title: Experience with plerixafor for hematopoietic cell mobilization in nine patients with germ cell tumors.
abstract: OBJECTIVE
  To evaluate the efficacy of plerixafor as a just-in-time therapy for patients with germ cell tumors who were identified as poor hematopoietic cell mobilizers after the initiation of apheresis.
  
  
  METHODS
  Case series.
  
  
  METHODS
  National Cancer Institute-designated cancer center.
  
  
  METHODS
  Nine patients with germ cell tumors who received plerixafor as an adjunct to granulocyte colony-stimulating factor (G-CSF) for hematopoietic cell mobilization in an attempt to prevent mobilization failure between January 2009 and December 2012.
  
  
  RESULTS
  Patients were heavily pretreated, having received at least four prior treatment cycles. A median of three total apheresis days (range 1-4 days) was required for all patients, but a median of two apheresis days (range 1-2 days) was needed after the initiation of plerixafor. A median of 0.9 × 10⁶ CD34⁺ cells/kg (range 0.3-1.5 × 10⁶ CD34⁺ cells/kg) was harvested with G-CSF mobilization alone; in addition, a median of 2.6 × 10⁶ CD34⁺ cells/kg (range 0.6-32 × 10⁶ CD34⁺ cells/kg) was harvested using plerixafor. All nine patients received high-dose carboplatin and etoposide followed by hematopoietic cell transplantation. The median time to neutrophil engraftment was 11 days (range 8-12 days). The median time to platelet engraftment was 16 days (range 10-22 days).
  
  
  CONCLUSIONS
  The use of plerixafor in addition to G-CSF as just-in-time therapy permits patients with germ cell tumors to pursue potentially curative therapy with high-dose chemotherapy followed by autologous stem cell rescue.
authors.affiliation: Department of Pharmacy, Indiana University Health, Indianapolis, Indiana.
authors.forename: V J
authors.initials: VJ
authors.lastname: Daphne O'Hara
authors.forename: Alissa H
authors.initials: AH
authors.lastname: Karr
authors.forename: Shivani
authors.initials: S
authors.lastname: Srivastava
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kiel
mesh_terms: D000293:Adolescent; D000328:Adult; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006571:Heterocyclic Compounds / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor
keywords: Plerixafor; germ cell tumor; hematopoietic cell transplantation; mobilization