Plerixafor to the rescue: boosting peripheral blood stem cell mobilization in patients previously treated with hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy.
Hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy exerts deleterious effects on peripheral blood stem cell (PBSC) mobilization. We retrospectively reviewed the use of plerixafor to salvage mobilization in 18 Hyper-CVAD treated patients who initially mobilized poorly with chemotherapy and granulocyte colony stimulating factor (G-CSF). After plerixafor administration the median peripheral blood (PB) CD34 + count rose from 3.74/μL (0-17/μL) to 6.85/μL (0-47.2/μL). The patients collected a median of 1.64 (0.21-5.56) × 10(6) CD34 + cells/kg with a median number of 3 (1-4) doses in the same collection cycle, and 11 patients reached the 2.0 × 10(6) CD34 + cells/kg minimum required for transplant. Six patients were remobilized later with G-CSF and plerixafor, and three additional patients reached this goal. For these 14 patients the median number of doses of plerixafor required to reach 2.0 × 10(6) CD34 + cells/kg was 3 (range 1-4). In conclusion, plerixafor can be utilized successfully in many cases to overcome the effects of Hyper-CVAD on PBSC mobilization.
Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine.
Shan
S
Yuan
Shirong
S
Wang
Amandeep
A
Salhotra
Auayporn
A
Nademanee
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001596:Benzylamines; D000080027:Cyclams; D003520:Cyclophosphamide / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D006412:Hematopoietic Stem Cells / Q000187:drug effects*; D006571:Heterocyclic Compounds / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; C088327:plerixafor
Hyper-CVAD; Plerixafor; autologous peripheral blood stem cell (PBSC) mobilization; salvage mobilization