Abstract
Plerixafor + granulocyte-colony stimulating factor (G-CSF) is administered to patients with lymphoma who are poor mobilizers of hematopoietic stem cells (HSCs) in Europe. This international, multicenter, non-interventional registry study (NCT01362972) evaluated long-term follow-up of patients with lymphoma who received plerixafor for HSC mobilization versus other mobilization methods. Propensity score matching was conducted to balance baseline characteristics between comparison groups. The following mobilization regimens were compared: G-CSF + plerixafor (G + P) versus G-CSF alone; G + P versus G-CSF + chemotherapy (G + C); and G-CSF + plerixafor + chemotherapy (G + P + C) versus G + C. The primary outcomes were progression-free survival (PFS), overall survival (OS), and cumulative incidence of relapse (CIR). Overall, 313/3749 (8.3%) eligible patients were mobilized with plerixafor-containing regimens. After propensity score matching, 70 versus 36 patients were matched in the G + P versus G-CSF alone cohort, 124 versus 124 in the G + P versus G + C cohort, and 130 versus 130 in the G + P + C versus G + C cohort. For both PFS and OS, the upper bound of confidence interval for the hazard ratio was >1.3 for all comparisons, implying that non-inferiority was not demonstrated. No major differences in PFS, OS, and CIR were observed between the plerixafor and comparison groups.
Highlights
Lymphomas are the second most common indication for autologous hematopoietic stem cell (HSC) transplantation (HSCT)
Plerixafor has a mode of action different from other HSC mobilizing agents and acts by binding to chemokine (C-X-C motif) receptor 4 (CXCR4), preventing the binding of its ligand stromal cell-derived factor 1 (SDF-1, C-X-C motif chemokine 12, CXCL12) and thereby inhibiting events downstream of CXCL12 including SDF-1-mediated G-protein activation, receptor internalization, calcium flux, and chemotaxis [5, 6]
Propensity score method was used to identify study comparison groups that were balanced with respect to baseline characteristics, including, demographics, lymphoma type, disease characteristics and staging, prior treatment characteristics, and disease status [12]
Summary
Lymphomas are the second most common indication for autologous hematopoietic stem cell (HSC) transplantation (HSCT). The most common method for mobilizing HSCs from the peripheral blood is treatment with granulocytecolony stimulating factor (G-CSF) alone or combined with chemotherapy [1, 2]. Plerixafor has a mode of action different from other HSC mobilizing agents and acts by binding to chemokine (C-X-C motif) receptor 4 (CXCR4), preventing the binding of its ligand stromal cell-derived factor 1 (SDF-1, C-X-C motif chemokine 12, CXCL12) and thereby inhibiting events downstream of CXCL12 including SDF-1-mediated G-protein activation, receptor internalization, calcium flux, and chemotaxis [5, 6]. Unlike cytokines used for HSC mobilization (e.g., G-CSF), plerixafor is not a growth factor and does not cause cell proliferation or expansion. The approved use for plerixafor is in combination with G-CSF [9, 10]
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