Use of Plerixafor for Stem Cell Mobilization in the Setting of Autologous and Allogeneic Stem Cell Transplantations: An Update

Abstract

Mobilization failure is an important issue in stem cell transplantations. Stem cells are yielded from the peripheral blood via apheresis. Granulocyte colony-stimulating factor (G-CSF) is the most commonly used mobilization agent among patients and donors. G-CSF is administered subcutaneously for multiple days. However, patients with mobilization failure cannot receive autologous stem cell transplantation and, therefore, cannot be treated adequately. The incidence rate of mobilization failure among patients is about 6–23%. Plerixafor is a molecule that inhibits the binding of chemokine receptor-4 with stromal-cell-derived factor-1, thereby resulting in the release of CD34+ cells in the peripheral blood. Currently, plerixafor is used in patients with mobilization failure with G-CSF and is administered subcutaneously. Several studies conducted on different clinical settings have shown that plerixafor is effective and well tolerated by patients. However, more studies should be conducted to explore the optimal approach for plerixafor in patients with mobilization failure. The incidence of mobilization failure among donors is lower. However, plerixafor is not approved among donors with mobilization failure. Moreover, several clinical studies in donors have shown a beneficial effect of plerixafor. In addition, the adverse events of plerixafor are mild and transient, which can overcome the adverse events due to G-CSF. This review assessed the current role and effects of plerixafor in stem cell mobilization for autologous and allogeneic stem cell transplantations.

Day -1 CD34+ Cells and Platelet Count Predict the Number of Apheresis in Poor-Mobilizer Patients Rescued by Plerixafor

“…Notably, most data on plerixafor have been gathered in patients who had previously failed chemotherapy mobilization and were subsequently re-mobilized with the up-front combination of plerixafor and G-CSF [ 18 , 23 ]. However, our findings suggest that on-demand plerixafor administration in association with chemotherapy can be a valid strategy, in particular for patients requiring chemotherapy for the disease control, likewise allowing them to access a potential curative option as ASCT.…”

“…Plerixafor is a chemokine receptor antagonist, which acts to prevent the interaction between stromal-derived factor 1 in the bone marrow (BM) niche and C-X-C chemokine receptor type 4 on HPCs, thereby promoting their migration from BM to PB [ 22 ]. Mobilization regimens including plerixafor alone or in combination have been described in autologous and allogeneic transplant settings [ 23 , 24 ]. When used as up-front mobilization, the combination of G-CSF and plerixafor significantly expands the proportion of MM and lymphoma patients achieving a satisfactory cell dose collection [ 25 , 26 ].…”

“…When used as up-front mobilization, the combination of G-CSF and plerixafor significantly expands the proportion of MM and lymphoma patients achieving a satisfactory cell dose collection [ 25 , 26 ]. In addition to the up-front administration, plerixafor is used in many patients in the course of chemotherapy mobilization, based on a scarce CD34+ cell concentration before apheresis, or when the apheresis failed to achieve an adequate HPC dose (the so called ‘rescue’ or ‘just in time’ use) [ 18 , 23 ]. This strategy reduces the number of mobilization failures and maximizes the cell yield in a significant part of poor mobilizer patients [ 27 , 28 , 29 , 30 , 31 ].…”

Host Cell Targets for Unconventional Antivirals against RNA Viruses

“…However, HIV-1 can also use CXCR4 as a co-receptor. In fact, plerixafor (AMD3100), which is currently used for stem cell mobilization in MM patients undergoing autologous treatment [ 77 , 78 ], was originally conceived as a form of anti-HIV treatment [ 79 ]. Some examples are already available in the literature.…”

Automated chemotherapy compounding: Process optimization for the preparation of admixture containing high-dose of cyclophosphamide

“…2 Even if the efficacy of plerixafor has been previously proven, particularly in patients who failed mobilization with G-CSF, the cost of single administration cannot be ignored. 3 At the same time, CTX and G-CSF protocol, which has been efficiently applied for more than 25 years, is less expensive but often associated with serious treatment-related adverse events, like neutropenia, neutropenic fever, and hematuria. 4,5 It is well known that antineoplastic drugs are recognized as potent hazardous drugs due to their inherent carcinogenic, mutagenic, and nephrotoxic properties.…”