title: Second time a charm? Remobilization of peripheral blood stem cells with plerixafor in patients who previously mobilized poorly despite using plerixafor as a salvage agent.
abstract: BACKGROUND
  Plerixafor is a recently introduced agent used to improve peripheral blood stem cell (PBSC) mobilization in patients with hematologic malignancies. However, some patients still cannot mobilize adequately even with plerixafor.
  
  
  METHODS
  We retrospectively reviewed the PBSC collections of 18 consecutive lymphoma and multiple myeloma patients, who had previously mobilized poorly despite the use of plerixafor and received plerixafor again during remobilization.
  
  
  RESULTS
  During the first mobilization attempt, all 18 recombinant granulocyte-colony-stimulating factor (G-CSF; two) or G-CSF plus chemotherapy-mobilized patients (16) had poor response to plerixafor, with peripheral blood (PB) CD34+ counts ranging from 0 to 7.48 × 10(6)/L after the first dose. They collected only 0.15 × 10(6) to 1.63 × 10(6) (median, 0.40 × 10(6)) CD34+ cells/kg after one to four collections. The median average daily yield was 0.24 × 10(6) CD34+ cells/kg. Remobilization began 1 to 4 weeks later with G-CSF, plerixafor, and with (three) or without (15) cyclophosphamide. The PB CD34+ cell counts after the first dose of plerixafor were 3.04 × 10(6) to 127.54 × 10(6)/L (median, 14.58 × 10(6)/L). After one to four doses of plerixafor, each patient collected an additional 0.39 × 10(6) to 14.02 × 10(6) (median, 1.89 × 10(6)) CD34+ cells/kg, and the median daily average was 0.78 × 10(6) CD34+ cells/kg. Cumulatively, after two rounds of collections, 15 collected more than 2.0 × 10(6) CD34+ cells/kg. Thirteen have proceeded to autologous stem cell transplantation (ASCT) and successfully engrafted.
  
  
  CONCLUSIONS
  In patients who had responded poorly to the use of plerixafor as a mobilization salvage agent, response to remobilization with plerixafor for the second time was variable, but most (83.3%) patients were able to collect enough PBSCs to proceed to ASCT.
authors.affiliation: Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Department of Hematology, Department of Pharmacy, City of Hope National Medical Center, Duarte, California.
authors.forename: Shan
authors.initials: S
authors.lastname: Yuan
authors.forename: Auayporn
authors.initials: A
authors.lastname: Nademanee
authors.forename: Amrita
authors.initials: A
authors.lastname: Krishnan
authors.forename: Neil
authors.initials: N
authors.lastname: Kogut
authors.forename: Sepideh
authors.initials: S
authors.lastname: Shayani
authors.forename: Shirong
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D006571:Heterocyclic Compounds / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor