Transfusion · 2026
Comparative analysis of motixafortide versus plerixafor for stem cell mobilization and collection in multiple myeloma: A single center real-world experience.
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Close Sara, Liu Jun, Abousamra Lara, Konshina Ekaterina, Shao Claire, Green Eileen, Sarhan Suhayla, Geary Kristine, Shah Sanjana, Manis John, Bae Yong Jun, Maurer Rie, Cutler Corey, Mo Cliff, Nikiforow Sarah
Аннотация
BACKGROUND: Stem cell collection for autologous stem cell transplant after induction therapy remains standard for multiple myeloma (MM). Motixafortide, a novel C-X-C motif chemokine receptor 4 (CXCR4) antagonist with prolonged receptor occupancy compared to plerixafor, potentially enhances stem cell mobilization. Direct comparison with plerixafor in MM has not been reported. This quality initiative compares motixafortide + granulocyte colony-stimulating factor (G-CSF) versus plerixafor + G-CSF for stem cell mobilization in MM patients at a single center, assessing feasibility, collection/mobilization outcomes, and safety.
STUDY DESIGN AND METHODS: A prospective cohort of 30 MM patients receiving motixafortide + G-CSF was compared to a contemporary, retrospective cohort of covariate-matched 30 patients receiving plerixafor + G-CSF. Institutional apheresis procedure practices were followed. Primary outcomes included number of collection days, apheresis procedure duration, and adverse events requiring intervention.
RESULTS: Twenty-nine of 30 motixafortide patients completed mobilization. CD34+ stem cell yields and apheresis procedure times were similar between groups; 27 patients per group reached collection targets in 1 day. Motixafortide recipients experienced more frequent adverse reactions (ARs) than plerixafor recipients.
CONCLUSIONS: In this first real-world comparison, use of motixafortide was feasible but not superior to plerixafor for MM mobilization. Motixafortide was associated with substantially higher rates of injection-site and systemic ARs requiring intervention and imposed additional workflow demands for premedication and post-injection monitoring. Due to the non-superiority of motixafortide, decreasing acquisition costs for plerixafor and motixafortide's higher resource utilization, our institution favors continuing plerixafor as the default for MM mobilization. We reserve motixafortide for select patients, with ongoing evaluation of poor mobilizers to clarify its role in collection and post-transplant outcomes.
STUDY DESIGN AND METHODS: A prospective cohort of 30 MM patients receiving motixafortide + G-CSF was compared to a contemporary, retrospective cohort of covariate-matched 30 patients receiving plerixafor + G-CSF. Institutional apheresis procedure practices were followed. Primary outcomes included number of collection days, apheresis procedure duration, and adverse events requiring intervention.
RESULTS: Twenty-nine of 30 motixafortide patients completed mobilization. CD34+ stem cell yields and apheresis procedure times were similar between groups; 27 patients per group reached collection targets in 1 day. Motixafortide recipients experienced more frequent adverse reactions (ARs) than plerixafor recipients.
CONCLUSIONS: In this first real-world comparison, use of motixafortide was feasible but not superior to plerixafor for MM mobilization. Motixafortide was associated with substantially higher rates of injection-site and systemic ARs requiring intervention and imposed additional workflow demands for premedication and post-injection monitoring. Due to the non-superiority of motixafortide, decreasing acquisition costs for plerixafor and motixafortide's higher resource utilization, our institution favors continuing plerixafor as the default for MM mobilization. We reserve motixafortide for select patients, with ongoing evaluation of poor mobilizers to clarify its role in collection and post-transplant outcomes.