Efficacy of just-in-time plerixafor rescue for Hodgkin's lymphoma patients with poor peripheral blood stem cell mobilization

Authors

  • Shan Yuan,

    Corresponding author
    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California
    • Address reprint requests to: Shan Yuan, MD, Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA; e-mail: shyuan@coh.org.

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  • Auayporn Nademanee,

    1. Department of Hematology, City of Hope National Medical Center, Duarte, California
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  • Mark Kaniewski,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California
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  • Joycelynne Palmer,

    1. Department of Information Sciences, City of Hope National Medical Center, Duarte, California
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  • Sepideh Shayani,

    1. Department of Pharmacy, City of Hope National Medical Center, Duarte, California
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  • Shirong Wang

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California
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Abstract

Background

Plerixafor is a Food and Drug Administration–approved agent for improving peripheral blood stem cell (PBSC) mobilization in filgrastim (granulocyte–colony-stimulating factor [G-CSF])-stimulated patients with multiple myeloma and non-Hodgkin's lymphoma. Limited information is available on its use in Hodgkin's lymphoma (HL) patients. We describe our experience with plerixafor as an immediate rescue agent in HL patients with poor PBSC mobilization.

Study Design and Methods

We retrospectively reviewed the collection data of 27 consecutive HL patients at our center in whom plerixafor was added to rescue a failing PBSC collection after G-CSF and chemotherapy (26) or G-CSF alone (1). Plerixafor was added in 11 patients due to peripheral blood (PB) CD34+ counts that persisted below the threshold (>10 × 106/L) to initiate collection (median, 1.47 × 106; range 0 × 106-6.28 × 106/L) and in 16 patients due to low collection yields, who had a median yield of 0.33 × 106 (0.14 × 106-0.65 × 106) CD34+ cells/kg on the last collection before plerixafor administration.

Results

After a median of 2 (range, 2-4) collections with plerixafor, the patients collected a median of 1.82 × 106 (0.52 × 106-11.14 × 106) CD34+ cells/kg. The addition of plerixafor enabled 20 patients (74.1%) to reach the 2.0 × 106 CD34+ cells/kg minimum required for autologous stem cell transplantation (ASCT) during the same collection cycle. Subsequent remobilization in three patients with plerixafor enabled all three to reach this goal.

Conclusion

Plerixafor can be used in HL patients with poor mobilization as a rescue agent and boosts mobilization sufficiently in most patients in the same collection attempt, thus not only permitting ASCT, but also avoiding remobilization and the associated costs, treatment delays, and patient inconvenience.

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