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Rescue from failed growth factor and/or chemotherapy HSC mobilization with G-CSF and plerixafor (AMD3100): an
C J Fowler1, A Dunn, B Hayes-Lattin
1Division of Hematology and Medical Oncology, Department of Medicine, Northwest Marrow Transplant Program, Center for Hematological Malignancies, Oregon Health and Science University, Portland, OR 97239, USA.
Bone Marrow Transplantation
|February 3, 2009
Summary
Plerixafor combined with G-CSF successfully mobilized hematopoietic stem cells in patients who previously failed mobilization for autologous stem cell transplantation (Auto-SCT). This approach enables more patients to undergo potentially curative Auto-SCT.
Area of Science:
- Hematology
- Stem Cell Transplantation
- Pharmacology
Background:
- Autologous stem cell transplantation (Auto-SCT) offers curative potential for hematological malignancies.
- Successful engraftment in Auto-SCT relies on adequate hematopoietic stem cell (HSC) mobilization and collection.
- Standard mobilization strategies fail to mobilize sufficient HSCs in some patients, preventing them from receiving Auto-SCT.
Purpose of the Study:
- To evaluate the efficacy of plerixafor in combination with G-CSF for HSC mobilization in patients who failed prior mobilization attempts.
- To assess the feasibility of achieving sufficient CD34(+) HSC yields for Auto-SCT using plerixafor.
Main Methods:
- Retrospective analysis of patients treated with plerixafor and G-CSF on a compassionate use protocol.
- Patients had previously failed standard HSC mobilization strategies.
- Assessed mobilization success based on CD34(+) cell yield and apheresis procedures required.
Main Results:
- 17 out of 20 patients achieved successful HSC mobilization with one apheresis procedure.
- One additional patient required two apheresis procedures for successful mobilization.
- Plerixafor, a CXCR4 antagonist, augmented G-CSF-induced HSC mobilization.
Conclusions:
- The combination of plerixafor and G-CSF is effective in mobilizing sufficient HSCs in patients previously refractory to mobilization.
- This strategy expands eligibility for potentially curative Auto-SCT in patients with hematological malignancies.
- Plerixafor represents a valuable therapeutic option for challenging HSC mobilization cases.
