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Addition of plerixafor to a chemotherapy plus G-CSF mobilization in hard-to-mobilize patients

Bone Marrow Transplantation volume 46, pages 308–309 (2011)Cite this article

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In the autologous setting, high-dose therapy is at present supported by blood stem cells in about 99% of patients. Blood stem cells are collected after mobilization with G-CSF alone or combined with chemotherapy. A significant proportion of patients, however, are difficult to mobilize or fail to mobilize enough stem cells to start apheresis. According to a recent large single-center series, the failure rates (<2 × 106/kg CD34+ cells collected with maximum of five aphereses after a single mobilization attempt) were about 26% for patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) and about 6% in patients with multiple myeloma (MM); more than 90% of the patients were mobilized with G-CSF alone.1 In our own experience using chemotherapy combined with G-CSF (CT+G-CSF) mobilization, the failure rates were 16% in patients with NHL (41 of 258), 13% in patients with HL (5 of 40) and 3% (6 of 178) in patients with MM.

Selection of mobilization regimen used in patients with lymphoproliferative diseases depends on many issues.2, 3 Several patient and disease-related characteristics influence the decision as well as institutional experience and practices. In many lymphoma patients there may be a clinical need to use chemotherapy for the treatment of malignancy and hence the use of chemotherapy regimen followed by G-CSF for stem cell mobilization is straightforward. However, in myeloma patients after effective induction therapy, the use of CY for stem cell mobilization alone has little effect in terms of treatment response.4 Mobilization regimen consisting of CT+G-CSF resulted in higher numbers of stem cells being collected.1, 2, 3 However, chemotherapy-based mobilization is more toxic and needs more supportive care as well other resources.

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Authors and Affiliations

  1. Department of Medicine, Kuopio University Hospital, Kuopio, Finland

    E Jantunen, K Penttilä, M Pyörälä, T Kuittinen & T Nousiainen

  2. Laboratory of Eastern Finland, Kuopio, Finland

    E Mahlamäki

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  1. E Jantunen
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  2. K Penttilä
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  4. E Mahlamäki
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  5. T Kuittinen
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  6. T Nousiainen
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Correspondence to E Jantunen.

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Dr Jantunen has participated in EU leadership meetings organized by Genzyme.

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Jantunen, E., Penttilä, K., Pyörälä, M. et al. Addition of plerixafor to a chemotherapy plus G-CSF mobilization in hard-to-mobilize patients. Bone Marrow Transplant 46, 308–309 (2011). https://doi.org/10.1038/bmt.2010.93

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