Fludarabine Combination Regimen Severely Affected Peripheral Blood Stem Cell Mobilization

The optimal protocol for mobilization of hematopoietic stem cells in patients with lymphoid malignancies has not been determined so far. We retrospectively analyzed the efficacy and safety of Ara-C at a dose of 1.6 g/m 2 compared with CY at a dose of 4.0 g/m 2 , both combined with filgrastim. Seventy and forty-five patients, respectively, were included, among whom 60% were defined as 'predicted poor mobilizers'. The use of Ara-C was associated with significantly higher peak number of circulating CD34þ cells compared with CY (Po0.0001). In the Ara-C group, 95% of patients with multiple myeloma (MM) collected at least 5 Â 10 6 CD34 þ cells/kg required for tandem transplantation, and 97% of lymphoma patients collected at least 2 Â 10 6 CD34 þ cells/kg, needed for a single autologous hematopoietic SCT (autoHSCT), which was achieved with a single leukapheresis in 91% of cases. Results for the CY group were significantly inferior (Po0.0001). No patient mobilized with Ara-C experienced febrile neutropenia, whereas 35% required platelet transfusions. Among patients who proceeded to autoHSCT, the time of both neutrophil and platelet recovery was significantly shorter for those mobilized with Ara-C than CY. We conclude that intermediate-dose Ara-C þ filgrastim is a very effective and relatively safe mobilization protocol for patients with lymphoid malignancies.Bone Marrow Transplantation (2013) 48, 915-921;

Section: Analysis Of Circulating Cd34mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intermediate-dose Ara-C plus G-CSF for stem cell mobilization in patients with lymphoid malignancies, including predicted poor mobilizers

Giebel

Krużel

Czerw

et al. 2013

“…[7][8][9][10][11][12][13][14][15][16] However, the value of patient characteristics and prior treatment clinical factors to successfully score and accurately predict the risk of poor mobilization is controversial, and recent studies do suggest that they are inaccurate predictors and should not be used to identify candidates for optimized strategies to prevent mobilization failure. 17,18 At present, the measurement of preapheresis levels of CD34+ cells in PB 7,[19][20][21][22] is the most robust and recommended indicator to identify potential poor mobilizers and efficiently rescue them with novel mobilization strategies, including the use of plerixafor.…”

Section: Introductionmentioning

confidence: 99%

Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34+ cell levels and preemptive intervention vs remobilization

Sánchez-Ortega

Querol

Encuentra

et al. 2014

This retrospective study presents data from 105 consecutive multiple myeloma and lymphoma patients who had PB CD34+ cell counts o 10/μL on day 4 of steady-state G-CSF mobilization for autologous hematopoietic cell transplantation. Our results confirm the capacity of plerixafor to improve mobilization outcomes in this clinical setting. In addition, they show that the effectiveness of plerixafor, compared with G-CSF only, translates to patients with very low (o 3.5/μL) circulating CD34+ cell counts: overnight CD34+ cell count expansion (5.3-vs 1.7-fold), overall CD34+ cell yield (2.29 vs 0.15 × 10 6 CD34+ cells per kg) and patients yielding ⩾ 2 × 10 6 CD34+ cells per kg (63% vs 3%). Furthermore, our data also show that preemptive plerixafor is significantly more effective and more efficient than in remobilization: CD34+ cell yield in the first apheresis (3.28 vs 2.0 × 10 6 CD34+ cells per kg) and overall (3.73 vs 2.44 × 10 6 CD34+ cells per kg), patients yielding ⩾ 2 × 10 6 CD34+ cells per kg in the first apheresis (85% vs 44%) and overall (92% vs 64%), all this requiring less days and doses of plerixafor treatment (1.08 vs 1.48). These data would advocate using plerixafor as an early preemptive intervention based on day 4 circulating CD34+ counts, including very high-risk patients with very low circulating levels.

“…[5][6][7][8][9] Risk factors for poor mobilization include older age, 10 prior radiation therapy, extensive prior chemotherapy, exposure to lenalidomide or purine analogues and extensive BM involvement by malignancy. [11][12][13] Options for those patients who fail to mobilize are limited. For some, they may include BM harvest, which is more invasive, associated with a higher risk of complications and is more resource intensive.…”

Section: Introductionmentioning

confidence: 99%

A plerixafor-based strategy allows adequate hematopoietic stem cell collection in poor mobilizers: results from the Canadian Special Access Program

Sheppard

Bredeson

Huebsch

et al. 2014

Plerixafor effectively mobilizes hematopoietic stem cells (HSCs). However, most patients' cells are successfully collected using traditional strategies and there is limited cost-effectiveness data. The objectives of this study were to: (1) summarize the published reports of mobilization using a plerixafor-based strategy during compassionate access programs and (2) describe the Canadian experience with plerixafor during its availability by Health Canada's Special Access Program. A literature search identified reports of plerixafor-based mobilization during compassionate access programs. Overall, successful collection of at least 2 × 10 6 CD34+ cells/ kg was achieved in~75% of patients, and about two-thirds of patients went on to HSCT. A greater proportion of patients had successful collections when plerixafor was used in the upfront or preemptive settings. Plerixafor was made available by Health Canada's SAP from September 2008 to December 2010. In 96 of 132 (73%) patients, there was successful collection of at least 2 × 10 6 CD34+ cells/kg. Ninety-nine (75%) patients went on to receive an autologous transplant. Plerixafor-based mobilization is effective in perceived poor mobilizers. The optimal way to incorporate plerixafor into a mobilization strategy, however, remains to be determined. Centre-specific analysis of resource utilization may help to identify the most cost-effective way to implement various plerixafor-based mobilization strategies.