The optimal mobilization strategy is still unknown; however, colony-stimulating factors remain the most commonly used mobilization agents. Currently, chemotherapy or plerixafor in combination with G-CSF is a reasonable option in heavily pretreated and hard-to-mobilize patients with non-Hodgkin's lymphoma and multiple myeloma.

Methotrexate (MTX) is a standard agent used in combination with calcineurin inhibitors for graft-versus-host disease (GVHD) prophylaxis in patients undergoing allogeneic hematopoietic cell (HCT) transplantation. We retrospectively compared the incidence of acute GVHD (aGVHD), transplant-related morbidity, and mortality in patients given sirolimus/tacrolimus ± antithymocyte globulin (ATG) versus MTX/tacrolimus or cyclosporine and allogeneic transplantation for hematologic malignancies. Between January 1, 2005, and April 30, 2009, 106 consecutive patients received peripheral blood HCT or bone marrow grafts after 1 of 6 myeloablative conditioning regimens. The incidence of grade II-IV aGVHD was 18.6% in patients who received sirolimus/tacrolimus compared to 48.9% who received MTX (P = .001). The incidence of grade III-IV aGVHD was 5% and 17% (P = .045), respectively. There was no difference in overall survival (OS) between the groups (P = .160). Chronic GVHD (cGVHD) occurred in 40.4% who received sirolimus and 41.9% receiving MTX (P = .89). The incidence of thrombotic microangiopathy or interstitial pneumonitis was not significantly different between groups. The reduction in the risk of severe aGVHD was offset by an increased (20% versus 4%, P = .015) incidence of and mortality from sinusoidal obstructive syndrome (SOS). Sirolimus/tacrolimus appears to reduce the incidence of aGVHD after conventional allotransplantion compared to MTX-calcineurin inhibitor prophylaxis; however, this did not improve survival.

images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 364;3 nejm.org january 20, 2011 e5 A 52-year-old man with acute myeloid leukemia underwent induction chemotherapy consisting of a 7-day intravenous infusion of cytarabine plus daunorubicin on days 1 through 3. Bone marrow biopsy performed on day 14 revealed that blast cells still accounted for 60 to 80% of the total cells in the marrow, indicating an inadequate response to initial induction therapy. Intermediate-dose cytarabine (1500 mg per square meter of body-surface area) was then administered every 12 hours for a total of 12 doses. After the ninth dose, the patient's palms became red and painful. He received a diagnosis of cytarabine-induced palmar-plantar erythrodysesthesia (also known as the hand-foot syndrome, acral erythema, or Burgdorf 's reaction). Over the next few days, well-demarcated erythematous plaques, bullae, and desquamation developed over his hands (Panels A and B) and feet. A large vesicle formed on his left heel (Panel C). He was given supportive care, and the acral erythema completely resolved by 20 days after the last dose of cytarabine.