Use of plerixafor in patients with Hodgkin lymphoma with poor mobilization of peripheral blood stem cells

Use of Plerixafor for Stem Cell Mobilization in the Setting of Autologous and Allogeneic Stem Cell Transplantations: An Update

Mobilization failure is an important issue in stem cell transplantations. Stem cells are yielded from the peripheral blood via apheresis. Granulocyte colony-stimulating factor (G-CSF) is the most commonly used mobilization agent among patients and donors. G-CSF is administered subcutaneously for multiple days. However, patients with mobilization failure cannot receive autologous stem cell transplantation and, therefore, cannot be treated adequately. The incidence rate of mobilization failure among patients is about 6–23%. Plerixafor is a molecule that inhibits the binding of chemokine receptor-4 with stromal-cell-derived factor-1, thereby resulting in the release of CD34+ cells in the peripheral blood. Currently, plerixafor is used in patients with mobilization failure with G-CSF and is administered subcutaneously. Several studies conducted on different clinical settings have shown that plerixafor is effective and well tolerated by patients. However, more studies should be conducted to explore the optimal approach for plerixafor in patients with mobilization failure. The incidence of mobilization failure among donors is lower. However, plerixafor is not approved among donors with mobilization failure. Moreover, several clinical studies in donors have shown a beneficial effect of plerixafor. In addition, the adverse events of plerixafor are mild and transient, which can overcome the adverse events due to G-CSF. This review assessed the current role and effects of plerixafor in stem cell mobilization for autologous and allogeneic stem cell transplantations.

Mobilization, Isolation and Characterization of Stem Cells from Peripheral Blood: a Systematic Review

Objectives

The purpose of this article is to systematically review the methods of mobilization, isolation and characterization of stem cells from peripheral blood and to discuss their potential therapeutic applications for bone tissue regeneration.

Material and Methods

An electronic literature search was performed through MEDLINE (PubMed) electronic database. The search was restricted to English language articles published during the last 10 years, from January 2006 to November 2016.

Results

In total, 37 literature sources were reviewed, and 11 of the most relevant articles that are suitable to the criteria were selected. Articles were analysed with data on animals and humans for mobilization, isolation and characterization of stem cells from peripheral blood. From the examination of selected articles, the mobilization materials, side effects, alternatives and factors affecting the extracted amount of mesenchymal stem cells (MSC) from mobilized peripheral blood of healthy individuals, as well as characterization of mobilized MSC were reviewed in this article.

Conclusions

Bone tissue engineering is a potential alternative strategy in bone regeneration and bone defect repair, however, insufficiency data display in the literature on potential therapeutic applications of peripheral blood stem cells for bone tissue regeneration.

Second time a charm? Remobilization of peripheral blood stem cells with plerixafor in patients who previously mobilized poorly despite using plerixafor as a salvage agent

BACKGROUND

Plerixafor is a recently introduced agent used to improve peripheral blood stem cell (PBSC) mobilization in patients with hematologic malignancies. However, some patients still cannot mobilize adequately even with plerixafor.

STUDY DESIGN AND METHODS

We retrospectively reviewed the PBSC collections of 18 consecutive lymphoma and multiple myeloma patients, who had previously mobilized poorly despite the use of plerixafor and received plerixafor again during remobilization.

RESULTS

During the first mobilization attempt, all 18 recombinant granulocyte-colony-stimulating factor (G-CSF; two) or G-CSF plus chemotherapy-mobilized patients (16) had poor response to plerixafor, with peripheral blood (PB) CD34+ counts ranging from 0 to 7.48 × 10(6)/L after the first dose. They collected only 0.15 × 10(6) to 1.63 × 10(6) (median, 0.40 × 10(6)) CD34+ cells/kg after one to four collections. The median average daily yield was 0.24 × 10(6) CD34+ cells/kg. Remobilization began 1 to 4 weeks later with G-CSF, plerixafor, and with (three) or without (15) cyclophosphamide. The PB CD34+ cell counts after the first dose of plerixafor were 3.04 × 10(6) to 127.54 × 10(6)/L (median, 14.58 × 10(6)/L). After one to four doses of plerixafor, each patient collected an additional 0.39 × 10(6) to 14.02 × 10(6) (median, 1.89 × 10(6)) CD34+ cells/kg, and the median daily average was 0.78 × 10(6) CD34+ cells/kg. Cumulatively, after two rounds of collections, 15 collected more than 2.0 × 10(6) CD34+ cells/kg. Thirteen have proceeded to autologous stem cell transplantation (ASCT) and successfully engrafted.

CONCLUSION

In patients who had responded poorly to the use of plerixafor as a mobilization salvage agent, response to remobilization with plerixafor for the second time was variable, but most (83.3%) patients were able to collect enough PBSCs to proceed to ASCT.