High Number of Successful Mobilizations Associated with the Use of Plerixafor and Colony Stimulating Factors In Patients with Multiple Myeloma (MM) and Lymphoma Treated at Memorial Sloan-Kettering Cancer Center

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2263-2263
Author(s):  
Nelly G. Adel ◽  
Mathew Sherry ◽  
Stephen J. Harnicar ◽  
Emily Mccullagh ◽  
Heather Landau ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Adult Patients ◽  
Stem Cell Mobilization ◽  
Cancer Center ◽  
Published Data ◽  
First Line ◽  
Colony Stimulating Factors ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Abstract 2263 Background: Autologous stem cell transplantation (ASCT) remains the only curative option for many lymphoma patients and it is an integral component of treatment for patients with multiple myeloma (MM). Stem cell mobilization has most commonly been performed using either chemotherapy and colony-stimulating factors or colony stimulating factors alone. This approach was challenged by the inability to collect enough CD 34 cell count to perform an ASCT. Plerixafor (Mozobil ®) previously known as AMD3100, a selective antagonist of CXCR4, has recently been approved for ASCT mobilization in combination with granulocyte- colony stimulating factor (G-CSF) for both multiple myeloma and lymphoma patients and is effective for patients who failed to mobilize enough CD34 cells with other modalities. Patients and Methods: This retrospective study examines all adult patients with MM and lymphoma who received plerixafor as a mobilization agent for ASCT at Memorial Sloan- Kettering Cancer Center between January 1st, 2009 and August 1st, 2010. Patient's information was obtained from the pharmacy data base and electronic medical records. Data included demographics, diagnosis, first line mobilization regimen, second and third line regimens, doses of plerixafor received, number of pheresis sessions and CD34 cells per kg collected per each session. The primary objective was to determine how many patients failed stem cell collection following mobilization at our center. Results: Fifty-six adult patients with lymphoma (N=23) and MM (N=33) were identified. Patients were excluded if they were treated for a pediatric malignancy or an alternate diagnosis. The average number of pheresis and CD34 cells/kg collected in each group are shown Table 1. Forty-three percent (10/23) patients with lymphoma received plerixafor and G-CSF as the first line option for mobilization and 57% (13/23) received plerixafor and G-CSF after failing other regimens. A total of 5 (22%) patients with lymphoma failed collection following mobilization with plerixafor, 1 as a primary mobilization failure and 4 having failed other mobilization strategies. Thirty-nine percent (13/33) of patients with MM received plerixafor and G-CSF as the first line option for mobilization and 61% (20/33)after failing other regimens, including cyclophosphamide (N=15) and G-CSF alone (N=5). Among the patients mobilized with plerixafor, 6% (2/33) failed collection, 1 who received plerixafor and G-CSF for primary mobilization and only 1 after failing other regimens. Conclusion: In lymphoma and MM patients plerixafor in combination with G-CSF is effective for stem cell mobilization and in this study we report higher success rates than in previously published data. The few number of failures with plerixafor plus G-CSF given as a primary mobilization regimen, supports its use in this setting and is attractive considering that it can reduce patient's exposure to chemotherapy. Disclosures: Matasar: Genzyme Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees.

Clinical Impact and Resource Utilization After Stem Cell Mobilization Failure in Patients with Multiple Myeloma and Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2142-2142
Author(s):  
Morie A Gertz ◽  
Robert Wolf ◽  
Ivana N. Micallef ◽  
Dennis A. Gastineau
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Growth Factors ◽  
Hodgkin Lymphoma ◽  
Resource Utilization ◽  
Stem Cell Mobilization ◽  
Hodgkin Disease ◽  
Non Hodgkin Lymphoma ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Abstract 2142 Poster Board II-119 High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal stem cell mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of stem cell mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing mobilization during the study period, stem cell collection (defined by the number of CD34+ cells/kg) was “ optimal” (≥5×106) in 53%, “low” (≥2 to 5×106) in 25%,“ poor” (<2×106) in 10%, and “failed” (<10 CD34+ cells/mL) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. Other costs often omitted include the need for hospitalization, which was seen in 5% to 11% of the patients in our study. Parenteral antibiotics were needed when fever developed in 7% of patients with Hodgkin disease, 4% with non-Hodgkin lymphoma, and 24% with multiple myeloma who underwent mobilization using a chemotherapy pulse. When stem cell mobilization was not immediately optimal, subsequent attempts to mobilize failed completely in 3 of 42 patients (7%) with Hodgkin disease (3% of the original Hodgkin disease cohort), 56 of 157 (36%) with multiple myeloma (6% of the original myeloma cohort), and 50 of 328 (15%) with non-Hodgkin lymphoma (7% of the original non-Hodgkin lymphoma cohort). These usually unappreciated costs of stem cell mobilization failure highlight the need for more effective mobilization strategies. Disclosures: Gertz: genzyme: Research Funding.

scholarly journals G-CSF Plus Preemptive Plerixafor Versus Cyclophosphamide Plus G-CSF for Autologous Stem Cell Mobilization in Multiple Myeloma: Effectiveness, Safety and Cost Analysis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5823-5823
Author(s):  
Ahmad Antar ◽  
Zaher Otrock ◽  
Mohamed Kharfan-Dabaja ◽  
Hussein Abou Ghaddara ◽  
Nabila Kreidieh ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Peripheral Blood ◽  
Stem Cell Mobilization ◽  
Cell Yield ◽  
Fixed Dose ◽  
High Dose ◽  
Peripheral Blood Cd34 ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Introduction: The optimal stem cell mobilization regimen for patients with multiple myeloma (MM) remains undefined. Most transplant centers use either a chemo-mobilization strategy using cyclophosphamide (CY) and granulocyte-colony stimulating factor (G-CSF) or a steady state strategy using G-CSF alone or with plerixafor in case of mobilization failure. However, very few studies compared efficacy, toxicity and cost-effectiveness of stem cell mobilization with cyclophosphamide (CY) and G-CSF versus G-CSF with preemptive plerixafor. In this study, we retrospectively compared our single center experience at the American University of Beirut in 89 MM patients using fractionated high-dose CY and G-CSF as our past preferred chemo-mobilization strategy in MM patients with our new mobilization strategy using G-CSF plus preemptive plerixafor. The change in practice was implemented when plerixafor became available, in order to avoid CY associated toxicity. Patients and methods: Patients in the CY group (n=62) (Table 1) received either fractionated high-dose CY (n=56) (5g/m2 divided in 5 doses of 1g/m2 every 3 hours) or CY at 50mg/kg/day for 2 doses (n=6). G-CSF was started on day +6 of chemotherapy at a fixed dose of 300 µg subcutaneously every 12 hours. All patients in the plerixafor group (n=27) (Table 1) received G-CSF at a fixed dose of 300 µg subcutaneously every 12 hours daily for 4 days. On day 5, if peripheral blood CD34+ was ≥ 20/µl, apheresis was started immediately. Plerixafor (240 µg/kg) was given 7-11 hours before the first apheresis if CD34+ cell count on peripheral blood on day 5 was <20/µl and before the second apheresis if CD34+ cells on the first collect were <3х106/kg. The median number of prior therapies was 1 (range: 1-3) in both groups. Results: Compared with plerixafor, CY use was associated with higher median peak peripheral blood CD34+ counts (35 vs 111 cells/µl, P= 0.000003), and total CD34+ cell yield (7.5 х 106 vs 15.9 х 106 cells/kg, P= 0.003). All patients in both groups collected ≥4x106 CD34+ cells/Kg. Moreover, 60 (96.7%) and 46 (74.2%) patients in the CY group vs 24 (88.8%) and 6 (22%) patients in the plerixafor group collected >6х106 and >10x106 CD34+ cells/kg, respectively (P=0.16; P<0.00001). Only 4 (6.4%) patients required two apheresis sessions in the CY group compared to 11 (40%) in the plerixafor group (P=0.0001). Conversely, CY use was associated with higher frequency of febrile neutropenia (60% vs 0%; P<0.00001), blood transfusions (27% vs 0%; P<0.00001), platelets transfusion (25% vs 0%; P<0.00001) and hospitalizations (64% vs 0%; P<0.00001). No one required intensive level of care and all recovered. Autografting was successfully performed in all patients using high-dose melphalan with a median time from mobilization to the first transplant of 31 days (range: 16-156) in the CY group compared to 13 days (range: 8-40) in the plerixafor group (P=0.027); and median infused CD34+ cells were 7х106/kg (range: 3.1-15.3) versus 5.27 (2.6-7.45), respectively (P=0.002). The average total cost of mobilization using the adjusted costs based on National Social Security Fund (NSSF) prices in Lebanon in the plerixafor group was slightly higher compared with the CY group ($7964 vs $7536; P=0.16). Conclusions: Our data indicate robust stem cell mobilization in MM patients with either fractionated high-dose CY and G-CSF or G-CSF alone with preemptive plerixafor. The chemo-mobilization approach was associated with two-fold stem cell yield, slightly lower cost (including cost of hospitalization) but significantly increased toxicity. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Bortezomib Given in Sequence with Anthracycline and Thalidomide-Containing Regimens Does Not Adversely Affect Stem Cell Mobilization and Engraftment in Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 541-541
Author(s):  
Geoffrey L. Uy ◽  
Nicholas M. Fisher ◽  
Steven M. Devine ◽  
Hanna J. Khoury ◽  
Douglas R. Adkins ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Stem Cell Mobilization ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Cd34 Cells ◽  
Cell Mobilization ◽  
High Dose Melphalan

Abstract Bortezomib (VELCADE®) is a selective inhibitor of the 26S proteasome proven to be safe and effective in the treatment of relapsed or refractory multiple myeloma (MM). While high-dose chemotherapy with autologous hematopoietic stem cell transplant (AHSCT) remains the standard of care, there is considerable interest in incorporating bortezomib into the initial treatment of MM. However, the role of bortezomib in frontline therapy for MM will depend in part on its effects on subsequent stem cell mobilization and engraftment. We conducted a pilot study of bortezomib administered pretransplant followed by high-dose melphalan with AHSCT. Two cycles of bortezomib 1.3 mg/m2 were administered on days 1, 4, 8, and 11 of a 21-day treatment cycle. One week after the last dose of bortezomib, stem cell mobilization was initiated by administering filgrastim 10 mcg/kg/day subcutaneously on consecutive days until stem cell harvest was completed. Stem cell collection began on day 5 of filgrastim via large volume apheresis (20 L/day) performed daily until a minimum of 2.5 x 106 CD34+ cells/kg were collected. Patients were subsequently admitted to the hospital for high-dose melphalan 100 mg/m2/day x 2 days followed by reinfusion of peripheral blood stem cells 48 hours later. Sargramostim 250 mcg/m2/day subcutaneously was administered starting day +1 post-transplant and continued until the absolute neutrophil count (ANC) ≥ 1,500/mm3 for 2 consecutive days. To date, 23 of a planned 40 patients have been enrolled in this study with 19 patients having completed their initial therapy with bortezomib followed by AHSCT. Patient population consists of 16 male and 7 female patients with the median age at diagnosis of 58 years (range 38–68). Myeloma characteristics at diagnosis were as follows (number of patients): IgG (16), IgA (7) with stage II (9) or stage III (14) disease. Prior to receiving bortezomib, 11 patients were treated with VAD (vincristine, Adriamycin and dexamethasone) or DVd (Doxil, vincristine and dexamethasone), 5 patients with thalidomide and 5 patients with both. Two patients did not receive any prior chemotherapy. All patients successfully achieved the target of 2.5 x 106 CD34+ cells/kg in either one (15/19 patients) or two (4/19 patients) collections with the first apheresis product containing a mean of 5.79 x 106 CD34+ cells/kg. Analysis of peripheral blood by flow cytometry demonstrated no significant differences in lymphocyte subsets before and after treatment with bortezomib. Following AHSCT, all patients successfully engrafted with a median time to neutrophil engraftment (ANC ≥ 500/mm3) of 11 days (range 9–14 days). Platelet engraftment (time to platelet count ≥ 20,000/mm3 sustained for 7 days without transfusion) occurred at a median of 12 days (range 9–30 days). Eleven patients were evaluable for response at 100 days post-transplant. Compared to pre-bortezomib paraprotein levels, 3 patients achieved a CR or near CR, 7 maintained a PR while 1 patient developed PD. We conclude that pretransplant treatment with 2 cycles of bortezomib does not adversely affect stem cell yield or time to engraftment in patients with MM undergoing AHSCT. Updated results and detailed analysis will be available at the time of presentation.

Cost Analysis of Using Plerixafor Plus G-CSF Versus Cyclophosphamide Plus G-CSF for Autologous Stem Cell Mobilization in Multiple Myeloma Patients Treated At Memorial Sloan-Kettering Cancer Center (MSKCC),

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4059-4059 ◽  
Author(s):  
Nelly G. Adel ◽  
Elaine Duck ◽  
Karen Collum ◽  
Emily Mccullagh ◽  
Lilian Reich ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Cost Analysis ◽  
Stem Cell Mobilization ◽  
Outpatient Basis ◽  
First Line ◽  
Salvage Regimen ◽  
Cell Mobilization ◽  
The Cost ◽  
Stem Cell Collection

Abstract Abstract 4059 Background: The combination of cyclophosphamide plus G-CSF has been the standard approach for autologous stem cell mobilization in Multiple Myeloma (MM) patients treated at MSKCC for many years. However with the recent FDA approval of plerixafor and its proven efficacy for stem cell collection in patients who had failed collection with cyclophosphamide and G-CSF, the use of plerixafor as first line agent has been advocated for patients with MM. Although proof of improved efficacy of such an approach over G-CSF/cyclophosphamide mobilization remains paramount, comparison of cost analysis between the 2 approaches is also an important parameter that needs to be considered before endorsing plerixafor as first line mobilization agent. Study Design and Method: We performed a retrospective analysis of all MM patients treated between 11/2008 and 3/2011 who received either cyclophosphamide plus G-CSF or plerixafor plus G-CSF as first line mobilization regimen. During this period of time, the target number of stem cell collection was 10 × 106stem cells/kg and patients collecting less than 4 × 106 stem cells/kg were considered mobilization failures and had a second attempt at stem cell mobilization using an alternative approach. Some patients received plerixafor as salvage regimen after failing cyclophosphamide mobilization, while others were re-challenged with a second cycle of plerixafor with cyclophosphamide and G-CSF after failing first line upfront plerixafor mobilization. Mobilization costs accounted for both groups included the costs associated with upfront mobilization, the second line mobilization in patients failing a first mobilization, as well as complications directly related to the mobilization procedures and consist of the following: Costs of drugs cyclophosphamide 3000 mg/m2, plerixafor 0.24 mg/kg, G-CSF 10 mcg/kg per dose administered prior and during pheresis sessions; hospitalization for cyclophosphamide administration; pheresis sessions; laboratory tests on pheresis days; and re-hospitalization occurring within 15 days of either mobilization approaches and considered directly related to the mobilization procedure. All costs were calculated using the institution's ratio of cost to charges, and were normalized and adjusted based on institutional charges for 2010. Results: Ninety-eight patients received cyclophosphamide and G-CSF while thirty-five patients received plerixafor as first line mobilization regimens. Eleven (11%) patients were readmitted due to cyclophosphamide complications, with an average hospital stay of 6.9 days, while none in the plerixafor arm was hospitalized. Twenty-one (21%) of the cyclophosphamide group failed mobilization and received plerixafor as salvage regimen of which 3 (3.1%) failed again and are considered ultimate failures. Two (6%) patients failed upfront mobilization with plerixafor and failed salvage mobilization and are considered ultimate failures (6%). The average number of pheresis sessions performed was 3.4 and 2.2 in the cyclophosphamide and plerixafor upfront groups respectively. In total the average cost per patient who received cyclophosphamide was 1.6 times greater than that of the patients who received plerixafor upfront. Conclusion: This cost analysis indicates that the use of plerixafor upfront for stem cell mobilization may be more cost effective than the current widely used approach employing cyclophosphamide. The cost difference between the two approaches could be attributed to several factors: Cyclophosphamide mobilization requires an initial inpatient hospitalization in our institution and often results in re-admissions due to expected toxicity; additionally, the rate of failures, and therefore need for an additional salvage mobilization appears to be much higher with cyclophosphamide; upfront plerixafor was associated with fewer pheresis sessions, and reduced G-CSF use. As many institutions administer cyclophosphamide mobilization on an outpatient basis, it is important to note that the cost benefit of plerixafor upfront remains even if the hospitalization cost of cyclophosphamide mobilization is removed; the cost ratio of cyclophosphamide becomes 1.3 times that of plerixafor. Overall, this single institution study provides, in the context of current clinical practices at MSKCC, the rational for adopting the use of plerixafor as upfront mobilization agent in MM patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A Pilot Study of Eltrombopag Plus G-CSF for Human CD34+ Cell Mobilization in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5815-5815
Author(s):  
Jacob P. Laubach ◽  
Revital Freedman ◽  
Robert A Redd ◽  
Mason Tippy ◽  
Kristen Cummings ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Pilot Study ◽  
Adverse Events ◽  
Median Number ◽  
Clinical Development ◽  
Stem Cell Mobilization ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Background: Administration of recombinant human thrombopoietin (rhTPO) with G-CSF for stem cell mobilization is associated with high CD34+ stem cell yield, rapid neutrophil recovery following autologus transplantation (ASCT), and decreased red blood cell (rbc) and platelet (plt) transfusions (Solomo, G. et al. Blood 1999). However, clinical development of rhTPO was complicated by the formation of neutralizing anti-TPO antibodies (Li, J. et al. Blood 2001), prompting discontinuation of further clinical development of recombinant TPO. Eltrombopag (Elt) is an orally bioavailable small molecule thrombopoietin receptor (TPO-R) agonist approved by the FDA for treatment of chronic immune thrombocytopenic purpura (ITP). In vitro studies have demonstrated that Elt promotes megakaryocyte proliferation and differentiation of CD34+ bone marrow progenitor cells (Erickson-Miller CL Stem Cells 2009), suggesting that Elt might be a surrogate for rhTPO for stem cell mobilization. In this pilot trial, we evaluated the combination of Elt plus standard G-CSF and cyclophosphamide (C) for stem cell mobilization in patients (pts) with multiple myeloma (MM), a disease for which ASCT remains a standard of care (Blade et al. Blood 2010). Methods: Primary objectives included determination of the median number of CD34+ cells/kg mobilized and the maximum tolerated dose (MTD) of Elt. Pts had MM that was stable or responsive to at least two cycles of chemotherapy with plans for stem cell mobilization and ASCT. Four pts were to be enrolled in each of four dose escalation arms in which they received 0 (Arm D), 50 (Arm A), 100 (Arm B), or 150 mg (Arm C) of eltrombopag in combination with standard C + G-CSF. Adverse events (AEs) were graded by NCI-CTCAE v4. Results: 17 pts have been screened and enrolled to date. Two patients withdrew consent prior to receiving Elt and were excluded from statistical analysis. 15 patients have completed participation in the study to date and two patients remain to be enrolled in Arm C. The first subject in Arm A experienced delayed engraftment that was determined to be unrelated to ELT; rather, the event was attributed to administration of a one-time high dose of corticosteroid for management of a severe hypersensitivity reaction to DMSO that occurred during stem cell infusion. A second subject in Arm A had undergone mobilization with Elt prior to the previously described delayed engraftment event, and to ensure safety underwent a second mobilization with G-CSF and plerixafor. During ASCT, this patient received cells from the second mobilization procedure. While neither event met criteria for a dose-limiting toxicity, the protocol was amended such that three additional patients enrolled in Arm A underwent two rounds of mobilization - the first with Elt plus C and G-CSF and a second with G-CSF plus plerixafor - and received as part of ASCT cells mobilized with Elt. Each of these patients engrafted successfully. The median number of CD34+ cells/kg collected during the first collection day of apheresis in Arms D, A, B, and C was 8.0, 11.0, 15.3, and 26.4. The median total number of CD34+ stem cells collected following mobilization with Elt plus C and G-CSF in Arms D, A, B, and C was 13.2, 12.7, 15.4, and 26.4. The percentage of patients in Arms D, A, B, and C who achieved a target collection of 8 x 10^6 CD34+ stem cells in one collection day was 50, 60, 75, and 100%. There have been no severe adverse events related to Elt . Conclusions: Administration of Elt in combination with C plus G-CSF for stem cell mobilization in pts with MM undergoing ASCT was safe and well tolerated, with no DLTs or severe AEs attributable to Elt. The small size of this pilot study precludes formal statistical comparison of outcomes across treatment Arms, but there appears to be a trend toward increase in yield of CD34+ cells and decrease in apheresis procedures required with increasing doses of Elt. Disclosures Richardson: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees.

scholarly journals Safety and Efficacy of Plerixafor on a Convenient Dose Schedule to Facilitate Outpatient Hematopoietic Stem Cell Collection for Autologous Hematopoietic Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5736-5736 ◽  
Author(s):  
Christopher Chen ◽  
Andrew M. Yeager ◽  
Faiz Anwer ◽  
Ali McBride ◽  
Keri R Maher ◽  
...  
Keyword(s):  
Stem Cells ◽  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Package Insert ◽  
Stem Cell Mobilization ◽  
Cancer Center ◽  
Standard Protocol ◽  
Hematopoietic Stem ◽  
Cell Mobilization

Abstract Background Plerixafor and granulocyte-colony stimulating factor (G-CSF) are commonly used in combination to mobilize CD34+ cells for collection for autologous hematopoietic stem cell transplantation (HSCT). Standard protocol involves four consecutive days of G-CSF followed by plerixafor, administered 11 hours before apheresis (for 8 am harvest next day, 9 pm administration the night before harvest). However, this timing is often logistically impractical for both patients and staff members. To examine whether plerixafor could be given on a less stringent timeline without compromising efficacy, we conducted a retrospective review of multiple myeloma patients who underwent mobilization and collection at our institution from 2010 to 2013. A further subset analysis was also performed on patients based on patient comorbidities such as age, BMI, and prior treatment with Lenalidomide to assess whether or not the earlier administration of plerixafor would affect cell collections in patients with differing characteristics. Methods 52 consecutive patients with multiple myeloma at the University of Arizona Cancer Center were studied to analyze the effectiveness of G-CSF/Plerixafor mobilization with plerixafor given at approximately 14 to 17 hours before apheresis instead of 11 hours as instructed by plerixafor package insert. G-CSF was given according to standard protocol, with patients receiving a rounded dose of 10mcg/kg, to either 300 or 480mcg daily, at 0800 for four consecutive days. Plerixafor was given on the 4th day at 14 to 17 hours (2-5 PM instead of 9PM) before apheresis, which commenced at 0800 the following morning. Patients were given additional doses of plerixafor if inadequate numbers of cells were collected in the initial apheresis session. Results The patient population consisted of 52 consecutive patients, aged 36 to 77 years old, with BMIs ranged 18.7 to 46.6, of which 28 had previously been treated with Lenalidomide. The median number of apheresis sessions to reach goal CD34+ count of 2 X 10^6 was 1 (range 1-4). 11 patients required 2 or more collections (6 patients required 2 collections, 4 required 3, and one individual required 4 collections). Mean CD34+ count collected after all required apheresis sessions per patient was 9.74 x 10^6 (range 2.07 x 10^6 - 24.99 x 10^6). All patients collected sufficient stem cells to proceed with autologous HSCT. Patient were then divided into further groups for further analysis: age (62 or less vs greater than 62), BMI (less than 28 vs 28 or greater), and lenalidomide treatment in the past. None of those three characteristics showed any statistical difference in the number of CD34+ stem cells collected (See graph 1, 2, and 3). Conclusion Based on these data, plerixafor mobilization remains an effective method of stem cell mobilization despite lengthening of the interval from medication administration to apheresis. Moreover, this alleviates the major logistical disadvantage of using plerixafor for stem cell mobilization. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures McBride: Sanofi: Research Funding.

scholarly journals The Comparison of the Autologous Peripheral Blood Stem Cell Mobilization and Collection in Young and Elderly Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4747-4747
Author(s):  
Ayse Birekul ◽  
Ali Unal ◽  
Cagri mehmet Unal ◽  
Yildizhan Esra ◽  
Serdar Sivgin ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Elderly Patients ◽  
Mononuclear Cells ◽  
Young Group ◽  
Elderly Group ◽  
Stem Cell Mobilization ◽  
Success Rates ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Introduction: Adequate hematopoietic stem cell mobilization and collection is essential for patients who are a candidate for autologous stem cell transplantation. In this study, we compared mobilization success rates, the amount of collected stem cells and the factors that could affect the procedure for patients younger and older than 60 years old. Materials (or patients) and methods: For this study, 112 patients who admitted to Erciyes University BMT Center for autologous stem cell transplantation were enrolled. Thirty-three of them (36%) were under 60 years called young group and 76 of them (%64) over 60 years called elderly group.Among the participants, 73 of them were multiple myeloma, 23 of them Non-Hodgkin's lymphoma, 17 of them Hodgkin's lymphoma. Between the groups we compared the amount of pre-apheresis white blood cell (WBC), platelets, peripheral CD34+ cells, value of collected CD34+ cells and mononuclear cells, mobilization failure and success rates and number of apheresis sessions. Results: The median values of pre-apheresis peripheral CD34+ cells were 8,72 /µl and platelets were 86 ×109/L in the young group; CD34+ cells were 8,95/µl and platelets were 86,5 ×109/L in the elderly group (p=0,918, p=0,899). The median values of collected CD34+ cells were 7,61×106/kg (2,52-46,62) and 7,60×106/kg (2,87-25,50) in under and over 60 years, respectively (p=0,800). Also the median values of total collected mononuclear cells (MNC) were 1,41×107/kg and 1,4 ×107/kg in young and elderly group (p=0,607). It was found as 1,89 days in the elderly group and 1,7 days in the young group when we compared their apheresis sessions (p=0,786). There was no statistical significance between two groups; despite the mobilization failure rates were 18 % and 6 % in patients older and younger than 60 years (p=0,087). On the other hand, the number of multiple myeloma in the patients with applied autologous stem cell mobilization was higher in elderly patients than young ones (p=0,004) and we also demonstrated that the failure of mobilization were lower in patients with multiple myeloma than lymphoma patients (p=0,003). There was no significant difference between the amounts of pre-apheresis WBC, platelets and peripheral CD34+ cells in mobilization failure group and success group.Table.Total<60years>60yearsP valueNumber of patients (%)11237(33)75(67)AgeMean4165Pre-apheresisWBC (median)8.958.720.918PLT (median)8686.50,899CD34+ Cell (µl)8.728,950,918CollectedCD34+ Cell (×106/kg)7,617,600,800MNC (×107/kg)1,411,400,607Apheresis sessions (day)1,71.890,607Mobilization failure (%)2(6)13(18)0,087 Discussion: We demonstrated that the amount of pre-apheresis peripheral or collected CD34+ cells and numbers of apheresis sessions are not significantly different in comparison of the young and elderly patients who are planned autologous stem cells transplantation. Mobilization failure rate was higher in lymphoma patients than myeloma patients. It was also found that mobilization failure rates were higher in elderly patients than young patients. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document