Identification of prognostic factors for plerixafor‐based hematopoietic stem cell mobilization

Abstract

The introduction of plerixafor has enabled successful collection of stem cells in the majority of patients with lymphoma or myeloma in whom previous attempts at mobilization have failed. However, a proportion of patients have been shown to be resistant to this mobilization regimen. To identify the factors that impair stem cell mobilization and collection with plerixafor, we reviewed the data for 197 patients who had undergone mobilization with plerixafor and granulocyte-colony stimulating factor in Central Europe. Predictors of mobilization failure were evaluated using logistic regression analysis. Among the 197 patients mobilized, the target of 2.0 3 10 6 CD341 cells/kg was collected from 133 (67.5%). Our analysis revealed that previous treatment with lenalidomide, bortezomib, melphalan, radiotherapy, or autologous stem cell transplantation and regimen of plerixafor use in combination with chemotherapy had no significant effect on the efficiency of collection. In contrast, an age 65 years (odds ratio 0.331, 95% CI: 0.112-0.977, P < 0.05), a diagnosis of non-Hodgkin's lymphoma (odds ratio 0.277, 95% CI: 0.124-0.622, P < 0.01), and treatment with four chemotherapy regimens (odds ratio 0.366, 95% CI: 0.167-0.799, P < 0.05) were associated significantly with failed mobilization. The rate of successful mobilizations was decreased in patients treated with purine analogues (odds ratio 0.323, 95% CI: 0.096-1.094, P 5 0.07) but increased in female patients (odds ratio 1.961, CI: 0.943-4.080, P 5 0.07). Patients who are characterized by the above negative features could benefit potentially from further improvement in the mobilization strategy. Am. J. Hematol. 86:550-553, 2011. V

Plerixafor use for peripheral blood stem cell mobilization in Korea

“…A recent study on identifying prognostic factors for prescribing plerixafor-based PBSC mobilization showed that an age of 65 years, a diagnosis of non-Hodgkin's lymphoma, and treatment with four chemotherapy regimens were significantly associated with mobilization failure. Given the congruence between these prognostic factors and GITMO criteria of 'predicted poor mobilizers', it is evident that PBSC mobilization is impacted by the existence of risk factors and hence, the early use of plerixafor for high-risk groups should be carefully considered [5]. Further study is warranted to prevent mobilization failure by maximizing the benefit of plerixafor in Korean clinical setting.…”

How to Find the Optimal Mobilisation Strategy – Impact, Challenges and Solutions

“…33 HSC mobilisation may be affected by: age, ethnicity, type and dose of cytokines used, the patient's diagnosis, number and type of previous chemotherapy cycles or radiation, and interval from last chemotherapy cycle. [33][34][35][36][37][38][39][40] However, these findings are not consistent across all studies and it is difficult to predict how individual patients will respond. Peripheral blood CD34 + cell counts correlate with numbers of CD34 + cells collected.…”

Pharmacoeconomics of Hematopoietic Stem Cell Mobilization: An Overview of Current Evidence and Gaps in the Literature

“…Various patient-related and disease-related characteristics have been identified as having a negative impact on mobilization success rates. These include advanced age [25][26][27]; diagnosis of NHL [25]; prior radiation therapy, extensive prior chemotherapy, or prior treatment with lenalidomide or purine analogs [26][27][28][29][30][31][32][33][34][35][36][37][38]; a hypocellular marrow, marrow involvement at diagnosis, low platelet count, and refractory disease [25]; and prior mobilization failure. Historical failure rates with traditional mobilization approaches have been reported to be as high as 18% to 38% [18,[39][40][41][42], although more recent studies consistently show mobilization failure rates to be below 15% in patients with up-frontetreated MM [43][44][45] and below 10% when CM is incorporated into planned chemotherapy cycles for patients with NHL [46][47][48].…”