Experience with Plerixafor for Hematopoietic Cell Mobilization in Nine Patients with Germ Cell Tumors

Authors

  • V. J. Daphne O'Hara,

    1. Department of Pharmacy, Indiana University Health, Indianapolis, Indiana
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  • Alissa H. Karr,

    1. Department of Pharmacy, Indiana University Health, Indianapolis, Indiana
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  • Shivani Srivastava,

    1. Department of Medicine, Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana
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  • Patrick J. Kiel

    Corresponding author
    1. Department of Medicine, Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana
    2. Department of Pharmacy, Indiana University Simon Cancer Center, Indianapolis, Indiana
    • Address for correspondence: Patrick J. Kiel, Hematology/Stem Cell Transplant, Department of Pharmacy, Indiana University Simon Cancer Center, 550 North University Boulevard, UH 5630, Indianapolis, IN 46202; e-mail: pkiel@iuhealth.org.

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Abstract

Study Objective

To evaluate the efficacy of plerixafor as a just-in-time therapy for patients with germ cell tumors who were identified as poor hematopoietic cell mobilizers after the initiation of apheresis.

Design

Case series.

Setting

National Cancer Institute–designated cancer center.

Patients

Nine patients with germ cell tumors who received plerixafor as an adjunct to granulocyte colony-stimulating factor (G-CSF) for hematopoietic cell mobilization in an attempt to prevent mobilization failure between January 2009 and December 2012.

Measurements and Main Results

Patients were heavily pretreated, having received at least four prior treatment cycles. A median of three total apheresis days (range 1–4 days) was required for all patients, but a median of two apheresis days (range 1–2 days) was needed after the initiation of plerixafor. A median of 0.9 × 106 CD34+ cells/kg (range 0.3–1.5 × 106 CD34+ cells/kg) was harvested with G-CSF mobilization alone; in addition, a median of 2.6 × 106 CD34+ cells/kg (range 0.6–32 × 106 CD34+ cells/kg) was harvested using plerixafor. All nine patients received high-dose carboplatin and etoposide followed by hematopoietic cell transplantation. The median time to neutrophil engraftment was 11 days (range 8–12 days). The median time to platelet engraftment was 16 days (range 10–22 days).

Conclusions

The use of plerixafor in addition to G-CSF as just-in-time therapy permits patients with germ cell tumors to pursue potentially curative therapy with high-dose chemotherapy followed by autologous stem cell rescue.

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