The Effective Use of Plerixafor as a Real-Time Rescue Strategy for Patients Poorly Mobilizing Autologous CD34+ cells

摘要

Plerixafor enhances CD34+ cell mobilization, however, its optimal use is unknown. We hypothesized that plerixafor could “rescue” patients in the midst of mobilization when factors indicated a poor CD34+ yield. Of 295 consecutive autologous peripheral blood mobilization attempts at our center, 39 (13%) utilized plerixafor as rescue strategy due to a CD34+ cell concentration <10/µL (median 5.95/µL, n=30), low CD34+ cell yield from prior apheresis day (median 1.06 × 10⁶ CD34+ cells/kg, n=7), or other (n=2). Patients received a median of 1 plerixafor dose (range 1–4). Thirty-four (87%) collected ≥ 2 × 10⁶ CD34+ cells /kg and 26 (67%) collected ≥ 4 × 10⁶ CD34+ cells /kg. Median collections for lymphoma (n=24) and myeloma (n=15) patients were 4.1 × 10⁶ and 8.3 × 10⁶ CD34/kg, respectively. A single dose of plerixafor was associated with an increase in the mean peripheral blood CD34+ concentration of 17.2 cells/µL (p<0.001) and mean increased CD34+ cell yield following a single apheresis of 5.11 × 10⁶/kg (p<0.03). A real-time rescue use of plerixafor is feasible and may allow targeted use of this agent.