An evidence-based and risk-adapted GSF versus GSF plus plerixafor mobilization strategy to obtain a sufficient CD34+ cell yield in the harvest for autologous stem cell transplants

Milena Todorović Balint; Nikola Lemajić; Vladimir Jurišić; Sofija Pantelić; Dejana Stanisavljević; Nada Kraguljac Kurtović; Bela Balint

doi:10.1016/j.tranon.2023.101811

An evidence-based and risk-adapted GSF versus GSF plus plerixafor mobilization strategy to obtain a sufficient CD34⁺ cell yield in the harvest for autologous stem cell transplants

Transl Oncol. 2024 Jan:39:101811. doi: 10.1016/j.tranon.2023.101811. Epub 2023 Oct 31.

Authors

Milena Todorović Balint¹, Nikola Lemajić², Vladimir Jurišić³, Sofija Pantelić⁴, Dejana Stanisavljević⁵, Nada Kraguljac Kurtović⁶, Bela Balint⁷

Affiliations

¹ Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Serbia. Electronic address: bb.lena@gmail.com.
² Medical Faculty, University of Belgrade, Serbia.
³ Faculty of Medical Sciences, University of Kragujevac, Serbia.
⁴ Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
⁵ Medical Faculty, University of Belgrade, Serbia; Institute for Medical Statistics and Informatics, Belgrade, Serbia.
⁶ Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia.
⁷ Department of Medical Sciences, Serbian Academy of Sciences and Arts, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia.

Abstract

Background: Plerixafor is a bicyclam molecule with the ability to reversibly bind to receptor CXCR-4 thus leading to an increased release of stem cells (SC) into the circulation. This study aims to evaluate the efficacy of G-CSF plus plerixafor versus G-CSF alone mobilizing regimens on the basis of CD34⁺ cell yield and engraftment kinetics following hematopoietic SC transplants.

Methods: The study incorporated 173 patients with plasma cell neoplasms (PCN), Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), undergoing mobilization and following autologous SC-transplant. For patients with mobilization failure and those predicted to be at risk of harvesting inadequate CD34⁺ yields (poor-responders), plerixafor was administered. Data was collected and compared in relation to the harvesting protocols used, cell quantification, cell-engraftment potential and overall clinical outcome.

Results: A total of 101 patients received plerixafor (58.4 %) and the median CD34⁺increase was 312 %. Chemotherapy-mobilized PCN-patients required less plerixafor administration (p = 0.01), no difference was observed in lymphoma groups (p = 0.46). The median CD34⁺cell yield was 7.8 × 10⁶/kg bm. Patients requiring plerixafor achieved lower, but still comparable cell yields. Total cell dose infused was in correlation with engraftment kinetics. Patients requiring plerixafor had delayed platelet engraftment (p = 0.029).

Conclusions: Adequately selected plerixafor administration reduces "mobilization-related-failure" rate and assure a high-level cell dose for SC transplants, with superior "therapeutic-potential" and safety profile. The mobilization strategy that incorporates "just-in-time" plerixafor administration, also leads to a reduction of hospitalization days and healthcare resource utilization. For definitive conclusions, further controlled/larger clinical trials concerning correlation of CD34⁺ cell count/yield, with hematopoietic reconstitution are required.

Keywords: Autologous transplantation; CD34(+) cell mobilization; Cytokines; G-CSF; Plerixafor.