD34(+) progenitors/kg with G-CSF (day 4 peripheral blood CD34(+) cell > 0.015/ml) and 4.9 × 10(6) CD34(+) progenitors/kg with G-CSF+plerixafor (day 4 peripheral blood CD34(+) cell 0.005-0.015/ml). The median number of days of apheresis was 2 in both groups. This clinical guideline is an effective mobilization algorithm that minimizes mobilization failures, reduces poor apheresis yields, does not require risk factor identification and is simple to implement.
authors.affiliation: Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. chenan@ohsu.edu
authors.forename: A I
authors.initials: AI
authors.lastname: Chen
authors.forename: T
authors.initials: T
authors.lastname: Bains
authors.forename: S
authors.initials: S
authors.lastname: Murray
authors.forename: R
authors.initials: R
authors.lastname: Knight
authors.forename: K
authors.initials: K
authors.lastname: Shoop
authors.forename: J
authors.initials: J
authors.lastname: Bubalo
authors.forename: C
authors.initials: C
authors.lastname: Fowler
authors.forename: S
authors.initials: S
authors.lastname: Slater
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D008223:Lymphoma / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000097:blood / Q000628:therapy; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor