Plerixafor to the rescue: boosting peripheral blood stem cell mobilization in patients previously treated with hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy

Abstract

Hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone/methotrexate, cytarabine (Hyper-CVAD) chemotherapy exerts deleterious effects on peripheral blood stem cell (PBSC) mobilization. We retrospectively reviewed the use of plerixafor to salvage mobilization in 18 Hyper-CVAD treated patients who initially mobilized poorly with chemotherapy and granulocyte colony stimulating factor (G-CSF). After plerixafor administration the median peripheral blood (PB) CD34 + count rose from 3.74/μL (0–17/μL) to 6.85/μL (0–47.2/μL). The patients collected a median of 1.64 (0.21–5.56) × 10⁶ CD34 + cells/kg with a median number of 3 (1–4) doses in the same collection cycle, and 11 patients reached the 2.0 × 10⁶ CD34 + cells/kg minimum required for transplant. Six patients were remobilized later with G-CSF and plerixafor, and three additional patients reached this goal. For these 14 patients the median number of doses of plerixafor required to reach 2.0 × 10⁶ CD34 + cells/kg was 3 (range 1–4). In conclusion, plerixafor can be utilized successfully in many cases to overcome the effects of Hyper-CVAD on PBSC mobilization.

Keywords::

• Plerixafor
• autologous peripheral blood stem cell (PBSC) mobilization
• salvage mobilization
• Hyper-CVAD

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