Preemptive plerixafor based mobilization strategy in multiple myeloma patients for autologous stem cell transplantation

Plerixafor use in autologous hematopoietic stem cell mobilization

“…[ 14 25 ] In our study, plerixafor was primarily used in the upfront setting based on clinical risk predictors of poor mobilization, or sometimes for a logistic reason to avoid the second pheresis, and about 88% of patients had a successful collection comparable to the other studies reporting on upfront plerixafor use. [ 1 12 23 26 ] In our study, about 52% of the patients in the plerixafor group (both upfront and salvage) needed a second or a third pheresis. In the GCSF group, 20% required more than one apheresis.…”

“…Although one of the few from India remarking on plerixafor use in mobilization for autologous transplant and its comparison with stable GSCF mobilization for clinical outcomes, our study had limitations of being a retrospective study, including missing data in certain areas, small sample size, and period bias. [ 9 11 12 14 23 32 ] Our study also does not report preemptive plerixafor use, the most common strategy followed in most transplant centers. Nevertheless, based on our results of upfront plerixafor use, we suggest that clinical risk predictors should also be considered besides PB CD34 in practicing preemptive plerixafor.…”

“…The most common and cost-effective setting of plerixafor use is preemptive based on the peripheral blood CD34 on day 4 or 5 of GCSF mobilization with about 75%–95% of patients achieving optimal collection with generally a single or two phereses. [ 10 22 23 24 ] As in house CD34 enumeration was unavailable during the study period, preemptive plerixafor use was not done in our study. With upfront plerixafor, irrespective of clinical factors or PB CD34 count, the optimal collection is achieved in 77% of patients though sometimes at a higher total cost.…”

“…The literature data shows a two to three-fold higher CD34 collection in the plerixafor group compared to the GCSF alone group. [ 1 2 14 19 23 27 28 ] Most of the studies on plerixafor use report that a significantly greater number of patients eventually undergo transplant after plerixafor use compared to stable GCSF mobilization alone (RR = 2.59, 95% confidence interval: 1.40–4.81; P < 0.0001), respectively. [ 7 19 29 30 31 ] We did not observe any significant difference in the number of patients finally undergoing transplant in the plerixafor group vs. GCSF only group (90% vs. 98%, respectively).…”