Yuan Shan, Nademanee Auayporn, Kaniewski Mark, Palmer Joycelynne, Shayani Sepideh, Wang Shirong
Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, City of Hope National Medical Center, Duarte, California.
Transfusion. 2014 Aug;54(8):2015-21. doi: 10.1111/trf.12594. Epub 2014 Mar 24.
Plerixafor is a Food and Drug Administration-approved agent for improving peripheral blood stem cell (PBSC) mobilization in filgrastim (granulocyte-colony-stimulating factor [G-CSF])-stimulated patients with multiple myeloma and non-Hodgkin's lymphoma. Limited information is available on its use in Hodgkin's lymphoma (HL) patients. We describe our experience with plerixafor as an immediate rescue agent in HL patients with poor PBSC mobilization.
We retrospectively reviewed the collection data of 27 consecutive HL patients at our center in whom plerixafor was added to rescue a failing PBSC collection after G-CSF and chemotherapy (26) or G-CSF alone (1). Plerixafor was added in 11 patients due to peripheral blood (PB) CD34+ counts that persisted below the threshold (>10 × 10(6) /L) to initiate collection (median, 1.47 × 10(6) ; range 0 × 10(6) -6.28 × 10(6) /L) and in 16 patients due to low collection yields, who had a median yield of 0.33 × 10(6) (0.14 × 10(6) -0.65 × 10(6) ) CD34+ cells/kg on the last collection before plerixafor administration.
After a median of 2 (range, 2-4) collections with plerixafor, the patients collected a median of 1.82 × 10(6) (0.52 × 10(6) -11.14 × 10(6) ) CD34+ cells/kg. The addition of plerixafor enabled 20 patients (74.1%) to reach the 2.0 × 10(6) CD34+ cells/kg minimum required for autologous stem cell transplantation (ASCT) during the same collection cycle. Subsequent remobilization in three patients with plerixafor enabled all three to reach this goal.
Plerixafor can be used in HL patients with poor mobilization as a rescue agent and boosts mobilization sufficiently in most patients in the same collection attempt, thus not only permitting ASCT, but also avoiding remobilization and the associated costs, treatment delays, and patient inconvenience.
普乐沙福是一种经美国食品药品监督管理局批准的药物，用于改善在接受非格司亭（粒细胞集落刺激因子[G-CSF]）刺激的多发性骨髓瘤和非霍奇金淋巴瘤患者中的外周血干细胞（PBSC）动员。关于其在霍奇金淋巴瘤（HL）患者中的应用信息有限。我们描述了我们使用普乐沙福作为PBSC动员不佳的HL患者的即时救援药物的经验。
我们回顾性分析了我们中心27例连续HL患者的采集数据，这些患者在接受G-CSF和化疗（26例）或仅接受G-CSF（1例）后，添加普乐沙福以挽救失败的PBSC采集。11例患者因外周血（PB）CD34+细胞计数持续低于启动采集的阈值（>10×10⁶/L）（中位数为1.47×10⁶；范围为0×10⁶ - 6.28×10⁶/L）而添加普乐沙福，16例患者因采集产量低而添加，在使用普乐沙福前的最后一次采集时，其CD34+细胞/kg产量中位数为0.33×10⁶（0.14×10⁶ - 0.65×10⁶）。
在使用普乐沙福进行中位数为2次（范围为2 - 4次）采集后，患者采集到的CD34+细胞/kg中位数为1.82×10⁶（0.52×10⁶ - 11.14×10⁶）。添加普乐沙福使20例患者（74.1%）在同一采集周期内达到自体干细胞移植（ASCT）所需的最低2.0×10⁶ CD34+细胞/kg。随后，3例患者再次使用普乐沙福进行动员，均达到了这一目标。
普乐沙福可用于动员不佳的HL患者作为救援药物，并在大多数患者的同一采集尝试中充分提高动员效果，从而不仅允许进行ASCT，还避免了再次动员以及相关的费用、治疗延迟和患者不便。
