Hematopoietic progenitor cell mobilization for autologous transplantation – a literature review

Abstract

The use of high-dose chemotherapy with autologous support of hematopoietic progenitor cells is an effective strategy to treat various hematologic neoplasms, such as non-Hodgkin lymphomas and multiple myeloma. Mobilized peripheral blood progenitor cells are the main source of support for autologous transplants, and collection of an adequate number of hematopoietic progenitor cells is a critical step in the autologous transplant procedure. Traditional strategies, based on the use of growth factors with or without chemotherapy, have limitations even when remobilizations are performed. Granulocyte colony-stimulating factor is the most widely used agent for progenitor cell mobilization. The association of plerixafor, a C-X-C Chemokine receptor type 4 (CXCR4) inhibitor, to granulocyte colony stimulating factor generates rapid mobilization of hematopoietic progenitor cells. A literature review was performed of randomized studies comparing different mobilization schemes in the treatment of multiple myeloma and lymphomas to analyze their limitations and effectiveness in hematopoietic progenitor cell mobilization for autologous transplant. This analysis showed that the addition of plerixafor to granulocyte colony stimulating factor is well tolerated and results in a greater proportion of patients with non-Hodgkin lymphomas or multiple myeloma reaching optimal CD34+ cell collections with a smaller number of apheresis compared the use of granulocyte colony stimulating factor alone.

Comparison and cost analysis of three protocols for mobilization and apheresis of haematopoietic progenitor cells

“…The main objective of mobilization is to collect a sufficient number of progenitor cells so that the patient can undergo an autologous transplant. However, optimal mobilization requires collection of a minimum number of cells in the least number of sessions and as little time as possible to reduce the cost, avoid adverse events, such as hospitalization due to febrile neutropenia, and decrease the failure rate …”

“…Since the introduction of a new mobilizing agent, plerixafor (Mozobil), a C‐X‐C chemokine receptor type 4 (CXCR4) antagonist used in combination with G‐CSF, the need to optimize the process and take the following objectives into account has arisen: to reduce the number of apheresis sessions necessary to collect the minimum target of CD34+ cells, to decrease the percentage of mobilization failures and to achieve an adequate cost‐benefit ratio.…”

“…In recent years, the role of plerixafor has been studied in patients called “poor mobilizers” by either preventively starting this treatment the day before the first session or as a rescue during the following days …”

Cure of Insulin-Dependent Diabetes Mellitus by an Autologous Hematopoietic Stem Cell Transplantation Performed to Control Multiple Myeloma in a Patient with Chronic Renal Failure on Regular Hemodialysis

“…The agents that are used in the peripheral blood progenitor cell mobilization include: growth factors such as G-CSF, cyclophosphamide in combination with G-CSF, and plerixafor (CXCR4, chemokine receptor type-4 inhibitor) which is used to increase the yield of stem cell collections in patients experiencing poor mobilization [47][48][49][50]. However, G-CSF is the predominant stem cell mobilizer used clinically [36].…”

“…Poor mobilization occurs in up to 25% of patients and it has the following risk factors: lymphoma or MM as the primary illness, heavily pre-treated cancer patients with chemotherapy ± radiotherapy, genetic diseases such as Fanconi anemia, poor BM reserve due to low cellularity, old age, low baseline CD34+ cell count prior to apheresis and low platelet count before mobilization [36,46]. As mobilized peripheral blood progenitor cells are the main sources for auto-HSCT, collection of adequate number these cells is a critical step in the auto-HSCT setting [47]. The goal of CD34+ cell mobilization is to collect enough cells to achieve a rapid and sustained hematopoietic recovery after HDC, since delayed hematopoietic recovery is associated with increased toxicity and TRM [48].…”