Factors affecting successful mobilization with plerixafor: an Italian prospective survey in 215 patients with multiple myeloma and lymphoma

Transfusion. 2014 Feb;54(2):331-9. doi: 10.1111/trf.12265. Epub 2013 Jun 19.

Abstract

Background: Although the efficacy of plerixafor in peripheral blood stem cell (PBSC) mobilization has been explored in several studies, factors associated with successful plerixafor mobilization after administration of granulocyte-colony-stimulating factor (G-CSF), with or without chemotherapy, have not been investigated. We analyzed data on PBSC mobilization from a large Italian database of lymphoma and myeloma plerixafor-treated patients.

Study design and methods: Two endpoints were established to define successful mobilization: patients with at least 2 × 10(6) CD34+ cells/kg collected by three leukapheresis procedures and patients achieving a peak count of at least 20 × 10(6) CD34+ cells/L during mobilization.

Results: Plerixafor achieved successful mobilization in both predicted (n = 64) and proven poor mobilizers (PMs; n = 143), classified according to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) criteria. Successful mobilization was independent of type of mobilization (steady state or chemotherapy); age; sex; disease; number or type of chemotherapy regimens preceding plerixafor; radiation therapy; prior treatment with melphalan, carmustine, lenalidomide, and radioimmune conjugates; and laboratory variables. Multivariate analysis identified previous fludarabine treatment and premobilization platelet count as predictors of successful mobilization.

Conclusion: This large, prospective, nationwide study confirmed plerixafor efficacy for mobilizing PBSCs when added to G-CSF with or without chemotherapy. Plerixafor can overcome negative effects of most predictors of poor mobilization to achieve satisfactory harvest both in predicted and proven PM.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Benzylamines
  • Blood Component Removal / methods
  • Chemoradiotherapy
  • Cyclams
  • Data Collection
  • Female
  • Hematopoietic Stem Cell Mobilization / methods*
  • Heterocyclic Compounds / therapeutic use*
  • Humans
  • Italy
  • Leukapheresis / methods
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Multiple Myeloma / therapy*
  • Platelet Count
  • Predictive Value of Tests
  • Prospective Studies
  • Receptors, CXCR4 / antagonists & inhibitors*
  • Young Adult

Substances

  • Benzylamines
  • Cyclams
  • Heterocyclic Compounds
  • Receptors, CXCR4
  • plerixafor