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Published on: December 8, 2023
Experience with plerixafor for hematopoietic cell mobilization in nine patients with germ cell tumors
V J Daphne O'Hara1, Alissa H Karr, Shivani Srivastava
1Department of Pharmacy, Indiana University Health, Indianapolis, Indiana.
Study Objective:
To evaluate the efficacy of plerixafor as a just-in-time therapy for patients with germ cell tumors who were identified as poor hematopoietic cell mobilizers after the initiation of apheresis.
Design:
Case series.
Setting:
National Cancer Institute-designated cancer center.
Patients:
Nine patients with germ cell tumors who received plerixafor as an adjunct to granulocyte colony-stimulating factor (G-CSF) for hematopoietic cell mobilization in an attempt to prevent mobilization failure between January 2009 and December 2012.
Measurements And Main Results:
Patients were heavily pretreated, having received at least four prior treatment cycles. A median of three total apheresis days (range 1-4 days) was required for all patients, but a median of two apheresis days (range 1-2 days) was needed after the initiation of plerixafor. A median of 0.9 × 10⁶ CD34⁺ cells/kg (range 0.3-1.5 × 10⁶ CD34⁺ cells/kg) was harvested with G-CSF mobilization alone; in addition, a median of 2.6 × 10⁶ CD34⁺ cells/kg (range 0.6-32 × 10⁶ CD34⁺ cells/kg) was harvested using plerixafor. All nine patients received high-dose carboplatin and etoposide followed by hematopoietic cell transplantation. The median time to neutrophil engraftment was 11 days (range 8-12 days). The median time to platelet engraftment was 16 days (range 10-22 days).
Conclusions:
The use of plerixafor in addition to G-CSF as just-in-time therapy permits patients with germ cell tumors to pursue potentially curative therapy with high-dose chemotherapy followed by autologous stem cell rescue.
