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Impact of body mass index (BMI) on the efficacy of plerixafor for hematopoietic progenitor cell (HPC) mobilization

Bone Marrow Transplantation volume 57, pages 1194–1197 (2022)Cite this article

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Plerixafor in combination with a granulocyte colony-stimulating factor (G-CSF) is commonly used to mobilize hematopoietic progenitor cells (HPC) for autologous transplantation. Effects of body mass index (BMI) on plerixafor mobilization efficacy are controversial with conflicting results from previous studies. One hundred and fifty-five patients mobilized with G-CSF plus plerixafor were included in our analysis. The first 83 patients before November 2012 received upfront plerixafor/G-CSF mobilization. Remaining patients received a “just-in-time” approach with plerixafor added if peripheral CD34+ count was <10/µL by day 4 with G-CSF use. For analysis, patients receiving plerixafor were divided into obese (BMI ≥ 30) and non-obese (BMI < 30) groups to evaluate mobilization outcomes. A median of 2 plerixafor doses were given in both obese/non-obese groups. Median peak peripheral CD34+ count was 42/µL versus 33/µL in obese/non-obese patients, respectively (P = 0.19). Median CD34+ collection on Day 1 was 2.1 × 106 CD34+ cells/kg and 2.7 × 106 CD34+ cells/kg in obese/non-obese groups, respectively (P = 0.57). Successful collection of ≥2 and 5 × 106 CD34+ cells/kg occurred in 91% and 66% of obese versus 91 and 62% of non-obese patients, respectively (P = 1, 0.74). Higher BMI does not compromise cell mobilization for autologous transplant in myeloma and lymphoma patients.

Peripheral blood hematopoietic progenitor cells (HPC) have replaced bone marrow as the preferred graft source for autologous hematopoietic cell transplantation (AHCT) [1, 2]. The most common indications for autologous transplant are non-Hodgkin lymphoma (NHL), multiple myeloma (MM), and Hodgkin lymphoma [2]. HPC mobilization yield (and in turn, the infused cell dose) is a predictor of post-transplant hematopoietic recovery. Many risk factors contribute to poor HPC yield (CD34+ cells) and mobilization failure. Commonly reported risk factors include advanced age, number of prior therapies, radiation exposure, certain therapeutic agents (e.g., melphalan, lenalidomide, fludarabine), and degree of bone marrow involvement [1,2,3]. BMI has not been found to be a risk factor for poor mobilization in healthy patients mobilized with single agent granulocyte colony-stimulating factor (G-CSF) [1].

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Fig. 1

Data availability

The datasets generated and analyzed during the current study are not publicly available due to containing identifiable patient information but are available in a deidentified fashion from the corresponding author on reasonable request.

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Acknowledgements

SW acknowledges the WVCTSI support from the National Institute of General Medical Sciences grant U54GM104942.

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  1. Rebecca M. Gonzalez

    Present address: Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA

Authors and Affiliations

  1. Department of Pharmacy, West Virginia University Medicine, Morgantown, WV, USA

    Spencer K. Yingling, Rebecca M. Gonzalez, Megan Dillaman, Kelsea Seago & Aaron Cumpston

  2. Osborn Hematopoietic Malignancy and Transplantation Program, MBRCC, West Virginia University, Morgantown, WV, USA

    Spencer K. Yingling, Megan Dillaman, Kelsea Seago, Kelly G. Ross, Lauren Veltri & Aaron Cumpston

  3. Department of Biostatistics, MBRCC, West Virginia University, Morgantown, WV, USA

    Sijin Wen

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Contributions

SY Data collection, data analysis, data interpretation, drafting paper, critical revisions, paper approval. RG Concept design, data collection, data interpretation, critical revisions, paper approval. MD Data interpretation, critical revisions, paper approval. KS Data interpretation, critical revisions, paper approval. SW Statistical analysis, critical revisions, paper approval. KR Data interpretation, critical revisions, paper approval. LV Data interpretation, critical revisions, paper approval. AC Concept design, data analysis, data interpretation, drafting paper, critical revisions, paper approval.

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Correspondence to Spencer K. Yingling.

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Yingling, S.K., Gonzalez, R.M., Dillaman, M. et al. Impact of body mass index (BMI) on the efficacy of plerixafor for hematopoietic progenitor cell (HPC) mobilization. Bone Marrow Transplant 57, 1194–1197 (2022). https://doi.org/10.1038/s41409-022-01685-8

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