The Effective Use of Plerixafor as a Real-Time Rescue Strategy for Patients Poorly Mobilizing Autologous CD34+ cells

Plerixafor enhances CD34+ cell mobilization, however, its optimal use is unknown. We hypothesized that plerixafor could “rescue” patients in the midst of mobilization when factors indicated a poor CD34+ yield. Of 295 consecutive autologous peripheral blood mobilization attempts at our center, 39 (13%) used plerixafor as rescue strategy due to a CD34+ cell concentration <10/μl (median 5.95/μl, n = 30), low CD34+ cell yield from prior apheresis day (median 1.06 × 106 CD34+ cells/kg, n = 7), or other (n = 2). Patients received a median of one plerixafor dose (range: 1–4). Thirty-four (87%) collected =2 × 10 6 CD34+ cells/kg and 26 (67%) collected =4 × 10 6 CD34+ cells/kg. Median collections for lymphoma (n = 24) and myeloma (n = 15) patients were 4.1 × 106 and 8.3 × 106 CD34/kg, respectively. A single dose of plerixafor was associated with an increase in the mean peripheral blood CD34+ concentration of 17.2 cells/μl (P < 0.001) and mean increased CD34+ cell yield following a single apheresis of 5.11 × 106/kg (P < 0.03). A real-time rescue use of plerixafor is feasible and may allow targeted use of this agent. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc.