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Plerixafor and pegylated filgrastim: a case of safe and effective hematopoietic stem cell mobilization

Bone Marrow Transplantation volume 45, pages 1367–1368 (2010)Cite this article

Plerixafor, a Food and Drug Administration-approved CXCR4 antagonist for hematopoietic stem cell mobilization, is effective at mobilizing hematopoietic stem cells in patients with non-Hodgkin's lymphoma when administered with G-CSF.1 Most centers initiate peripheral blood hematopoietic stem cell apheresis early in the week, as some patients require 4 to 5 days to achieve satisfactory stem cell yields. The regimen of filgrastim and plerixafor requires filgrastim administration daily, starting 4 days before apheresis, and plerixafor administration at 2100 hours on the day before apheresis, each to continue throughout the apheresis period.1 This administration scheme creates practical barriers for patients, physicians, and support staff. The primary barriers include administration of filgrastim over a weekend and plerixafor in the late evening. The alternate timing of plerixafor dosing appears to be effective in the initial reports.2 Pegylated filgrastim has shown efficacy and safety in mobilizing peripheral blood hematopoietic stem cells in healthy donors and patients with multiple myeloma.3 We are unaware of reports using a combination of pegylated filgrastim, filgrastim, and plerixafor for hematopoietic stem cell mobilization and would like to describe our experience with a patient receiving this regimen.

This report suggests that safe and effective mobilization can be achieved in a patient with prior radiotherapy and radioimmunotherapy for non-Hodgkin's lymphoma with the combination of pegylated filgrastim, filgrastim and plerixafor. We have no reason to believe that use of a pegylated form of filgrastim would affect the mobilization efficacy or toxicity with plerixafor. We are not certain of the necessity of filgrastim when using pegylated filgrastim with plerixafor mobilization, but the administration schedule we used spared the inconvenience of weekend filgrastim and daily 2100 plerixafor administration. Hopefully, our case will serve as a stimulus for larger centers to study safe and practical mobilization regimens such as the one above, which will allow enhanced convenience for patients.

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References

  1. Dipersio JF, Micallef I, Stiff PJ, Bolwell BJ, Maziarz RT, Angell J et al. A phase III, multicenter, randomized, double-blind, placebo controlled, comparative trial of AMD3100 (Plerixafor)+G-CSF vs Placebo+G-CSF in non-Hodgkin's lymphoma (NHL) patients for autologous hematopoietic stem cell (aHSC) transplantation. Blood (ASH Annu Meet Abstr) 2007; 110(Abstract 601).

  2. Chari A, Vendivil A, Clark-Garvey S, Schwartz J, Slotky R, Diuguid D et al. Feasibility of Cd34-positive stem cell mobilization by administration of AMD3100 six hours prior to leukapheresis. Biol Blood Marrow Transplant 2009; 15: S1 (Abstract 110).

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology and Medical Oncology, Saint Louis University, MO, USA

    M J Fesler, G Kudva & P J Petruska

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  1. M J Fesler
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  2. G Kudva
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  3. P J Petruska
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Correspondence to M J Fesler.

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Fesler, M., Kudva, G. & Petruska, P. Plerixafor and pegylated filgrastim: a case of safe and effective hematopoietic stem cell mobilization. Bone Marrow Transplant 45, 1367–1368 (2010). https://doi.org/10.1038/bmt.2009.342

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