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Plerixafor and G-CSF for autologous stem cell mobilization in AL amyloidosis

Bone Marrow Transplantation volume 49, page 1233 (2014)Cite this article

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Risk-adapted melphalan and SCT (RA-SCT) is considered a standard therapy for selected patients with systemic AL amyloidosis (AL), with median OS exceeding 10 years when used as initial therapy.1 With this approach, peri-transplant mortality has been reduced but complications related to stem cell mobilization, particularly with high-dose G-CSF (16 mcg/kg), remain significant concerns. These concerns are amplified with the growing use of RA-SCT as consolidation post induction or as second-line therapy at relapse. Plerixafor is a small molecule that reversibly inhibits chemokine stromal cell-derived factor 1-α binding to its cognate CXC chemokine receptor, and its addition to G-CSF, compared to G-CSF alone, in patients with multiple myeloma was well tolerated and led to significantly increased CD34+ cell yields.2 Based on this experience we evaluated the use of plerixafor and G-CSF (10 mcg/kg) for stem cell mobilization in 12 consecutive patients with AL (7 men, 5 women) between 4 June 2012 and 9 September 2013.

Median age at mobilization was 58 years (range 46–72), time from diagnosis to mobilization 7.5 months (2–123) and number of organs involved 2 (1–4). The kidney (n=9) and heart (n=8, all stage 2) were most commonly involved. Nine patients had had prior bortezomib-based induction therapy (median 3 cycles). One had undergone SCT 10 years earlier and had relapsed, and two were untreated, including one who was a year post orthotopic heart transplant. Five patients had creatinine ⩾1.5 mg/dL, including two on hemodialysis (HD).

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References

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Authors and Affiliations

  1. Division of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA

    E Kaul, G Shah, C Chaulagain & R L Comenzo

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  1. E Kaul
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  2. G Shah
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  3. C Chaulagain
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  4. R L Comenzo
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Correspondence to E Kaul.

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Competing interests

RLC: consultant/scientific advisor, Takeda, Prothena; clinical research funding, Takeda, Prothena, Teva. The other authors declare no conflict of interest.

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Kaul, E., Shah, G., Chaulagain, C. et al. Plerixafor and G-CSF for autologous stem cell mobilization in AL amyloidosis. Bone Marrow Transplant 49, 1233 (2014). https://doi.org/10.1038/bmt.2014.117

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