Plerixafor Added to Chemotherapy Plus G-CSF Is Safe and Allows Adequate PBSC Collection in Predicted Poor Mobilizer Patients with Multiple Myeloma or Lymphoma

Abstract

We evaluated the safety and efficacy of plerixafor, subsequent to disease-specific chemotherapy followed by granulocyte-colony stimulating factor (G-CSF), in 37 multiple myeloma (MM) or lymphoma patients, who were candidates for autologous stem cell transplantation (ASCT) predicted as poor mobilizers (PMs). Patients were identified as predicted PMs according to the history of a previously failed mobilization attempt or the presence of ≥1 factors predicting an unsuccessful harvest, such as advanced disease, prior extensive radiotherapy, or prolonged treatment, with stem cell poisons, advanced age, or extensive bone marrow involvement. Plerixafor (0.24 mg/kg) was administered subcutaneously for up to 3 consecutive days while continuing G-CSF for 9 to 11 hours before the planned apheresis. Plerixafor administration was safe and no significant adverse events were recorded. We observed a median 4-fold increase (range: 1.4-32) in the number of circulating CD34(+) cells following plerixafor compared with baseline CD34(+) cell concentration (from a median of 5 cells/μL, range: 1-32, to a median of 32 cells/μL, range: 6-201). Twenty-seven of the 37 patients (14 of 17 with MM and 13 of 20 with lymphoma) had ≥2×10(6) CD34(+) cells/kg collected in 1-3 apheretic procedures. Of the 27 patients rescued with plerixafor, 24 (13 MM, 11 lymphoma) have been transplanted with plerixafor-mobilized peripheral blood stem cells, showing a rapid and durable hematologic recovery. Our results suggest that the addition of plerixafor to G-CSF after disease-oriented chemotherapy is safe and allows for a satisfactory harvest in order to perform a safe ASCT, in a relevant proportion of lymphoma and MM patients considered to be PMs.

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

“…18 Moreover, plerixafor has been shown to be feasible to combine with chemotherapy and G-CSF in predicted poor mobilizers with MM or lymphoma. 31 However, the major limitation to the use of plerixafor is related to high cost. To solve this problem, many investigators have developed algorithms for same day decision on the use of plerixafor based on peripheral blood CD34+ cell count on the fourth or fifth day of mobilization.…”

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

“…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. Thus far, there are no definitive studies comparing the mobilization effectiveness, and importantly, the cost effectiveness of C+G-CSF versus P+G-CSF as mobilization regimens.…”

Plerixafor and autologous stem cell transplantation

“…Recently, Attolico et al [20] published data of an interesting study of the use of plerixafor and G-CSF after disease-oriented chemotherapy in 37 multiple myeloma or lymphoma patients, who were candidates for autologous stem cell transplantation (ASCT) predicted as poor mobilizers. Plerixafor was found to be safe and allowed for a satisfactory harvest to enable a safe ASCT in these groups of patients.…”