Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma

Growth factor plus preemptive (‘just-in-time’) plerixafor successfully mobilizes hematopoietic stem cells in multiple myeloma patients despite prior lenalidomide exposure

“…Importantly, the detrimental effect of lenalidomide on HSC mobilization was associated with the extent of exposure, leading to the recommendation that transplant-eligible, lenalidomide-treated patients should undergo HSC collection Preemptive plerixafor in lenalidomide-treated patients LJ Costa et al during the first 6 months of therapy. Multiple subsequent and independent reports confirmed the detrimental effect of lenalidomide on mobilization, with mobilization failure rates up to 25% [8][9][10] along with a dose-dependent effect. 9,10 The use of CY plus growth-factor mobilization is often employed in MM with intent to obtain better CD34 þ yield while still providing anti-MM therapy, although the relevance of the latter has never been demonstrated.…”

“…Multiple subsequent and independent reports confirmed the detrimental effect of lenalidomide on mobilization, with mobilization failure rates up to 25% [8][9][10] along with a dose-dependent effect. 9,10 The use of CY plus growth-factor mobilization is often employed in MM with intent to obtain better CD34 þ yield while still providing anti-MM therapy, although the relevance of the latter has never been demonstrated. Nevertheless, chemotherapy mobilization is associated with significant morbidities, including increased risk of infection and rate of hospitalization and excessive cost.…”

“…[4][5][6] The use of the IMID lenalidomide in the induction regimen was early identified as a risk factor for poor AHSC mobilization. [7][8][9][10] This negative effect, noticed particularly with growth factor mobilization, is at least partially overcome with the use of chemotherapy mobilization, [11][12][13] although this strategy carries higher cost and toxicity. [14][15][16][17] The CXCR4-SDF1-binding inhibitor plerixafor dramatically enhances filgrastim-based CD34 þ mobilization in patients with MM, 18 but is expensive, limiting its use in all patients undergoing mobilization.…”

International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100)

“…This inability to collect may be overcome by chemomobilization. [31][32][33][34] This may have an impact on the choice of induction therapy. It should be noted, however, that preliminary data indicate successful harvest with the addition of plerixafor in 85% of 50 patients previously treated with lenalidomide who failed to collect X2 million CD34 þ cells with G-CSF alone (preliminary findings: CUP post hoc analysis).…”

“…Most retrospective studies addressing mobilization have identified patient age, method of mobilization, time to stem cell mobilization, number of prior regimens, and prior melphalan and/or radiation exposure as predictors of mobilization failing to achieve a minimal dose. [29][30][31][32][33][34][35] More recently, exposure to lenalidomide has been associated with failure to mobilize adequate numbers of stem cells using growth factors alone. This inability to collect may be overcome by chemomobilization.…”