Plerixafor as first- and second-line strategies for autologous stem cell mobilization in patients with non-Hodgkin's lymphoma or multiple myeloma.

Study Objective: To describe the institutional experience of plerixafor plus filgrastim as the initial peripheral blood stem cell (PBSC) mobilization (first-line strategy) and as rescue therapy after failure with filgrastim plus cyclophosphamide (second-line strategy).

Design: Retrospective medical record review.

Setting: Academic medical center.

Patients: Thirty-three patients (median age 62 yrs) who received plerixafor between January 2008 and December 2009.

Measurements And Main Results: We collected data on total CD34(+) cell yield and number of apheresis sessions in both first-line and second-line plerixafor recipients. Mobilization with plerixafor plus filgrastim resulted in a median yield of 8.95 × 10(6) and 2.45 × 10(6) CD34(+) cells/kg in patients with multiple myeloma or non-Hodgkin's lymphoma, respectively. As rescue mobilization, plerixafor plus filgrastim successfully mobilized CD34(+) cells in 16 (84%) of 19 patients. When comparing first-line plerixafor plus filgrastim therapy with second-line therapy, we found an increase in CD34(+) yield and 1 less apheresis day in patients with multiple myeloma, but no difference in patients with non-Hodgkin's lymphoma.

Conclusion: A regimen of plerixafor plus filgrastim successfully mobilized CD34(+) cells in a median of 1 apheresis day for patients with multiple myeloma and 2 apheresis days for patients with non-Hodgkin's lymphoma, including patients who failed initial filgrastim plus cyclophosphamide mobilization. Plerixafor plus filgrastim could be a viable first-line option in patients with multiple myeloma, as it improved CD34(+) cell yield and decreased number of apheresis days compared with second-line plerixafor plus filgrastim therapy, whereas it was comparable to second-line therapy in patients with non-Hodgkin's lymphoma.