Abstract
Plerixafor is a stem cell mobilising agent, and when administered along with G-CSF has been shown to improve CD34+ stem cell collections in lymphoma and multiple myeloma patients compared to G-CSF alone. Patients who failed to mobilize 6 cells/kg on Day 1 collection received Plerixafor and G CSF for further collections. Study population was divided into two groups as plerixafor yes (PY) who are poor mobilizers and Plerixafor No (PN) who are good mobilizers. Out of 49 patients, 28 patients were in PY group and 21 patients in PN group. Median value of apheresis CD34 of day 1 was 1.75 (range 0.258 to 8.52) in PY group and 2.63 (range 1.06 to 6.29) in PN group and that of day 2 was 3.845 (range 0.317 to 13.89) in PY group and 3.18 (range 0.88 to 6.348) in PN group. Median value of total apheresis CD34 was 8.10 (range 4.33 to 18.66) in PY group and 7.58 (range 4.06 to 9.8) in PN group. Median day of neutrophil engraftment was 11.5 (range 9 - 22) in PY group and 11 (range 9 - 36) in PN group whereas median day of platelet engraftment was 14 (range 9 - 98) in PY group and 13 (range 11 - 98) in PN group. It can be concluded that the use of plerixafor not only enabled poor mobilizers of Lymphoma and Multiple Myeloma to collect adequate stem cells to proceed to ASCT, but also had early neutrophil and platelet engraftment which was comparable with good mobilizers.
Highlights
Plerixafor is a stem cell mobilising agent approved for use along with granulocyte colony-stimulating factor (G-CSF) in lymphoma and multiple myeloma patients whose cells mobilize poorly from bone marrow [1]
It can be concluded that the use of plerixafor enabled poor mobilizers of Lymphoma and Multiple Myeloma to collect adequate stem cells to proceed to autologous peripheral blood stem cell transplant (ASCT), and had early neutrophil and platelet engraftment which was comparable with good mobilizers
Forty-nine patients diagnosed to have multiple myeloma or Lymphoma who were in remission and required autologous peripheral blood stem cell transplant (ASCT) were enrolled in our study and their data was analyzed
Summary
Plerixafor is a stem cell mobilising agent approved for use along with G-CSF in lymphoma and multiple myeloma patients whose cells mobilize poorly from bone marrow [1]. The most important risk factor for inadequate mobilization is prior chemotherapy that received especially those toxic to stem cells such as high dose cyclophosphamide (>7.5 g/m2), melphalan, carmustine, procarbazine, fludarabine, nitrogen mustard and chlorambucil. Interruption of the receptor-ligand interaction results in mobilization of CD34 hematopoietic stem cells to peripheral blood from bone marrow where they can be collected by leukapheresis. Plerixafor when administered along with G-CSF has shown to improve CD34+ stem cell collections in lymphoma and multiple myeloma patients [8] [9]. Plerixafor is administered as a subcutaneous injection at a recommended dose of 0.24 mg/kg which results in sustained increase in circulating CD34+ cells. Dose adjustments are not needed for patients with hepatic or renal insufficiency and are well tolerated [10]
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