Effectiveness of an algorithm-based approach to the utilization of plerixafor in patients undergoing chemotherapy-based stem cell mobilization.
Autologous stem cell transplantation remains a mainstay of therapy for diseases such as multiple myeloma and relapsed lymphoma. The use of plerixafor has been shown to augment the ability to collect adequate stem cells, but the optimal use of this agent when used with chemotherapy is not yet clear. We utilized an algorithm-based approach with the addition of plerixafor to 54 patients undergoing chemomobilization with reduced-dose etoposide who had a less than optimal preapheresis CD34(+) cell count. We used a CD34(+) precount of 20 cells/μL as a threshold to initiate stem cell apheresis. Ninety-four percent of patients were successfully collected and proceeded to transplantation. Fourteen of 51 (28%) patients who successfully collected required plerixafor to augment stem cell yield. Of the patients who successfully collected, 94% (89% of the entire population) were able to collect in 2 or fewer days. Compared with previous data from our institution, the rate of patients collecting > 4 × 10(6) CD34(+) cells/kg in a single collection was increased from 39% to 69%. The safety profile of this approach was acceptable. The use of this algorithm-based method to determine when and whether to add plerixafor to chemomobilization was shown to be a successful and cost-effective approach to stem cell collection.
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC. Electronic address: echow1@u.washington.edu.
Eric
E
Chow
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Kamakshi V
KV
Rao
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
William A
WA
Wood
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Deborah
D
Covington
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Paul M
PM
Armistead
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
James
J
Coghill
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Jonathan S
JS
Serody
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Don A
DA
Gabriel
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Katarzyna J
KJ
Jamieson
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Yara A
YA
Park
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Jay S
JS
Raval
Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, NC.
Thomas C
TC
Shea
D000328:Adult; D000368:Aged; D000465:Algorithms; D001596:Benzylamines; D001781:Blood Component Removal / Q000379:methods; D000080027:Cyclams; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous; D055815:Young Adult
D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D005047:Etoposide; C088327:plerixafor
Autologous stem cell transplantation; Etoposide; Plerixafor; Stem cell mobilization