Optimizing Autologous Stem Cell Mobilization Strategies to Improve Patient Outcomes: Consensus Guidelines and Recommendations

Abstract

Autologous hematopoietic stem cell transplantation (aHSCT) is a well-established treatment for malignancies such as multiple myeloma (MM) and lymphomas. Various changes in the field over the past decade, including the frequent use of tandem aHSCT in MM, the advent of novel therapies for the treatment of MM and lymphoma, and the addition of new stem cell mobilization techniques, have led to the need to reassess current stem cell mobilization strategies. Mobilization failures with traditional strategies are common and result in delays in treatment and increased cost and resource utilization. Recently, plerixafor-containing strategies have been shown to significantly reduce mobilization failure rates, but the ideal method to maximize stem cell yields and minimize costs associated with collection has not yet been determined. A panel of experts convened to discuss the currently available data on autologous hematopoietic stem cell mobilization and transplantation and to devise guidelines to optimize mobilization strategies. Herein is a summary of their discussion and consensus.

Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34+ cell levels and preemptive intervention vs remobilization

“…17,18 At present, the measurement of preapheresis levels of CD34+ cells in PB 7,[19][20][21][22] is the most robust and recommended indicator to identify potential poor mobilizers and efficiently rescue them with novel mobilization strategies, including the use of plerixafor. 23,24 Plerixafor in combination with steady-state G-CSF mobilization in patients with lymphoma and multiple myeloma has been shown very reproducibly to increase PBSC yields and the number of patients yielding target cell doses, both in first-line mobilization [25][26][27][28] and as remobilization strategy in patients who failed prior mobilization attempts, including those with a variety of high-risk clinical factors. [29][30][31][32][33][34][35] Following drug approval by Food and Drug Administration and European Medicines Agency, several groups developed treatment algorithms to guide the use of plerixafor based on CD34+ cell levels in PB and/or the first apheresis product, in combination with a variety of clinical factors.…”

Mobilization policy in multiple myeloma: minimum target or law of redundancy? Two different approaches by the two sides of the Atlantic Ocean

“…4 However, target dose should be programtailored, as in the case of tandem ASCT, in which the suggested minimum target is 6 × 10 6 CD34+/kg. 5 Single agent G-CSF is the standard procedure for HPCs mobilization in MM patients in many US centers, while chemotherapy followed by G-CSF is still widely used in European Union. However, chemotherapy-based mobilization regimens may cause significant neutropenia and infections, which might jeopardize a successful harvest.…”

Lenfoma hastalarında yetersiz hematopoiteik kök hücre mobilizasyonu için risk faktörleri

“…The patients were treated with chemotherapy with (14 patients) or without (43 patients) radiotherapy. The median number of the chemotherapy cycles is 9 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and the median of the number of the chemotherapy regimens is 2 (range 1-5). The number of the patients who were treated with rituximab was 27.…”