Mobilization of hematopoetic stem cells using plerixafor - experience of the Czech Republic transplantation centers

Czech version

Authors: Z. Kořístek ¹; D. Pohlreich ²; D. Lysák ³; M. Lánská ⁴; J. Novák ⁵; T. Kepák ⁶; Skoumalová I. Mužík J. ^{7 8}
Authors‘ workplace: Interní hematoonkologická klinika, Fakultní nemocnice Brno ¹; I. interní klinika, Všeobecná fakultní nemocnice Praha ²; Hematologicko-onkologické oddělení, Fakultní nemocnice Plzeň ³; 2. interní klinika - oddělení klinické hematologie, Fakultní nemocnice Hradec Králové ⁴; Oddělení klinické hematologie, Fakultní nemocnice Královské Vinohrady, Praha ⁵; Klinika dětské onkologie, Fakultní nemocnice Brno ⁶; Hemato-onkologická klinika, Fakultní nemocnice Olomouc ⁷; Institut biostatistiky a analýz, Masarykova univerzita, Brno ⁸
Published in: Transfuze Hematol. dnes,18, 2012, No. 1, p. 6-12.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Plerixafor is a novel kind of drug which administration leads to a hematopoietic stem and progenitor cells (HSC) mobilization independently of chemotherapy or G-CSF. Plerixafor is a small molecule bicyclam derivate and inhibits reversibly the SDF-1/CXCR4 interaction, which belongs to the most important mechanisms binding HSC to the bone marrow microenvironment. Inhibition of SDF-1/CXCR4 interaction results in a fast mobilization of HSC into a peripheral blood. Plerixafor is a very valuable substance especially for patients who are not able to mobilize sufficient numbers of HSC after G-CSF ± chemotherapy and, therefore, who are not the candidates for autologous peripheral blood stem cells (PBSC) transplantation because they are not able to collect adequate transplants. The aim of this study is to evaluate results reached with plerixafor in transplant centres in Czech Republic.

Patients and methods:
Plerixafor was given between 2/2009 and 8/2011 to 93 patients of age from 4 months to 71 years (63% males, 37% females), who were assessed to be proven (failed previous or current mobilization attempt; 82%) or predicted (high risk of failed mobilization; 13.5%) poor mobilizers.

Results:
The primary objective to collect a safe transplant (≥ 2x10⁶ CD34+ cells/kg) was reached in 71.6% of mobilizations. Plerixafor adverse events were mild and well tolerated. Overall, 66 patients (71.0%) were treated by 69 transplantations using collected PBSC, engraftment was fast and durable.

Conclusion:
We conclude that plerixafor is a very efficient mobilization agent which allows collecting safe PBSC transplants of a good quality without significant adverse events in a majority of patients who failed standard mobilization. Plerixafor administration enables these patients to proceed to high dose therapy with autologous transplantation, which could significantly improve their prognosis or have a curative effect in certain patients.

Key words:
plerixafor, mobilization, PBSC, CD34+ cells, poor mobilizer, autologous hematopoietic transplantation

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