Work

255: Rescue Mobilization of Hematopoietic Progenitor Cells with AMD3100 + G-CSF is Successful in Patients Who Previously Failed Mobilization

Year: 2008

Type: article

Abstract: Background: The failure rate for hematopoietic progenitor cell mobilization varies from 5% in Multiple Myeloma pts to 30% in pts with non-Hodgkin lymphoma and Hodgkin lymphoma. Methods: We report the results of a single center experience with AMD3100 (plerixafor) + G-CSF as a rescue progenitor cell mobilization in patients who had failed a prior mobilization. Mobilization failure was defined as inability to collect ≥ 2 × 106 CD34+ cells/kg or inability to achieve a peripheral blood CD34+ cells/μl of ≥10 and not apheresed. Rescue mobilization consisted of G-CSF at 10 mcg/kg/day sq on days 1–4 plus AMD3100 at 240 mcg/kg/day sq on the evening of day 4 and continued until the goal of 5 × 106 CD34+ cells/kg was reached or a maximum of 7 aphereses. Apheresis began on day 5 regardless of the peripheral blood CD 34+ cells/μl. Results: Twenty-nine pts participated in this compassionate use protocol. Demographics were 11 females and 18 males; 14 pts had NHL, 10 MM, 3 AL amyloidosis and 2 HD. The median age was 63 years (range 37–73). Prior mobilization was G-CSF alone in 25 pts, G-CSF + GM-CSF in 2 and chemotherapy + G-CSF in 2. Median time from prior mobilization failure to AMD3100 rescue mobilization was 0.7 months (range 0.4–33). The median peripheral blood CD34+ cells/μl value prior to AMD3100 was 4.8 (range 0–18.2) and 12 hours post AMD3100 was 12.4 (range 2–49.5), a 2.7 fold increase (range 0.5–7.4). The median number of CD34+ cells harvested was 4.71 × 106 CD34+ cells/kg (range 0.25–9.37). Seven pts (24%) failed to achieve a minimum of ≥2 × 106 CD34+ cells/kg. Twenty-two of 29 pts (76%) successfully collected at least 2 × 106 CD34+ cells/kg and 12 (41%) collected ≥ 5 × 106 CD34+ cells/kg. Median number of aphereses in the successful pts was 5 (range 2–7) and the median number of aphereses to reach 2 × 106 CD34+ cells/kg was 2 (range 1–7). Twenty-five pts (86%) went on to ASCT. This included 4 pts who collected ≤ 2 × 106 CD34+ cells/kg (1.01, 1.44, 1.5, and 1.98) and underwent bone marrow harvest. One pt who successfully collected has not yet undergone ASCT. All pts had successful engraftment; median time to neutrophil engraftment (500/μl) was 13 days (range 11–18) and median time to platelet engraftment (50,000/μl) was 22 days (range 16–231). Conclusion: The addition of AMD3100 to G-CSF effectively mobilizes CD34+ cells in the majority of pts, in whom a prior mobilization with either growth factors or chemotherapy has failed to mobilize sufficient cells for ASCT.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.264