Use of plerixafor for peripheral blood stem cell mobilization failure in children

Plerixafor is safe and efficacious for mobilization of peripheral blood stem cells in pediatric patients

“…There were no adverse events, including no reports of diarrhea or nausea that were reported and attributable to plerixafor administration, including the patient who received a higher‐than‐recommended plerixafor dose. The lack of adverse effects recognized in this study is similar to that reported by Emir and colleagues, but much less than the rate of adverse effects reported by Maschan and colleagues who reported that 24% of their patients experienced diarrhea, nausea, ossalgia, or uticaria . While it was possible that adverse events could have been missed due to the retrospective nature of this study, a detailed chart review did not reveal any adverse events attributed to plerixafor during the harvest procedure that required clinical intervention.…”

“…Unfortunately, there is no gold standard second‐line strategy for pediatric patients who fail standard mobilization regimen. In adult populations several studies have shown that the addition of plerixafor to chemotherapy and filgrastim increases the number of patients able to achieve optimal cell collection . Recently, a few reports of plerixafor use in pediatrics have been published, with success rates varying from 57% to 94% …”

A multicenter report on the safety and efficacy of plerixafor based stem cell mobilization in children with malignant disorders

“…4 Risk factors for poor mobilization include multiple prior chemotherapy cycles, exposure to platinum or alkylating agents, and prior radiation therapy or a primary diagnosis of neuroblastoma, medulloblastoma or relapsed/refractory Hodgkin lymphoma (HL). [4][5][6] Plerixafor, a bicyclam derivative and a reversible CXCR4 receptor antagonist, disrupts the interaction of SDF-1 with its receptor CXCR4 on the surface of stem cells, causing release of stem cells from the marrow. 1 Plerixafor along with GCSF has been successfully used in adults either after failure of chemotherapy and cytokinebased mobilization, or as a preemptive agent if peripheral blood (PB) CD34+ cell counts are inadequate.…”

Efficacy of plerixafor in children with malignant tumors failing to mobilize a sufficient number of hematopoietic progenitors with G-CSF

“…10,11 Most studies of plerixafor have been carried out in adults and only single cases and small series have been reported in children. [12][13][14][15][16][17] However, children may be a more suitable population for enhancing mobilization. Indeed, apheresis is technically more sophisticated in low-weight children, with more pronounced citrate toxicity and lower flow rate, resulting in a greater number of procedures and frequent need to prime apheresis contours with packed RBCs.…”