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Worel N, Fritsch G, Agis H, Böhm A, Engelich G, Leitner GC, Geissler K, Gleixner K, Kalhs P, Buxhofer-Ausch V, Keil F, Kopetzky G, Mayr V, Rabitsch W, Reisner R, Rosskopf K, Ruckser R, Zoghlami C, Zojer N, Greinix HT. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure. J Clin Apher 2016; 32:224-234. [PMID: 27578390 DOI: 10.1002/jca.21496] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 12/30/2022]
Abstract
Plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) is approved for autologous stem cell mobilization in poor mobilizing patients with multiple myeloma or malignant lymphoma. The purpose of this study was to evaluate efficacy and safety of plerixafor in an immediate rescue approach, administrated subsequently to G-CSF alone or chemotherapy and G-CSF in patients at risk for mobilization failure. Eighty-five patients mobilized with G-CSF alone or chemotherapy were included. Primary endpoint was the efficacy of the immediate rescue approach of plerixafor to achieve ≥2.0 × 106 CD34+ cells/kg for a single or ≥5 × 106 CD34+ cells/kg for a double transplantation and potential differences between G-CSF and chemotherapy-based mobilization. Secondary objectives included comparison of stem cell graft composition including CD34+ cell and lymphocyte subsets with regard to the mobilization regimen applied. No significant adverse events were recorded. A median 3.9-fold increase in CD34+ cells following plerixafor was observed, resulting in 97% patients achieving at least ≥2 × 106 CD34+ cells/kg. Significantly more differentiated granulocyte and monocyte forming myeloid progenitors were collected after chemomobilization whereas more CD19+ and natural killer cells were collected after G-CSF. Fifty-two patients underwent transplantation showing rapid and durable engraftment, irrespectively of the stem cell mobilization regimen used. The addition of plerixafor in an immediate rescue model is efficient and safe after both, G-CSF and chemomobilization and results in extremely high success rates. Whether the differences in graft composition have a clinical impact on engraftment kinetics, immunologic recovery, and graft durability have to be analysed in larger prospective studies.
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Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Fritsch
- Children?s Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Hermine Agis
- Medical Department I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Böhm
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | - Georg Engelich
- First Medical Department, Hospital Wiener Neustadt, Austria
| | - Gerda C Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Geissler
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Karoline Gleixner
- Medical Department I, Division of Haematology, Medical University of Vienna, Vienna, Austria
| | - Peter Kalhs
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | | | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Viktor Mayr
- Medical Department II, Hospital Krems, Austria
| | - Werner Rabitsch
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | - Regina Reisner
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Konrad Rosskopf
- Department of Blood Group Serology, Medical University Graz, Graz, Austria
| | - Reinhard Ruckser
- Medical Department II, Division of Oncology, Donauhospital Vienna, Vienna, Austria
| | - Claudia Zoghlami
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Niklas Zojer
- Department of Internal Medicine I, Wilhelminen Hospital, Vienna, Austria
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