Plerixafor given before the third leukapheresis to rescue an unsuccessful stem cell mobilization with CY and G-CSF.

摘要

High-dose chemotherapy followed by infusion of auto-logous peripheral blood hematopoietic stem cells (HSCs) is a salvage treatment for relapsed patients with non-Hodgkin's lymphoma (NHL). Mobilization of HSCs from the marrow to the blood is routinely obtained in these patients by means of chemotherapy and G-CSF. However, patients who have previously received multiple lines of chemotherapy have >30% risk of failing to mobilize a sufficient number of CD34+ cells (> 1-2 x 10~6kg) in the peripheral blood. In the past, these cases could undergo a BM harvest primed with a short course of G-CSF, or could not be transplanted. Recently, AMD 3100 or Plerixafor (Mozobil, Genzyme, Cambridge, MA, USA), a CXCR4 chemokine antagonist, has been approved by the Food and Drug Administration for mobilization of HSCs when combined with G-CSF in lymphoma and myeloma patients. Plerixafor results in the rapid mobilization of hematopoietic stem cells into the peripheral blood by reversibly blocking the binding of SDF-1alpha, a chemokine stromal cell-derived factor-1alpha, to its CXC chemokine receptor, CXCR4. Data on the use of plerixafor in stem cell mobilization with chemotherapy in lymphoma patients are very limited. It has been shown, however, that plerixafor does not mobilize lymphoma cells.