title: Plerixafor for mobilization of blood stem cells in autologous transplantation: an update.
abstract: BACKGROUND
  About 99% of all autologous transplants are now performed with blood stem cells. G-CSF alone or combined with chemotherapy have been used to mobilize CD34(+) cells. Plerixafor is a novel drug used for mobilization purposes.
  
  
  METHODS
  We have evaluated recent data in regard to plerixafor use in predicted or proven poor mobilizers. In addition, we have looked for preemptive strategies to optimize the use of this expensive drug. Also cost-efficacy issues and effects of plerixafor on graft composition and post-transplant outcomes will be discussed.
  
  
  CONCLUSIONS
  Plerixafor added to G-CSF is superior than G-CSF alone for mobilization of CD34(+) cells. This combination is also efficient in patients who have failed a previous mobilization attempt with other methods or in patients with risk factors for poor mobilization. Addition of plerixafor to G-CSF or chemotherapy plus G-CSF mobilization in patients who appear to mobilize poorly is under active investigation and algorithms for a preemptive use of this expensive agent have been proposed. Grafts collected after plerixafor appear to contain more lymphoid cells than the grafts collected without it. Whether this affects post-transplant outcomes such as immune reconstitution and risk of relapse needs to be evaluated.
authors.affiliation: University of Eastern Finland, Clinical Medicine , Kuopio , Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Ville
authors.initials: V
authors.lastname: Varmavuo
mesh_terms: D000818:Animals; D018952:Antigens, CD34 / Q000378:metabolism; D064592:Autografts; D001596:Benzylamines; D015415:Biomarkers / Q000378:metabolism; D002465:Cell Movement / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D000080027:Cyclams; D016527:Drug Costs; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000187:drug effects* / Q000378:metabolism; D006571:Heterocyclic Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D015415:Biomarkers; D000080027:Cyclams; D006571:Heterocyclic Compounds; C088327:plerixafor
keywords: autologous stem cell transplantation; graft cellular composition; outcome after autologous stem cell transplantation; plerixafor; poor mobilization; preemptive use of plerixafor; review