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Hematopoietic Cell Collection

Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34+ cell levels and preemptive intervention vs remobilization

Bone Marrow Transplantation volume 50, pages 34–39 (2015)Cite this article

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Abstract

This retrospective study presents data from 105 consecutive multiple myeloma and lymphoma patients who had PB CD34+ cell counts <10/μL on day 4 of steady-state G-CSF mobilization for autologous hematopoietic cell transplantation. Our results confirm the capacity of plerixafor to improve mobilization outcomes in this clinical setting. In addition, they show that the effectiveness of plerixafor, compared with G-CSF only, translates to patients with very low (<3.5/μL) circulating CD34+ cell counts: overnight CD34+ cell count expansion (5.3- vs 1.7-fold), overall CD34+ cell yield (2.29 vs 0.15 × 106 CD34+ cells per kg) and patients yielding ⩾2 × 106 CD34+ cells per kg (63% vs 3%). Furthermore, our data also show that preemptive plerixafor is significantly more effective and more efficient than in remobilization: CD34+ cell yield in the first apheresis (3.28 vs 2.0 × 106 CD34+ cells per kg) and overall (3.73 vs 2.44 × 106 CD34+ cells per kg), patients yielding ⩾2 × 106 CD34+ cells per kg in the first apheresis (85% vs 44%) and overall (92% vs 64%), all this requiring less days and doses of plerixafor treatment (1.08 vs 1.48). These data would advocate using plerixafor as an early preemptive intervention based on day 4 circulating CD34+ counts, including very high-risk patients with very low circulating levels.

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Acknowledgements

We would like to pay tribute to the late Dr Gregorio Martín-Henao, Director of the Banc de Sang i Teixits Processing Laboratory, from where he played a central role in the development of this collaboration among the BST and affiliated transplant centers, implemented our current mobilization and CD34 monitoring protocols and started the work presented here, before sadly passing away in December 2012. Gregorio’s ideas and expertise are part of this study, remain with us, his colleagues and friends, and will have a lasting impact on our standards of practice and the benefit to our patients.

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Authors and Affiliations

  1. Department of Haematology, Institut Català d’Oncología (ICO) – Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain

    I Sánchez-Ortega, M Encuentra & R F Duarte

  2. Banc de Sang i Teixits, Barcelona, Spain

    S Querol, S Ortega, A Serra, J M Sanchez-Villegas, J R Grifols, M M Pujol-Balaguer & M Pujol-Bosch

  3. Hospital Mutua de Terrassa, Barcelona, Spain

    J M Martí

  4. Hospital Arnau de Vilanova, Barcelona, Spain

    T Garcia-Cerecedo

  5. Hospital Vall d’Hebron, Barcelona, Spain

    P Barba

  6. Institut Català d’Oncologia – Badalona, Barcelona, Spain

    J M Sancho

  7. Hospital Santa Creu i Sant Pau, Barcelona, Spain

    A Esquirol & J Sierra

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  1. I Sánchez-Ortega
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Correspondence to R F Duarte.

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Competing interests

RFD reports honoraria as a speaker and advisory board member for Genzyme-Sanofi, Amgen and Italfarmaco, whose products are discussed here. The remaining authors report no relevant conflict of interest.

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Sánchez-Ortega, I., Querol, S., Encuentra, M. et al. Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34+ cell levels and preemptive intervention vs remobilization. Bone Marrow Transplant 50, 34–39 (2015). https://doi.org/10.1038/bmt.2014.196

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