Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

On demand plerixafor is safe and effective for hematopoietic progenitor cell mobilization in patients with light chain amyloidosis at risk for mobilization failure with G-CSF alone

Bone Marrow Transplantation volume 58, pages 610–612 (2023)Cite this article

Subjects

TO THE EDITOR:

AL amyloidosis (AL) is a systemic disease characterized by the deposition of misfolded free light chain fibrils into vital organs leading to organ damage. In transplant-eligible patients, high-dose melphalan conditioning and autologous hematopoietic cell transplant (auto-HCT) are a mainstay of treatment [1]. Successful peripheral blood (PB) hematopoietic progenitor cell (HPC) mobilization and collection are essential to proceed with the transplant. Current strategies with granulocyte-colony stimulating factor (G-CSF) have an associated mobilization failure rate (defined as yield of CD34+ cells/kg <2 × 106 after 3–5 days of apheresis) up to 10% [2]. Plerixafor is a bicyclam molecule that reversibly binds to CXCR4 on HPCs and inhibits its binding to stromal cell-derived factor 1 (SDF-1) [3]. It is an effective mobilizer with a favorable safety profile [4] and was FDA approved in 2008 for HPC mobilization in combination with G-CSF in non-Hodgkin lymphoma and multiple myeloma [5]. In AL, reports of plerixafor use suggest similar efficacy [6,7,8] though the optimal timing and cost-effectiveness has not been established [9,10,11,12]. Recent guidelines recommend plerixafor, on demand or planned, together with G-CSF for mobilization of select patients with AL [13]. In the current study, we retrospectively assessed the on demand use of plerixafor in combination with G-CSF to mobilize AL patients at risk of insufficient collection with G-CSF alone, and describe factors and outcomes associated with its use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. D’Souza A, Dispenzieri A, Wirk B, Zhang MJ, Huang J, Gertz MA, et al. Improved outcomes after autologous hematopoietic cell transplantation for light chain amyloidosis: A Center for International Blood and Marrow Transplant Research Study. J Clin Oncol. 2015;33:3741–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Perotti C, Del Fante C, Viarengo G, Perlini S, Vezzoli M, Rodi G, et al. Peripheral blood progenitor cell mobilization and collection in 42 patients with primary systemic amyloidosis. Transfusion. 2005;45:1729–34.

    Article  CAS  PubMed  Google Scholar 

  3. Uy GL, Rettig MP, Cashen AF. Plerixafor, a CXCR4 antagonist for the mobilization of hematopoietic stem cells. Expert Opin Biol Ther. 2008;8:1797–804.

    Article  CAS  PubMed  Google Scholar 

  4. DiPersio JF, Micallef IN, Stiff PJ, Bolwell BJ, Maziarz RT, Jacobsen E, et al. Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin’s lymphoma. J Clin Oncol. 2009;27:4767–73.

    Article  CAS  PubMed  Google Scholar 

  5. Brave M, Farrell A, Ching Lin S, Ocheltree T, Pope Miksinski S, Lee SL, et al. FDA review summary: Mozobil in combination with granulocyte colony-stimulating factor to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation. Oncology. 2010;78:282–8.

    Article  CAS  PubMed  Google Scholar 

  6. Lee SY, Sanchorawala V, Seldin DC, Mark Sloan J, Andrea N, Quillen K. Plerixafor-augmented peripheral blood stem cell mobilization in AL amyloidosis with cardiac involvement: a case series. Amyloid. 2014;21:149–53.

    Article  PubMed  Google Scholar 

  7. Dhakal B, Strouse C, D’Souza A, Arce-Lara C, Esselman J, Eastwood D, et al. Plerixafor and abbreviated-course granulocyte colony–stimulating factor for mobilizing hematopoietic progenitor cells in light chain amyloidosis. Biol Blood Marrow Transpl. 2014;20:1926–31.

    Article  CAS  Google Scholar 

  8. Badar T, Dhakal B, Szabo A, Padmanabhan A, Johnson BD, Heidtke S, et al. An updated single center experience with plerixafor and granulocyte colony-stimulating factor for stem cell mobilization in light chain amyloidosis. J Clin Apher. 2019;34:686–91.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Worel N, Fritsch G, Agis H, Böhm A, Engelich G, Leitner GC, et al. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure. J Clin Apher. 2017;32:224–34.

    Article  PubMed  Google Scholar 

  10. Costa LJ, Alexander ET, Hogan KR, Schaub C, Fouts TV, Stuart RK. Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization. Bone Marrow Transpl. 2011;46:64–9.

    Article  CAS  Google Scholar 

  11. Abhyankar S, DeJarnette S, Aljitawi O, Ganguly S, Merkel D, McGuirk J. A risk-based approach to optimize autologous hematopoietic stem cell (HSC) collection with the use of plerixafor. Bone Marrow Transpl. 2012;47:483–7.

    Article  CAS  Google Scholar 

  12. Vishnu P, Roy V, Paulsen A, Zubair AC. Efficacy and cost-benefit analysis of risk-adaptive use of plerixafor for autologous hematopoietic progenitor cell mobilization. Transfusion. 2012;52:55–62.

    Article  CAS  PubMed  Google Scholar 

  13. Sanchorawala V, Boccadoro M, Gertz M, Hegenbart U, Kastritis E, Landau H, et al. Guidelines for high dose chemotherapy and stem cell transplantation for systemic AL amyloidosis: EHA-ISA working group guidelines. Amyloid. 2022;29:1–7.

    Article  CAS  PubMed  Google Scholar 

  14. Shapiro J, Perkins J, Bookout R, Tombleson R, Ayala E, Janssen WE, et al. Evaluation of a risk-based algorithm for the utilization of plerixafor as primary mobilization of CD34+ cells in autologous hematopoietic cell transplant candidates. Blood. 2011;118:4060.

    Article  Google Scholar 

  15. Basak GW, Jaksic O, Koristek Z, Mikala G, Mayer J, Masszi T, et al. Identification of prognostic factors for plerixafor-based hematopoietic stem cell mobilization. Am J Hematol. 2011;86:550–3.

    Article  PubMed  Google Scholar 

  16. Micallef IN, Stiff PJ, Stadtmauer EA, Bolwell BJ, Nademanee AP, Maziarz RT, et al. Safety and efficacy of upfront plerixafor + G-CSF versus placebo + G-CSF for mobilization of CD34(+) hematopoietic progenitor cells in patients ≥60 and <60 years of age with non-Hodgkin’s lymphoma or multiple myeloma. Am J Hematol. 2013;88:1017–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. AH is supported by U2CDK129330 (to John Sedor and Walter Boron).

Author information

Author notes

  1. These authors jointly supervised this work: Anne Hubben, Danai Dima.

Authors and Affiliations

  1. Cleveland Clinic, Department of Hematology and Medical Oncology, Cleveland, OH, USA

    Anne Hubben, Danai Dima, Beth Faiman, Christina Ferraro, Sandra Mazzoni, Louis Williams, Christy Samaras, Jason Valent, Craig Sauter, Faiz Anwer & Jack Khouri

  2. University of Kansas, Department of Hematology and Medical Oncology, Kansas City, KS, USA

    Tahani Atieh

  3. Cleveland Clinic Florida, Department of Hematology and Medical Oncology, Maroone Cancer Center, Weston, FL, USA

    Chakra Chaulagain

Authors
  1. Anne Hubben
    View author publications

    Search author on:PubMed Google Scholar

  2. Danai Dima
    View author publications

    Search author on:PubMed Google Scholar

  3. Tahani Atieh
    View author publications

    Search author on:PubMed Google Scholar

  4. Chakra Chaulagain
    View author publications

    Search author on:PubMed Google Scholar

  5. Beth Faiman
    View author publications

    Search author on:PubMed Google Scholar

  6. Christina Ferraro
    View author publications

    Search author on:PubMed Google Scholar

  7. Sandra Mazzoni
    View author publications

    Search author on:PubMed Google Scholar

  8. Louis Williams
    View author publications

    Search author on:PubMed Google Scholar

  9. Christy Samaras
    View author publications

    Search author on:PubMed Google Scholar

  10. Jason Valent
    View author publications

    Search author on:PubMed Google Scholar

  11. Craig Sauter
    View author publications

    Search author on:PubMed Google Scholar

  12. Faiz Anwer
    View author publications

    Search author on:PubMed Google Scholar

  13. Jack Khouri
    View author publications

    Search author on:PubMed Google Scholar

Contributions

AH was responsible for study design, data extraction and analysis, interpretation of results, writing the manuscript, and creating the Table. DD contributed to the interpretation of results, writing the manuscript, and updating reference lists. JK was responsible for study design, data analysis, interpretation of results, and review of the manuscript. TA contributed to data extraction and reviewed the manuscript. CC, BF, CF, SM, LW, C Samaras, JV, C Sauter, and FA contributed to the interpretation of results, and reviewed and provided feedback on the manuscript.

Corresponding author

Correspondence to Anne Hubben.

Ethics declarations

Competing interests

Anne Hubben, Danai Dima, Tahani Atieh, Lisa Rybicki, Chakra Chaulagain, Beth Faiman, Christy J. Samaras, Sandra Mazzoni, Louis Williams, and Jack Khouri have no conflict of interest to declare. Faiz Anwer: Bristol Myers Squibb (Consultancy, Research Funding, and Speakers Bureau), Janssen (Consultancy), Allogene Therapeutics (Research Funding). Jason Valent: Alexion, AstraZeneca Rare Disease (Research Funding). Craig Sauter: Genzyme/Sanofi (Other: PI), Kite Pharma Inc (Consultancy), CSL Behring (Consultancy), Ono Pharmaceuticals (Consultancy), Karyopharm Therapeutics Inc. (Consultancy), Gamida Cell (Consultancy), Bristol Myers Squibb (Other: PI), Precision Biosciences (Other: PI).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hubben, A., Dima, D., Atieh, T. et al. On demand plerixafor is safe and effective for hematopoietic progenitor cell mobilization in patients with light chain amyloidosis at risk for mobilization failure with G-CSF alone. Bone Marrow Transplant 58, 610–612 (2023). https://doi.org/10.1038/s41409-023-01938-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41409-023-01938-0

Search

Advanced search

Quick links