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Ann Hematol. 2016 Mar;95(4):603-11. doi: 10.1007/s00277-016-2589-y. Epub 2016 Jan 11.

Prognostic factors for re-mobilization using plerixafor and granulocyte colony-stimulating factor (G-CSF) in patients with malignant lymphoma or multiple myeloma previously failing mobilization with G-CSF with or without chemotherapy: the Korean multicenter retrospective study.

Author information

1
Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
2
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
3
Seoul National University College of Medicine, Seoul, Korea.
4
Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
5
Chonnam National University Hwasun Hospital, Hwasun, Korea.
6
Chonbuk National University Medical School, Jeonju, Korea.
7
National Cancer Center, Goyang, Korea.
8
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
9
Ulsan University Hospital, Ulsan, Korea.
10
Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
11
Kyungpook National University Hospital, Daegu, Korea.
12
Medical Department Sanofi-Aventis Korea, Seoul, Korea.
13
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. csuh@amc.seoul.kr.

Abstract

Plerixafor in combination with granulocyte colony-stimulating factor (G-CSF) has been shown to improve the rates of successful peripheral blood stem cell (PBSC) mobilization in patients with malignant lymphoma or multiple myeloma (MM) who experienced prior failure of PBSC mobilization. We evaluated the mobilization results of re-mobilization using plerixafor and G-CSF in insufficiently mobilizing patients. Forty-four patients with lymphoma (n = 29) or MM (n = 15) were included in the study. The median age was 50 (range, 24-64) years. Previous mobilization regimens were chemotherapy with G-CSF (n = 28), including cyclophosphamide with G-CSF (n = 15), and G-CSF only (n = 16). All patients with lymphoma achieved at least partial response (PR) before the mobilization, including 13 complete responses (CRs). Eleven patients with MM achieved at least PR and four patients with MM were in stable disease before mobilization. The median number of apheresis was 3 (range, 1-6). The median yield of PBSC collections was 3.41 (0.13-38.11) × 10(6) CD34(+) cells/kg. Thirty-four (77.3 %) patients had successful collections defined as at least 2 × 10(6) CD34(+) cells/kg. The rate of successful collections was not different between the two underlying diseases (79.3 % in lymphoma and 73.3 % in MM). Of the entire cohort, 38 (86.4 %) of patients went on to receive an autologous transplant. Previous long-term use of high-risk drugs (>4 cycles use of alkylating agents, platinum-containing agents, or thalidomide) (HR 10.8, 95 % CI 1.1-110.0, P = 0.043) and low platelet count (<100 × 10(9)/L) 1 day before the first apheresis (HR 27.9, 95 % CI 2.9-273.7, P = 0.004) were independent prognostic factors for predicting failure of PBSC re-mobilization using plerixafor and G-CSF. In conclusion, re-mobilization using plerixafor and G-CSF showed a success rate of 77.3 % in patients with lymphoma or MM who experienced prior failure of PBSC mobilization, and the majority of them underwent autologous transplant. Therefore, plerixafor-based re-mobilization was an effective method in poor mobilizers.

KEYWORDS:

Granulocyte colony-stimulating factor; Malignant lymphoma; Mobilization; Multiple myeloma; Plerixafor; Prognostic factor

PMID:
26754633
DOI:
10.1007/s00277-016-2589-y
[Indexed for MEDLINE]

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