Abstract
The safety, kinetics and efficacy of plerixafor+pegfilgrastim for hematopoietic stem and progenitor cell (HSPC) mobilization are poorly understood. We treated 12 study patients (SP; lymphoma n=10 or myeloma n=2) with pegfilgrastim (6 mg SC stat D1) and plerixafor (0.24 mg/kg SC nocte from D3). Six SP were ‘predicted poor-mobilizers’ and six were ‘predicted adequate-mobilizers’. Peripheral blood (PB) CD34+ monitoring commenced on D3. Apheresis commenced on D4. Comparison was with 22 historical controls (HC; lymphoma n=18, myeloma n=4; poor mobilizers n=4), mobilized with pegfilgrastim alone. Eight (67%) SP had PB CD34+ count ⩽5 × 106/L D3 post pegfilgrastim; all SP surpassed this threshold the morning after plerixafor. In SP, PBCD34+ counts peaked D4 6/12 (50%), remaining ⩾5 × 106/L for 4 days in 8/12 (67%). All SP successfully yielded target cell numbers (⩾2 × 106/kg) within four aphereses. After maximum four aphereses, median total CD34+ yield was higher in SP than HC; 8.0 (range 2.4–12.9) vs 4.8 (0.4–14.0) × 106/kg (P=0.04). Seven of twelve (58%) SP achieved target yield after one apheresis. Flow cytometry revealed no tumor cells in PB or apheresis product of SP. Plerixafor+pegfilgrastim was well tolerated with bone pain (n=2), diarrhoea (n=2) and facial paraesthesiae (n=3). Plerixafor+pegfilgrastim is a simple, safe and effective HSPC mobilization regimen in myeloma and lymphoma, in both poor and good mobilizers, and is superior to pegfilgrastim alone.
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Dr Herbert was the recipient of a Research Support Grant-In-Aid during from Genzyme during the design and recruitment period of this study.
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Herbert, K., Demosthenous, L., Wiesner, G. et al. Plerixafor plus pegfilgrastim is a safe, effective mobilization regimen for poor or adequate mobilizers of hematopoietic stem and progenitor cells: a phase I clinical trial. Bone Marrow Transplant 49, 1056–1062 (2014). https://doi.org/10.1038/bmt.2014.112
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DOI: https://doi.org/10.1038/bmt.2014.112
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