Hematopoietic Stem Cell Mobilization Strategies

Hematopoietic stem cell (HSC) mobilisation is a critical process for both autologous and allogeneic transplantation, enabling the collection of sufficient CD34+ cells from peripheral blood. Traditional mobilisation relies on granulocyte-colony stimulating factor (G-CSF), which induces HSC proliferation and egress from the bone marrow niche. Chemotherapeutic agents such as cyclophosphamide or etoposide plus cytarabine enhance mobilisation by transiently disrupting the stromal environment. More recently, targeted inhibitors of the stromal cell-derived factor-1/CXCR4 axis, notably plerixafor and motixafortide, have been introduced to overcome poor mobilisation. Emerging strategies integrate biosimilar G-CSF, optimised dosing schedules and novel small molecules to fine-tune stem cell yield while minimising toxicity. Ongoing research focuses on predictive biomarkers, donor and patient characteristics, and combinations of growth factors with chemokines to achieve rapid, efficient and reproducible mobilisation. These advances have global significance, offering improved graft quality, reduced apheresis sessions and expanded access to transplantation for patients with haematological malignancies and genetic disorders.

Research from Nature Portfolio

Recent studies have demonstrated that combining a novel CXCR4 inhibitor with conventional mobilising agents significantly enhances the yield and quality of harvested stem cells. A multicentre phase 3 trial in multiple myeloma patients showed that adding a cyclic-peptide CXCR4 antagonist to G-CSF enabled over 90% of individuals to reach optimal CD34+ cell doses within one or two apheresis sessions, while enriching for primitive haematopoietic progenitors. This combination was well tolerated and represents a step change in mobilisation strategies for autologous transplant programmes.

Hematopoietic Stem Cell Mobilization Strategies publication trend

The graph below shows the total number of articles in hematopoietic stem cell mobilization strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Hematopoietic Stem Cell (HSC): A multipotent cell capable of self-renewal and differentiation into all blood lineages.

Mobilisation: The process of inducing stem cells to migrate from the bone marrow into peripheral blood.

CD34+ cell: A marker used to identify and quantify haematopoietic stem and progenitor cells in blood or bone marrow.

Granulocyte-Colony Stimulating Factor (G-CSF): A cytokine that stimulates neutrophil production and HSC egress.

CXCR4 inhibitor: A molecule that blocks the chemokine receptor CXCR4, disrupting retention signals in the marrow niche.

References

1. Motixafortide and G-CSF to mobilize hematopoietic stem cells for autologous transplantation in multiple myeloma: a randomized phase 3 trial. Nature Medicine (2023).
2. Efficacy and safety of stem cell mobilization with etoposide +cytarabine plus G-CSF in poor mobilizers with relapsed or refractory lymphoma. Frontiers in Immunology (2024).
3. Stem Cells Collection and Mobilization in Adult Autologous/Allogeneic Transplantation: Critical Points and Future Challenges. Cells (2024).
4. G-CSF + plerixafor versus G-CSF alone mobilized hematopoietic stem cells in patients with multiple myeloma and lymphoma: a systematic review and meta-analysis. Annals of Medicine (2024).
5. Scoping Review of Factors Associated with Stem Cell Mobilization and Collection in Allogeneic Stem Cell Donors. Transplantation and Cellular Therapy (2024).
6. Biosimilar G-CSF Based Mobilization of Peripheral Blood Hematopoietic Stem Cells for Autologous and Allogeneic Stem Cell Transplantation. Theranostics (2014).