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

G-CSF plus preemptive plerixafor vs hyperfractionated CY plus G-CSF for autologous stem cell mobilization in multiple myeloma: effectiveness, safety and cost analysis

“…Median time to neutrophil engraftment was 11 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in the CY group compared with 12 days (10-15) in the plerixafor group (P = 0.027). Similarly, median time to platelet engraftment was 12 days (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) in the CY group compared with 12 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in the plerixafor group (P = 0.12).…”

“…17,18 The high cost of plerixafor led many investigators to introduce it in a preemptive strategy, which could even be more cost-effective than CY followed by G-CSF. 19,20 Very few studies compared efficacy, toxicity and cost-effectiveness of stem cell mobilization with CY and G-CSF vs G-CSF with preemptive plerixafor. In this study, we retrospectively reviewed our singlecenter experience at the American University of Beirut Medical Center in transplant-eligible MM patients using fractionated highdose CY and G-CSF as our past preferred chemo-mobilization strategy compared with our new mobilization strategy using G-CSF plus preemptive plerixafor.…”

Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study

“…To overcome this hurdle, investigators have proposed 'on demand' use of plerixafor in patients identified to have inadequate SC mobilization with G-CSF, with the assumption that such an approach promotes cost containment by limiting plerixafor use but taking advantage of its efficacy in patients in whom poor mobilization is anticipated. 20 In addition, since cyclophosphamide is considered important for SC mobilization in patients with MM, most of whom get exposed to lenalidomide during induction, the same plerixafor 'on demand' approach has also been tested following C+G-CSF. 5,[21][22][23][24] However, this approach is based on the premise that upfront chemotherapy mobilization is more cost effective than upfront plerixafor mobilization, an assumption that has not been adequately tested.…”

A novel hematopoietic progenitor cell mobilization and collection algorithm based on preemptive CD34 enumeration

“…31 Several previous studies have shown the benefit of timing the dose of plerixafor to predict and improve mobilization. [32][33][34] Notably, Li and colleagues 35 recently published a study examining 148 patients treated before the FDA approval of plerixafor compared with 188 mobilized patients of whom 64 received plerixafor. These 64 patients included 41 poor mobilizers, defined as patients with fewer than 15 CD34 cells 3 10 6 /L blood after at least 5 days of G-CSF administration and 23 "high-risk" patients who had failed prior G-CSF mobilization.…”