Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis · 2025
Safety and efficacy of G-CSF alone with pre-emptive plerixafor for autologous peripheral blood hematopoietic stem cell mobilization in newly diagnosed multiple myeloma.
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Elemary Youssef, Sabry Waleed, Stakiw Julie, Bosch Mark, Goubran Hadi, Sanayei James, Kodad Shruthi, MacKay Rebecca, Lacey Jill, Sarker Sabuj, Elemary Mohamed
Аннотация
BACKGROUND: Mobilization failure remains a challenge in autologous stem cell transplantation for multiple myeloma (MM). Chemotherapy-based mobilization protocols, though effective, are associated with toxicity, hospitalization, and delay in transplant timing. We developed an algorithm-based protocol for peripheral blood stem cell (PBSC) mobilization using G-CSF alone, with pre-emptive Plerixafor based on peripheral blood CD34+ cell counts.
METHODS: This retrospective study included MM patients who underwent stem cell collection between July 2013 and November 2023 at Saskatoon Cancer Centre. The mobilization protocol aimed to collect ≥ 4 × 106 CD34+ cells/kg, using daily CD34 count monitoring to determine the use of Plerixafor. Predefined thresholds guided the decision for Plerixafor administration and apheresis timing.
RESULTS: Out of 176 patients (median age 61 years), 100 % achieved successful mobilization. Preemptive Plerixafor was required in 13.6 % of patients (n = 24), with 1-3 doses administered. The median number of apheresis days was 2 (range: 1-4). The median CD34 yield was 6.4 × 106 cells/kg. All patients received high-dose melphalan and underwent autologous transplant, with median neutrophil and platelet engraftment at 12 and 15 days, respectively. All patients were alive at day 100 post-transplant.
CONCLUSION: An algorithm-driven, G-CSF-only mobilization with pre-emptive Plerixafor use based on CD34 counts resulted in 100 % successful collections, early engraftment, minimal plerixafor use, and no mobilization failures. This approach avoids chemotherapy toxicity, optimizes Plerixafor use, and prevents transplant delays.
METHODS: This retrospective study included MM patients who underwent stem cell collection between July 2013 and November 2023 at Saskatoon Cancer Centre. The mobilization protocol aimed to collect ≥ 4 × 106 CD34+ cells/kg, using daily CD34 count monitoring to determine the use of Plerixafor. Predefined thresholds guided the decision for Plerixafor administration and apheresis timing.
RESULTS: Out of 176 patients (median age 61 years), 100 % achieved successful mobilization. Preemptive Plerixafor was required in 13.6 % of patients (n = 24), with 1-3 doses administered. The median number of apheresis days was 2 (range: 1-4). The median CD34 yield was 6.4 × 106 cells/kg. All patients received high-dose melphalan and underwent autologous transplant, with median neutrophil and platelet engraftment at 12 and 15 days, respectively. All patients were alive at day 100 post-transplant.
CONCLUSION: An algorithm-driven, G-CSF-only mobilization with pre-emptive Plerixafor use based on CD34 counts resulted in 100 % successful collections, early engraftment, minimal plerixafor use, and no mobilization failures. This approach avoids chemotherapy toxicity, optimizes Plerixafor use, and prevents transplant delays.