Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization

Plerixafor augments PBSC collection, but the optimal approach for incorporating it into mobilization is uncertain. Forty-nine consecutive patients mobilized with G-CSF alone were analyzed, and a day 4 peripheral blood CD34 + cell count of 0.015/ml was found to predict for a day 5 apheresis yield of...

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Veröffentlicht in:	Bone marrow transplantation (Basingstoke) Jg. 47; H. 12; S. 1526 - 1529
Hauptverfasser:	Chen, A I, Bains, T, Murray, S, Knight, R, Shoop, K, Bubalo, J, Fowler, C, Slater, S, Maziarz, R T
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London Nature Publishing Group UK 01.12.2012 Nature Publishing Group
Schlagworte:	631/250/1904 631/532 Adoption Adult Aged Algorithms Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Apheresis Autografts Biological and medical sciences Blood Bone marrow Bone marrow transplantation Bone marrow, stem cells transplantation. Graft versus host reaction CD34 antigen Cell Biology Failure rates Female Granulocyte colony-stimulating factor Granulocyte Colony-Stimulating Factor - administration & dosage Hematology Hematopoietic Stem Cell Mobilization - methods Hemopoiesis Heterocyclic Compounds - administration & dosage Humans Internal Medicine Lymphoma Lymphoma - blood Lymphoma - therapy Male Medical sciences Medicine Medicine & Public Health Middle Aged Monoclonal gammopathy original-article Paraproteinemia Paraproteinemias - blood Paraproteinemias - therapy Patients Peripheral blood Physiological aspects Progenitor cells Public Health Risk analysis Risk factors Stem cell transplantation Stem Cells T cells Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation, Autologous Treatment Outcome Yield United States Plerixafor mobilization algorithm Mobilization Autograft Hematology Stem cell Hematopoietic cell Graft Antagonist Algorithm CXCR4 chemokine receptor
ISSN:	0268-3369, 1476-5365, 1476-5365
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Zusammenfassung:	Plerixafor augments PBSC collection, but the optimal approach for incorporating it into mobilization is uncertain. Forty-nine consecutive patients mobilized with G-CSF alone were analyzed, and a day 4 peripheral blood CD34 + cell count of 0.015/ml was found to predict for a day 5 apheresis yield of 2 × 10 6 CD34 + progenitors/kg, our institutional minimum necessary for a single autologous transplant. On the basis of this relationship, a clinical guideline was developed which recommended pre-emptive use of plerixafor if the day 4 peripheral blood CD34 + cell count was between 0.005 and 0.015/ml. A total of 166 consecutive subjects with lymphoma or plasma cell dyscrasias underwent G-CSF mobilization after adoption of this care pathway, and the mobilization failure rate was only 7% in patients managed per guideline. The median PBSC yield was 6.3 × 10 6 CD34 + progenitors/kg with G-CSF (day 4 peripheral blood CD34 + cell>0.015/ml) and 4.9 × 10 6 CD34 + progenitors/kg with G-CSF+plerixafor (day 4 peripheral blood CD34 + cell 0.005–0.015/ml). The median number of days of apheresis was 2 in both groups. This clinical guideline is an effective mobilization algorithm that minimizes mobilization failures, reduces poor apheresis yields, does not require risk factor identification and is simple to implement.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0268-3369 1476-5365 1476-5365
DOI:	10.1038/bmt.2012.74