title: Plerixafor on demand in ten healthy family donors as a rescue strategy to achieve an adequate graft for stem cell transplantation.
abstract: BACKGROUND
  In allogeneic hematopoietic stem cell (HSC) transplantation, the collection of an appropriate number of HSCs while maintaining a high level of safety for healthy donors is fundamental. Inadequate HSC mobilization can be seen with the standard use of granulocyte-colony-stimulating (G-CSF). Plerixafor (PL) is a chemokine receptor CXC Type 4-stromal-derived factor 1 inhibitor; its HSC-mobilizing properties are synergistic with G-CSF in poor mobilizing patients. The use of PL as adjuvant or alternative to G-CSF in healthy donors has shown a good safety profile but is so far off-label.
  
  
  METHODS
  We report 10 healthy HSC donors treated with PL because of insufficient response to G-CSF alone or contraindication to G-CSF. Eight donors did not mobilize enough CD34+ cells with G-CSF alone because poor mobilizers or because insufficient HSCs were harvested according to the clinical need of the patient; in two cases G-CSF administration and marrow harvest were unfeasible or contraindicated in the donor.
  
  
  RESULTS
  The use of PL for mobilization increased the number of circulating CD34+ cells by 2.8-fold and the CD34+/kg collection by 3.0-fold. Only mild adverse events were reported (bone pain or discomfort) and not univocally attributable to PL. Rate of engraftment and graft-versus-host disease were similar to those seen in recipients of grafts from G-CSF only-mobilized donors.
  
  
  CONCLUSIONS
  We exposed 10 allogeneic donors to mobilization with PL. PL was well tolerated in all cases and ensured procurement of an adequate graft for transplantation resulting in a normal hematopoietic engraftment.
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gattillo
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Marktel
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rizzo
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Malato
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Malabarba
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Coppola
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Assanelli
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Milani
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Tiago
authors.initials: T
authors.lastname: De Freitas
authors.affiliation: Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Corti
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bellio
authors.affiliation: Blood Transfusion Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.|Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D018952:Antigens, CD34 / Q000097:blood; D001596:Benzylamines; D001772:Blood Cell Count; D002292:Carcinoma, Renal Cell / Q000628:therapy; D003114:Colony-Forming Units Assay; D000080027:Cyclams; D004357:Drug Synergism; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000737:chemistry / Q000187:drug effects; D006571:Heterocyclic Compounds / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007680:Kidney Neoplasms / Q000628:therapy; D000078224:Lenograstim; D007937:Leukapheresis; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced; D010290:Parents; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011994:Recombinant Proteins / Q000494:pharmacology; D035781:Siblings; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000078224:Lenograstim; C088327:plerixafor