title: Salvage bone marrow harvest in patients failing plerixafor-based stem cell mobilization attempt: feasibility and autologous transplantation outcomes.
abstract: Inadequate mobilization of peripheral blood progenitor cells (PBPC) is sometimes a limiting factor to proceed with an autologous hematopoietic cell transplantation (auto-HCT), in an otherwise eligible patient. In such situations, a bone marrow harvest (BMH) procedure may be considered to achieve the CD34+ target dose for an autograft. Plerixafor-based mobilization has recently been shown to improve PBPC collection yields. However, the feasibility and outcomes of BMH in patients failing plerixafor-based mobilization is not known. We report here, 6 patients who underwent BMH after PBPC mobilization failure with plerixafor. The median CD34+ yield with plerixafor mobilization and BMH were 1.15 x 10^6/Kg (range, 0.2-1.7 × 10^6/Kg) and 0.32 (range, 0.12-0.38 × 10^6/Kg), respectively. Three patients proceeded to an auto-HCT, with only 1 patient receiving CD34+ cell dose of at least 2 × 10^6/Kg. While neutrophil recovery was seen, platelet recovery and red cell transfusion independence were delayed. All 3 autografted patients experienced disease progression by day +100. These data suggest, limited incremental benefit of a salvage BMH after plerixafor mobilization failure, cautioning against routine use of this strategy.
authors: Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV 26506, USA. askanate@hsc.wvu.edu
authors: Abraham S
authors: AS
authors: Kanate
authors: Kathy
authors: K
authors: Watkins
authors: Aaron
authors: A
authors: Cumpston
authors: Michael
authors: M
authors: Craig
authors: Mehdi
authors: M
authors: Hamadani
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000276:immunology; D001596:Benzylamines; D001792:Blood Platelets / Q000276:immunology / Q000473:pathology; D001854:Bone Marrow Cells / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D000080027:Cyclams; D018450:Disease Progression; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization; D006571:Heterocyclic Compounds / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D014182:Transplantation, Autologous; D017211:Treatment Failure
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor