Optimizing mobilization strategies in difficult-to-mobilize patients: The role of plerixafor

Mobilization of hematopoietic progenitor cells for autologous transportation: consensus recommendations

“…The generally applied dose is 10 µg/kg subcutaneously, with apheresis being started on the fifth or sixth day, until the number of target cells is achieved. 41,42 Some studies postulated that G-CSF dose division could result in better mobilization. The pharmacological profile of G-CSF demonstrates a maximum serum concentration within 2 to 8 hours after subcutaneous administration.…”

“…In contrast, chemomobilization is associated with lower predictability to the start of apheresis, as well as the toxicity and complications from the chemotherapy regimen used, including febrile neutropenia and need for hospitalization. 10,42,50,52 Moreover, when the chemomobilization is used as a cycle of part of the induction or rescue therapy, additional expenses with the chemotherapy itself and also hospitalization for treatment administration and management of complications result in higher costs related to the isolated use of G-CSF. 6 The combination of G-CSF with high-doses cyclophosphamide was shown to improve the efficiency of collection and increase the correlation between the CD34+ cell counts in peripheral blood and in the final collection.…”

“…Options for remobilization include dividing the G-CSF dose, remobilization with chemotherapy and G-CSF, remobilization with the same previous regimen, the combination of plerixafor and G-CSF and bone marrow collection. 10,42,59 Mobilization failures are generally defined as <2*106 CD34+ cells collected per kg in a single mobilization or more than 4 sessions of apheresis to collect this minimum number of cells. 10 The division of the G-CSF dose seems to be effective in approximately 1/3 of the patients; however, confirmatory data regarding the effectiveness of this strategy are scarce.…”

“…Finally, isolated reports seem to indicate that the addition of bone marrow cells to peripheral blood progenitor cells may benefit patients with poor mobilization. 10,42,59 Recommendation: in cases of mobilization failure, it is recommended to allow at least 3 …”

Novel Strategies in Hematopoietic Stem Cell Transplantation

“…The introduction of plerixafor in clinical practice for HSC mobilization has increased the effi ciency of the procedure allowing more patients, which were poorly mobilized to produce stem cells by conventional agents, to take advantage of this therapeutic strategy [13,14]. This is due mainly to the fact that more stem cells can be collected in a single session decreasing, thus, the necessary apheresis sessions [15], whereas, for NHL and multiple myeloma patients receiving autologous HSCT, plerixafor in combination with GCS-F led to an increase in the effi ciency of stem cell regrowth [13,14]. Novel CXCR4 antagonists seem to be more promising than plerixafor such as POL5551 [16,17], increasing the yield The second step in HSCT must secure that the donor will escape immune rejection by the recipient and that the transplanted cells will have access to niche spaces in the recipient bone marrow [19][20][21].…”