A retrospective study of autologous stem cell mobilization to guide an immediate salvage protocol using plerixafor for patients who mobilize stem cells poorly

Abstract

The addition of plerixafor to G-CSF decreases the risk of failed stem cell collection, but at considerable extra cost. Using a logistic regression model based on 354 autologous mobilizations, we have identified a local minimum peripheral blood CD34 count at which the probability of a successful collection is 50%. This seems an appropriate CD34 count at which to add immediate salvage plerixafor.

Peripheral blood stem cell mobilization in multiple myeloma comparison of two consecutive regimens in a limited resources country

“…[5][6][7] Because of limited resources, novel and costly drugs such as bortezomib and lenalidomide could be used in these situations for only a few patients and for just three to four cycles as a bridge to a second ASCT, and could not be used for long periods until further progression. For the same reasons, pre-emptive plerixafor currently used for poor mobilizers [20][21][22] is available for a very few patients. That is why, chemotherapy+ G-CSF remains the most used regimen in our practice.…”

Decision‐tree algorithm for optimized hematopoietic progenitor cell–based predictions in peripheral blood stem cell mobilization

“…Plerixafor, a direct CXCR4 antagonist, is a highly active mobilizing agent that might enable these patients to avoid mobilization failure. A growing body of studies has reported an “on‐demand” administration of plerixafor for avoiding mobilization failure and dispensing with the use of this expensive drug . To guide the use of plerixafor, Sorasio and coworkers developed an algorithm for the early detection of poorly mobilizing patients based on the percentage of circulating CD34+ cells on the first and second day of hematologic recovery.…”

“…A growing body of studies has reported an "on-demand" administration of plerixafor for avoiding mobilization failure and dispensing with the use of this expensive drug. 33,34 To guide the use of plerixafor, Sorasio and coworkers 35 developed an algorithm for the early detection of poorly mobilizing patients based on the percentage of circulating CD341 cells on the first and second day of hematologic recovery. Milone and coworkers 36 conducted a prospective study to evaluate another on-demand strategy based on the peripheral CD341 cell counts on the 13th day from a DHAP regimen (dexamethasone, cytarabine, and cisplatin) or the 15th day from HDCy mobilization.…”

Peripheral Blood CD34+ Percentage at Hematological Recovery after Chemotherapy Is a Good Early Predictor of Harvest: A Single-Center Experience

“…Several algorithms have been proposed to select patients for early PLX addition to avoid both mobilization failure and inappropriate administration of this expensive drug. Hay et al [16], moving from a retrospective analysis of 354 autologous apheresis attempts, proposed PLX administration in patients with CD34/mL peak or plateau at 16.5/mL. In 107 patients treated with cyclophosphamide and G-CSF, Farina et al [14] showed that (1) delayed leukocyte recovery (>12 days from administration of 3 to 4 g/m 2 and >14 days from administration of 6 to 7 g/m 2 ) and (2) CD34þ less than 10/mL at leukocyte recovery significantly increased the risk of mobilization failure.…”

“…In patients undergoing PBSC mobilization with G-CSF alone, a low CD34 þ count on day 4 [9,10] or 5 [11,12] was almost universally considered as predictor of harvest failure. In patients in which PBSC mobilization was tempted with chemotherapy plus G-CSF, the identification of early cut-off CD34 þ values was more difficult, due to higher individual variability in hematological recovery after chemotherapy and to differences between chemotherapy schedules [13][14][15][16].…”