Plerixafor-augmented peripheral blood stem cell mobilization in AL amyloidosis with cardiac involvement: a case series.
Nearly half of AL amyloidosis patients have cardiac involvement, an independent predictor of poor prognosis. High-dose melphalan and autologous stem-cell transplantation (HDM/SCT) can induce complete hematologic responses and prolong survival in AL amyloidosis. Granulocyte colony-stimulating factor (G-CSF)-induced mobilization of peripheral blood stem cell (PBSC) in AL amyloidosis patients is associated with volume overload, arrhythmias and capillary leak syndrome. Plerixafor has a different mechanism of action and has non-overlapping toxicities with G-CSF. We describe our experience in five patients with AL amyloidosis and cardiac involvement who received plerixafor with G-CSF for PBSC mobilization. Median age was 56 years; two patients had undergone heart transplantation within the year prior to HDM/SCT. Three patients received plerixafor after an initial trial of mobilization with G-CSF alone. No patient had any significant toxicities during mobilization and PBSC collection. The median total yield of PBSCs collected was 5.9 × 10(6) CD34+ cells/kg; the median number of leukapheresis days was 2. Neutrophil engraftment after HDM/SCT occurred at a median of nine days, platelet engraftment at a median of 13 days. Plerixafor was effective and well tolerated when used upfront or as rescue for PBSC mobilization in AL amyloidosis patients with cardiac involvement.
Department of Medicine, Boston University Medical Center , Boston, MA , USA.
Steve Y
SY
Lee
Vaishali
V
Sanchorawala
David C
DC
Seldin
J
J
Mark Sloan
Nancy
N
Andrea
Karen
K
Quillen
D000686:Amyloidosis / Q000150:complications / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D006333:Heart Failure / Q000150:complications / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000187:drug effects* / Q000276:immunology; D006571:Heterocyclic Compounds / Q000494:pharmacology*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D012074:Remission Induction; D014182:Transplantation, Autologous
D018906:Antineoplastic Agents, Alkylating; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; D008558:Melphalan; C088327:plerixafor
Amyloidosis; autologous; heart failure; plerixafor (JM 3100); stem cells; transplantation