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Author Spotlight: Exploring the Lifespan Dynamics of Healthy Human Hematopoiesis
Published on: December 8, 2023
A multicenter report on the safety and efficacy of plerixafor based stem cell mobilization in children with malignant
Nabanita Bhunia1, Rolla Abu-Arja1,2, Joseph R Stanek1,2
1Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Plerixafor is safe and effective for peripheral blood stem cell mobilization in children with cancer. This study suggests it can be used as a primary agent, not just after standard methods fail.
Area of Science:
- Pediatric Hematology Oncology
- Stem Cell Transplantation
- Malignancy Treatment
Background:
- Plerixafor is typically used for peripheral blood stem cell (PBSC) mobilization in pediatric cancer patients after standard mobilization (SM) fails.
- Limited data exists on its use as a primary agent in this population.
Purpose of the Study:
- To evaluate the safety and efficacy of plerixafor-based PBSC mobilization in children with malignancies.
- To compare outcomes of plerixafor used upfront with SM versus after SM failure.
Main Methods:
- Retrospective multicenter study of 47 pediatric patients with malignancies undergoing PBSC mobilization.
- Patients were divided into two groups: upfront plerixafor with SM (Group A) and plerixafor after SM failure (Group B).
- Group B was further divided into subgroups based on CD34 count or apheresis yield after initial mobilization attempts.
Main Results:
- Plerixafor mobilization was successful in 87.2% of patients, with similar success rates in both groups.
- Plerixafor significantly increased peripheral blood CD34 counts (median 4-fold increase).
- Adverse events were mild and transient in 8.5% of patients, and engraftment was successful in most who received transplants.
Conclusions:
- Plerixafor-based PBSC collection is safe and effective in pediatric oncology patients.
- The findings support considering plerixafor as a primary mobilizing agent in this population.
Background:
Pleraxifor for peripheral blood stem cell (PBSC) mobilization in children with malignancies is often given following failure of standard mobilization (SM) rather than as a primary mobilizing agent.
Study Design And Methods:
In this retrospective multicenter study, we report the safety of plerixafor-based PBSC mobilization in children with malignancies and compare outcomes between patients who received plerixafor upfront with SM (Group A) with those who received plerixafor following failure of SM (Group B). In the latter pleraxifor was given either following a low peripheral blood (PB) CD34 (<20 cells/cu.mm) (Group B1) or as a second collection process due to an unsuccessful yield (CD34 + < 2 × 106 /kg) (Group B2) following failed SM and first apheresis attempts.
Results:
The study cohort (n = 47) with a median age of 8 (range 0.6-21) year, comprised 19 (40%) Group A and 28 (60%) Group B patients (B1 = 12 and B2 = 16). Pleraxifor mobilization was successful in 87.2% of patients, similar between Groups A and B (84.2% vs 89.2%) and resulted in a median 4-fold increase in PB CD34. Median number of apheresis attempts was 2 in Groups A and B1 but 4 in Group B2. In Group B2, median total CD34+ yield post-plerixafor was 9-fold higher than after SM (P = .0013). Mild to moderate transient adverse events affected 8.5% of patients. Among patients who proceeded to autologous transplant (n = 39), all but one engrafted.
Conclusion:
Plerixafor-based PBSC collection was safe and effective in our cohort and supports consideration as a primary mobilizing agent in children with malignancies.
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