title: Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure.
abstract: Plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) is approved for autologous stem cell mobilization in poor mobilizing patients with multiple myeloma or malignant lymphoma. The purpose of this study was to evaluate efficacy and safety of plerixafor in an immediate rescue approach, administrated subsequently to G-CSF alone or chemotherapy and G-CSF in patients at risk for mobilization failure. Eighty-five patients mobilized with G-CSF alone or chemotherapy were included. Primary endpoint was the efficacy of the immediate rescue approach of plerixafor to achieve ≥2.0 × 106CD34+cells/kg for a single or ≥5 × 106CD34+cells/kg for a double transplantation and potential differences between G-CSF and chemotherapy-based mobilization. Secondary objectives included comparison of stem cell graft composition including CD34+cell and lymphocyte subsets with regard to the mobilization regimen applied. No significant adverse events were recorded. A median 3.9-fold increase in CD34+cells following plerixafor was observed, resulting in 97% patients achieving at least ≥2 × 106CD34+ cells/kg. Significantly more differentiated granulocyte and monocyte forming myeloid progenitors were collected after chemomobilization whereas more CD19+and natural killer cells were collected after G-CSF. Fifty-two patients underwent transplantation showing rapid and durable engraftment, irrespectively of the stem cell mobilization regimen used. The addition of plerixafor in an immediate rescue model is efficient and safe after both, G-CSF and chemomobilization and results in extremely high success rates. Whether the differences in graft composition have a clinical impact on engraftment kinetics, immunologic recovery, and graft durability have to be analysed in larger prospective studies.
authors: Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
authors: Nina
authors: N
authors: Worel
authors: Children?s Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria.
authors: Gerhard
authors: G
authors: Fritsch
authors: Medical Department I, Division of Oncology, Medical University of Vienna, Vienna, Austria.
authors: Hermine
authors: H
authors: Agis
authors: First Medical Department, Elisabethinen Hospital, Linz, Austria.
authors: Alexandra
authors: A
authors: Böhm
authors: First Medical Department, Hospital Wiener Neustadt, Austria.
authors: Georg
authors: G
authors: Engelich
authors: Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
authors: Gerda C
authors: GC
authors: Leitner
authors: Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria.
authors: Klaus
authors: K
authors: Geissler
authors: Medical Department I, Division of Haematology, Medical University of Vienna, Vienna, Austria.
authors: Karoline
authors: K
authors: Gleixner
authors: Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria.
authors: Peter
authors: P
authors: Kalhs
authors: First Medical Department, Elisabethinen Hospital, Linz, Austria.
authors: Veronika
authors: V
authors: Buxhofer-Ausch
authors: Third Medical Department, Hanusch Hospital, Vienna, Austria.
authors: Felix
authors: F
authors: Keil
authors: Department of Medicine I, General Hospital, St Poelten, Austria.
authors: Gerhard
authors: G
authors: Kopetzky
authors: Medical Department II, Hospital Krems, Austria.
authors: Viktor
authors: V
authors: Mayr
authors: Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria.
authors: Werner
authors: W
authors: Rabitsch
authors: Third Medical Department, Hanusch Hospital, Vienna, Austria.
authors: Regina
authors: R
authors: Reisner
authors: Department of Blood Group Serology, Medical University Graz, Graz, Austria.
authors: Konrad
authors: K
authors: Rosskopf
authors: Medical Department II, Division of Oncology, Donauhospital Vienna, Vienna, Austria.
authors: Reinhard
authors: R
authors: Ruckser
authors: Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria.
authors: Claudia
authors: C
authors: Zoghlami
authors: Department of Internal Medicine I, Wilhelminen Hospital, Vienna, Austria.
authors: Niklas
authors: N
authors: Zojer
authors: Division of Haematology, Medical University of Graz, Austria.
authors: Hildegard T
authors: HT
authors: Greinix
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts / Q000166:cytology; D001596:Benzylamines; D000080027:Cyclams; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006571:Heterocyclic Compounds / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor
keywords: binding inhibitor; poor stem cell mobilization; preemptive approach