Optimizing Plerixafor Algorithm For Mobilization Of Peripheral Blood Stem Cells In Patients With Multiple Myeloma Requiring Tandem Transplants
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION(2019)
Abstract
Background Plerixafor is used as an adjuvant to standard G-CSF mobilization to increases CD34+ cell mobilization and decreases the need for multiple days of collection. For patients with multiple myeloma (MM) and a collection goal of ≥5 × 10e6 CD34/kg our center follows an algorithm - if day 4 absolute CD34 is ≤20 cells/µl, patients are given a single dose of plerixafor in addition to G-CSF. For CD34 counts between 20 and 30/ µl, the administration of plerixafor was physician-dependent. Methods To assess the effectiveness of our algorithm we identified 119 consecutive MM patients who had GCSF only mobilization at our center and investigated the relationship between their day 4 absolute CD34, the administration of plerixafor and the number of days of apheresis. The patients were categorized into the following groups based upon day 4 CD34 count and administration of plerixafor (P): CD34 30 noP (n=26). Results In the 30noP group, 23/26 (88%) patients reached goal (range 4.01 × 106 – 9.14 × 106 CD34/kg) on day 1. Patients with Day 4 CD34 count between 20-30/ µl were significantly more likely to collect in one day if they have received Plerixafor (P=0.002). Conclusion This data justifies revision of the threshold for plerixafor administration to patients with a day 4, CD34 count from
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Key words
peripheral blood stem cells,plerixafor algorithm
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