The effect of preemptive use of plerixafor on stem cell mobilization in patients with lymphoma and multiple myeloma

Abstract

ABSTRACT Objective: The aim of this study is to investigate the effect of the preemptive use of plerixafor in patients with lymphoma and multiple myeloma which was administered as a preemptive single dose to the patients who were determined to have a CD34+ cell count of <15/ μL in the peripheral blood (PB) on the 4th day of mobilization. Patients and Methods: Thirty-five patients who were administered plerixafor on the 4th day after granulocyte colony-stimulating factor (G-CSF) alone for stem cell mobilization between January 2020 and November 2021 were included. CD34+ stem cell counts in PB before and after plerixafor, the amount of CD34+ stem cells collected, and the outcome of transplantation was examined. Results: The median CD34+ cell count in PB on the 4th day was 5.2/μL (0.1-13.4), which was determined to increase 206.6-fold (31.57- 49347) to 924.80 /μL (295.00-5056) following the administration of plerixafor on the 5th day (Z=-5.160; r= – 872.2; p<0.0001). The number of apheresis sessions was 1 in all patients. The median collected CD34+ cell count was 5.90x106/kg (2.70x106-14.4x106). Conclusion: The use of preemptive plerixafor shows that it is an effective mobilization method by increasing the rate of stem cell collection at an effective dose and reducing the mobilization time/apheresis sessions.

Keywords

• Apheresis
• Stem cell
• Mobilization
• Plerixafor
• Preemptive

References

1. Ljungman P, Bregni M, Brune M, et al. Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009. Bone Marrow Transplant 2010;45:219-34. doi: 10.1038/ bmt.2009.141
2. Passweg JR, Baldomero H, Gratwohl A, et al. The EBMT activity survey: 1990-2010. Bone Marrow Transplant 2012;47:906-23. doi: 10.1038/bmt.2012.66
3. Arora S, Majhail NS, Liu H. Hematopoietic progenitor cell mobilization for autologous stem cell transplantation in multiple myeloma in contemporary era. Clin Lymphoma Myeloma Leuk 2019;19:200-5. doi: 10.1016/j.clml.2018.12.010
4. Mohty M, Hübel K, Kröger N, et al. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014;49:865-72. doi: 10.1038/bmt.2014.39
5. Giralt S, Costa L, Schriber J, et al. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol of Blood Marrow Transplant 2014;20:295-308. doi: 10.1016/j. bbmt.2013.10.013
6. Farina L, Spina F, Guidetti A, et al. Peripheral blood CD34+ cell monitoring after cyclophosphamide and granulocytecolony- stimulating factor: an algorithm for the pre-emptive use of plerixafor. Leukemia Lymphoma 2014;55:331-6. doi: 10.3109/10428.194.2013.802783
7. Ataca Atilla P, Bakanay Ozturk SM, Demirer T. How to manage poor mobilizers for high dose chemotherapy and autologous stem cell transplantation? Transfusion Apher Sci 2017;56:190- 8. doi: 10.1016/j.transci.2016.11.005
8. Wuchter P, Ran D, Bruckner T, et al. Poor mobilization of hematopoietic stem cells-definitions, incidence, risk factors, and impact on outcome of autologous transplantation. Biol Blood Marrow Transplant 2010;16:490-9. doi: 10.1016/j. bbmt.2009.11.012

9. Lee JL, Kim SB, Lee GW, et al. Collection of peripheral blood progenitor cells: analysis of factors predicting the yields. Transfus Apher Sci 2003;29:29-37. doi: 10.1016/s1473- 0502(03)00097-1
10. Paripati H, Stewart AK, Cabou S, et al. Compromised stem cell mobilization following induction therapy with lenalidomide in myeloma. Leukemia 2008;22:1282-4. doi: 10.1038/ sj.leu.2405100
11. Olivieri A, Marchetti M, Lemoli R, et al. Proposed definition of ‘poor mobilizer’ in lymphoma and multiple myeloma: an analytic hierarchy process by ad hoc working group Gruppo ItalianoTrapianto di Midollo Osseo. Bone Marrow Transplant 2012;47:342-51. doi: 10.1038/bmt.2011.82
12. Shah EE, Young RP, Wong SW, et al. Impact of plerixafor use at different peripheral blood cd34(+) thresholds on autologous stem cell collection in patients with multiple myeloma. Blood Marrow Transplant 2020;26:876-83. doi: 10.1016/j. bbmt.2019.11.024
13. Douglas KW, Gilleece M, Hayden P, et al. UK consensus statement on the use of plerixafor to facilitate autologous peripheral blood stem cell collection to support high-dose chemoradiotherapy for patients with malignancy. J Clin Apher 2018;33:46-59. doi: 10.1002/jca.21563
14. Keating GM. Plerixafor: a review of its use in stem-cell mobilization in patients with lymphoma or multiple myeloma. Drugs 2011;71:1623-47. doi: 10.2165/11206.040.000000000- 00000
15. Cooper DL, Medoff E, Patel N, et al. Autologous stem cell mobilization in the age of plerixafor. Clin Lymphoma Myeloma Leuk 2016;16:411-6. doi: 10.1016/j.clml.2016.04.007
16. Spoerl S, Peter R, Wäscher D, et al. Patients’ outcome after rescue plerixafor administration for autologous stem cell mobilization: a single-center retrospective analysis. Transfusion 2017;57:115-21. doi: 10.1111/trf.13883
17. Gambell P, Herbert K, Dickinson M, et al. Peripheral blood CD34+ cell enumeration as a predictor of apheresis yield:an analysis of more than 1,000 collections. Blood Marrow Transplant 2012;18:763-72. doi: 10.1016/j.bbmt.2011.10.002
18. Szwajcer D, Jennings-Coutts A, Giftakis A, Wall DA. Identification of the CD34 enumeration on the day before stem cell harvest that best predicts poor mobilization. Transfusion 2011;51:587-90. doi: 10.1111/j.1537-2995.2010.02891.x
19. Sancho JM, Morgades M, Grifols JR, et al. Predictive factors for poor peripheral blood stem cell mobilization and peak CD34(+) cell count to guide pre-emptive or immediate rescue mobilization. Cytotherapy 2012;14:823-9. doi: 10.3109/14653.249.2012.681042
20. Costa LJ, Alexander ET, Hogan KR, Schaub C, Fouts TV, Stuart RK. Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization. Bone Marrow Transplant 2011;46:64-9. doi: 10.1038/bmt.2010.78
21. Solá C, Maroto P, Salazar R, et al. Bone marrow transplantation: prognostic factors of peripheral blood stem cell mobilization with cyclophosphamide and filgrastim (r-metHuG-CSF): The CD34+ cell dose positively affects the time to hematopoietic recovery and supportive requirements after high-dose chemotherapy. Hematology (Amsterdam, Netherlands) 1999;4:195-209. doi: 10.1080/10245.332.1999.11746443
22. Worel N, Fritsch G, Agis H, et al. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure. J Clin Apher 2017;32:224-34. doi: 10.1002/jca.21496
23. Micallef IN, Sinha S, Gastineau DA, et al. Cost-effectiveness analysis of a risk-adapted algorithm of plerixafor use for autologous peripheral blood stem cell mobilization. Blood Marrow Transplant 2013;19:87-93. doi: 10.1016/j. bbmt.2012.08.010
24. Vishnu P, Roy V, Paulsen A, Zubair AC. Efficacy and costbenefit analysis of risk-adaptive use of plerixafor for autologous hematopoietic progenitor cell mobilization. Transfusion 2012;52:55-62. doi: 10.1111/j.1537-2995.2011.03206.x