Plerixafor-aided Mobilization of Peripheral Blood Hematopoietic Stem Cells to Support Subsequent High-dose Chemotherapy After a Prior Autologous Transplant

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2020-02, Vol.20 (2), p.e50-e57
• Main Authors: Fergadis, Evangelos, Assi, Abraam, Kranidioti, Eleftheria, Kosma, Aikaterini, Karakosta, Maria, Miltiadous, Constantinos, Dimitriadis, George K., Grivas, Anastasios, Athanasopoulos, Aggelos, Lianos, Evangelos, Kosmas, Christos
• Format: Article
• Language: English
• Subjects: Adult; Aged; Benzylamines - pharmacology; Benzylamines - therapeutic use; Cyclams - pharmacology; Cyclams - therapeutic use; Ewing family of tumors; Female; Germ-cell tumors; Hematopoietic stem cell mobilization; Hematopoietic Stem Cell Mobilization - methods; Humans; Male; Middle Aged; Myeloma; Non-Hodgkin's lymphoma; Peripheral Blood Stem Cell Transplantation - methods; Plerixafor; Transplantation, Autologous - methods
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2019.11.022

An appreciable proportion of patients in need of salvage high-dose chemotherapy (HDC) and autologous peripheral blood stem cell (PBSC) transplantation (PBSCT) fail to mobilize adequate numbers of hematopoietic progenitors, and plerixafor is applied for that purpose. Limited data exist on remobilization of PBSCs in patients who have relapsed after prior HDC + PBSCT. Herein, we report on consecutive patients that had undergone successful prior single or tandem HDC for a variety of malignant neoplasms in our institution, and later required re-mobilization of PBSCs in order to support further HDC cycles. Plerixafor was administered in combination with granulocyte-colony stimulating factor alone, or after mobilizing chemotherapy. Five patients, 2 B-cell non-Hodgkin lymphomas, 1 multiple myeloma, 1 germ-cell tumor, and 1 Ewing sarcoma, having relapsed after prior HDC + PBSCT, were deemed candidates for further cycle(s) of PBSC-supported HDC. Plerixafor was applied in a “just-in-time” strategy after low CD34+ numbers were measured on the first day of anticipated hematopoietic stem cell collection (non-Hodgkin lymphoma, germ-cell tumor, and Ewing sarcoma), or pre-emptively in multiple myeloma. Successful collection of adequate PBSCs was achieved in all patients, from 1.8 to 3.8 × 106/kg after a median of 2 (range, 1-3) leukaphereses; 4 of 5 patients underwent subsequent HDC + PBSCT and engrafted after a median of 11 days (range, 9-55 days) and 25 days (range, 17-76 days) for neutrophils and platelets, respectively. Plerixafor proved effective to mobilize adequate numbers of PBSCs in individual patients with relapsed malignancies after prior single or tandem HDC + PBSCT. These PBSCs could establish sustained multi-lineage hematopoietic engraftment without any sequelae. Plerixafor, a stem cell mobilizer with proven potential to rescue “poorly” mobilizing patients, was applied after salvage chemotherapy (+ granulocyte-colony stimulating factor) in a limited series of patients with potentially curable malignancies who had relapsed after a previous autograft. This led to successful stem cell mobilization in all patients, who experienced sustained engraftment after further high-dose chemotherapy supported by the plerixafor-mobilized stem cells.