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HEMATOLOGY

Peripheral Blood Stem Cell Mobilization Tactics

PGY-2 Hematology/Oncology Pharmacy Resident, Department of Pharmacy, Simon Cancer Center-Clarian Health, Indiana University, Indianapolis, IN

Shivani Srivastava, MD

Assistant Professor of Medicine, Department of Medicine, Bone Marrow and Stem Cell Transplantation, School of Medicine, Indiana University

Patrick J Kiel, PharmD BCPS

Clinical Pharmacy Specialist, Hematology/Stem Cell Transplant, Simon Cancer Center-Clarian Health, Indiana University

Reprints: Dr. Kiel, Department of Pharmacy, Indiana University Simon Cancer Center-Clarian Health, 550 North University Blvd., UH 5630, Indianapolis, IN 46202, fax 317/274-8588, pkiel{at}clarian.org

OBJECTIVE: To evaluate the methods and collection techniques currently used in stem cell mobilization for patients undergoing autologous transplantation.

DATA SOURCES: Literature search was performed through PubMed (1948-August 2009) and MEDLINE (1977-August 2009). Reference citations from publications identified were also reviewed.

STUDY SELECTION AND DATA EXTRACTION: All literature identified was reviewed for inclusion. Original research and retrospective cohorts, along with previously published systematic reviews of stem cell mobilization and growth factors, were evaluated. Abstract data on plerixafor were also reviewed.

DATA SYNTHESIS: Successful mobilization of an adequate number of progenitor cells can help ensure and improve time to neutrophil and platelet engraftment. A variety of methods have been studied to find the safest and most predictable mobilization of CD34+ progenitor cells, including use of single agents or the combinations of hematopoietic growth factors, chemotherapy, and a novel chemokine receptor 4 antagonist. Currently, granulocyte colony-stimulating factor (G-CSF) 10 µg/kg daily started 4 days prior to apheresis remains the standard of care for initial mobilization therapy. In patients who fail to mobilize or who are at high risk for mobilization failure, cyclophosphamide in conjunction with G-CSF may be used. Plerixafor, a novel chemokine receptor antagonist, in combination with G-CSF has demonstrated superiority for achieving collection goals compared to G-CSF alone in 2 Phase 3 trials.

CONCLUSIONS: The optimal mobilization strategy is still unknown; however, colony-stimulating factors remain the most commonly used mobilization agents. Currently, chemotherapy or plerixafor in combination with G-CSF is a reasonable option in heavily pretreated and hard-to-mobilize patients with non-Hodgkin's lymphoma and multiple myeloma.

Key Words: G-CSF, mobilization, plerixafor, stem cell transplantation

Published Online, December 8, 2009. www.theannals.com, DOI 10.1345/aph.1M289