Efficacy of just-in-time plerixafor rescue for Hodgkin's lymphoma patients with poor peripheral blood stem cell mobilization

BACKGROUND: Plerixafor is a Food and Drug Administration-approved agent for improving peripheral blood stem cell (PBSC) mobilization in filgrastim (granulocyte-colony-stimulating factor [G-CSF])stimulated patients with multiple myeloma and non-Hodgkin's lymphoma. Limited information is available on its use in Hodgkin's lymphoma (HL) patients. We describe our experience with plerixafor as an immediate rescue agent in HL patients with poor PBSC mobilization. STUDY DESIGN AND METHODS: We retrospectively reviewed the collection data of 27 consecutive HL patients at our center in whom plerixafor was added to rescue a failing PBSC collection after G-CSF and chemotherapy (26) or G-CSF alone (1). Plerixafor was added in 11 patients due to peripheral blood (PB) CD34+ counts that persisted below the threshold (> 10 x 10(6)/L) to initiate collection (median, 1.47 x 10(6); range 0 x 10(6)-6.28 x 10(6)/L) and in 16 patients due to low collection yields, who had a median yield of 0.33 x 106 (0.14 x 106-0.65 x 106) CD34+ cells/kg on the last collection before plerixafor administration. RESULTS: After a median of 2 (range, 2-4) collections with plerixafor, the patients collected a median of 1.82 x 10(6) (0.52 x 10(6)-11.14 x 10(6)) CD34+ cells/kg. The addition of plerixafor enabled 20 patients (74.1%) to reach the 2.0 x 10(6) CD34+ cells/kg minimum required for autologous stem cell transplantation (ASCT) during the same collection cycle. Subsequent remobilization in three patients with plerixafor enabled all three to reach this goal. CONCLUSION: Plerixafor can be used in HL patients with poor mobilization as a rescue agent and boosts mobilization sufficiently in most patients in the same collection attempt, thus not only permitting ASCT, but also avoiding remobilization and the associated costs, treatment delays, and patient inconvenience.