How I treat patients who mobilize hematopoietic stem cells poorly

Transplantation with 2-5 × 106 mobilized CD34+cells/kg body weight lowers transplantation costs and mortality. Mobilization is most commonly performed with recombinant human G-CSF with or without chemotherapy, but a proportion of patients/donors fail to mobilize sufficient cells. BM disease, prior t...

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Bibliographic Details
Published in:Blood 2011-10, Vol.118 (17), p.4530-4540
Main Authors: To, L. Bik, Levesque, Jean-Pierre, Herbert, Kirsten E.
Format: Article
Language:English
Subjects:
Anemia, Aplastic
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bone Marrow Diseases
Bone Marrow Failure Disorders
Bone marrow, stem cells transplantation. Graft versus host reaction
Hematologic and hematopoietic diseases
Hematologic Neoplasms - therapy
Hematopoietic Stem Cell Mobilization - methods
Hematopoietic Stem Cell Transplantation - methods
Hematopoietic Stem Cells - pathology
Hematopoietic Stem Cells - physiology
Hemoglobinuria, Paroxysmal - therapy
Humans
Medical sciences
Models, Biological
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Transplantation Conditioning - methods
Treatment Failure
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Summary:Transplantation with 2-5 × 106 mobilized CD34+cells/kg body weight lowers transplantation costs and mortality. Mobilization is most commonly performed with recombinant human G-CSF with or without chemotherapy, but a proportion of patients/donors fail to mobilize sufficient cells. BM disease, prior treatment, and age are factors influencing mobilization, but genetics also contributes. Mobilization may fail because of the changes affecting the HSC/progenitor cell/BM niche integrity and chemotaxis. Poor mobilization affects patient outcome and increases resource use. Until recently increasing G-CSF dose and adding SCF have been used in poor mobilizers with limited success. However, plerixafor through its rapid direct blockage of the CXCR4/CXCL12 chemotaxis pathway and synergy with G-CSF and chemotherapy has become a new and important agent for mobilization. Its efficacy in upfront and failed mobilizers is well established. To maximize HSC harvest in poor mobilizers the clinician needs to optimize current mobilization protocols and to integrate novel agents such as plerixafor. These include when to mobilize in relation to chemotherapy, how to schedule and perform apheresis, how to identify poor mobilizers, and what are the criteria for preemptive and immediate salvage use of plerixafor.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2011-06-318220