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G-CSF plus plerixafor (Mozobil) to mobilize hematopoietic stem cells in patients with thrombocytopenia or leukopenia prior to auto-SCT

Bone Marrow Transplantation volume 48, pages 303–304 (2013)Cite this article

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Historically, PBSC mobilization strategies have consisted of chemotherapy and/or cytokines; these regimens are limited by chemotherapy-induced adverse events and a mobilization failure rate of up to 30%.1 Mobilization failure following cytokines with or without chemotherapy may be due to multiple factors including previous mobilization failure,2, 3 >6 months from prior therapy to the start of mobilization,3 prior therapy (for example, radiotherapy, melphalan, platinum-containing chemotherapy regimens, lenalidomide, fludarabine),2, 3, 4 low premobilization platelet counts2, 3 and low WBC counts.3, 5 Thrombocytopenia (platelets ⩽150 × 109/L) at the time of mobilization was consistently predictive of mobilization failure by univariate and multivariate analyses when examined in association with chemotherapy-based mobilization strategies.2, 3 Whether these trends hold true for patients who receive G-CSF plus plerixafor (a CXCR4 chemokine receptor antagonist), a recent addition to the therapeutic armamentarium, remains to be seen.6 Phase 3 studies demonstrated a significant improvement in mobilization outcomes with G-CSF combined with plerixafor, compared with G-CSF alone,1, 7 in non-Hodgkin’s lymphoma (NHL) and multiple myeloma patients. However, patients in the phase 3 studies were excluded if the platelet count was <100 × 109/L and the WBC was <2.5 × 109/L.1, 7

This is a brief report on evaluating the efficacy of plerixafor plus G-CSF in patients with thrombocytopenia or low WBC. In this retrospective analysis of patients with NHL or multiple myeloma in the plerixafor compassionate use program (CUP) in the United States,8, 9 the efficacy of G-CSF plus plerixafor mobilization was examined in patients who had failed prior mobilization and showed varying degrees of thrombocytopenia (platelets <85, <100 or 100−150 × 109/L) or leukopenia (WBC <2.5 × 109/L). Eligibility criteria were previously reported,8, 9 including requiring minimum WBC counts >2.5 × 109/L, absolute neutrophil counts >1.5 × 109/L and platelet counts >100 × 109/L. Some patients with platelet counts <85 × 109/L or low WBC counts received waivers for participation and were included in this analysis.

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Acknowledgements

The development of this manuscript was supported by Sanofi Oncology (formerly Genzyme Corporation). We would like to thank Julie Kern, PhD, and Purvi D Mody, PhD, for editorial support.

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Authors and Affiliations

  1. Department of Medicine/Division of Hematology, Mayo Clinic, Rochester, MN, USA

    I N Micallef

  2. Dana-Farber Cancer Institute, Boston, MA, USA

    E D Jacobsen

  3. Texas Transplant Institute, San Antonio, TX, USA

    P Shaughnessy

  4. Sanofi Oncology, Cambridge, MA, USA

    P J Gandhi & G Calandra

  5. Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    F van Rhee

  6. Internal Medicine Hematology/Oncology, Karmanos Cancer Institute, Detroit, MI, USA

    J Uberti

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  1. I N Micallef
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  2. E D Jacobsen
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  3. P Shaughnessy
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  4. P J Gandhi
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  5. G Calandra
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  6. F van Rhee
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  7. J Uberti
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Correspondence to I N Micallef.

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Competing interests

IM has served as consultant and advisor for and has received research funding from Genzyme. PS has received research funding from Genzyme. He has also served as advisor for and received honoraria from Genzyme, Millennium and Otsuka. PG is employed by Sanofi Oncology (formerly Genzyme Corporation), and GC was previously employed by Genzyme Corporation. The other authors declare no conflict of interest.

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Micallef, I., Jacobsen, E., Shaughnessy, P. et al. G-CSF plus plerixafor (Mozobil) to mobilize hematopoietic stem cells in patients with thrombocytopenia or leukopenia prior to auto-SCT. Bone Marrow Transplant 48, 303–304 (2013). https://doi.org/10.1038/bmt.2012.125

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