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document
Plerixafor plus granulocyte colony-stimulating factor versus placebo plus granulocyte colony-stimulating factor for mobilization of CD34 ( + ) hematopoietic stem cells in patients with multiple myeloma and low peripheral blood CD34 ( + ) cell count : results of a subset analysis of a randomized trial . Preapheresis peripheral blood ( PB ) CD34 ( + ) cell count is a strong predictor of hematopoietic stem cell ( HSC ) mobilization and is routinely used to optimize the timing , cost , and success of HSC collection in patients with multiple myeloma . However , a uniform PB CD34 ( + ) cell count that predicts mobilization failure has not been defined , resulting in the development of institute-specific algorithms for mobilization , particularly regarding the decision of when to use the novel stem cell mobilization agent plerixafor . In this post hoc analysis , we evaluated the mobilization efficacy of plerixafor plus granulocyte colony-stimulating factor ( G-CSF ) versus placebo plus G-CSF in patients with multiple myeloma , stratified by preapheresis PB CD34 ( + ) cell count : < 10 , < 15 , < 20 , and ≥20 cells/μL . Regardless of the PB CD34 ( + ) cell count , the total yield of CD34 ( + ) cells from apheresis was significantly higher in the plerixafor group than in the placebo group , and significantly more patients in the plerixafor group collected the minimum ( ≥2 × 10 ( 6 ) cells/kg ) and optimum ( ≥6 × 10 ( 6 ) cells/kg ) stem cell yields on each day of apheresis . As a corollary , the greater stem cell collection in plerixafor-treated patients resulted in the need for significantly fewer days of apheresis to reach minimum and optimum cell doses across all cell count groups . For all CD34 ( + ) cell count groups , the proportion of patients proceeding to transplantation and the median time to platelet and neutrophil engraftment were similar in the plerixafor and placebo groups . Our findings demonstrate that in patients with multiple myeloma who might be predicted to fail mobilization based on low PB CD34 ( + ) cell count , the addition of plerixafor to G-CSF allows for collection of the minimal and optimal cell doses in a greater proportion of patients compared with G-CSF alone . In addition , plerixafor plus G-CSF significantly improves the likelihood of optimal HSC collection in patients with higher preapheresis PB CD34 ( + ) cell counts ( ≥20 cells/μL ) compared with placebo plus G-CSF . Collectively , this analysis of predicted poor mobilizers validates the superiority of plerixafor plus G-CSF compared with G-CSF alone , which had been demonstrated previously in the overall patient population .
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Intervention_Pharmacological
Plerixafor plus granulocyte colony-stimulating factor
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Intervention_Control
placebo plus granulocyte colony-stimulating factor
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Intervention_Pharmacological
plerixafor plus granulocyte colony-stimulating factor ( G-CSF )
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Intervention_Control
placebo plus G-CSF
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Participant_Condition
multiple myeloma
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Participant_Condition
low peripheral blood CD34 ( + ) cell count
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Participant_Condition
multiple myeloma
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Participant_Condition
multiple myeloma
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Participant_Condition
stratified by preapheresis PB CD34 ( + ) cell count : < 10 , < 15 , < 20 , and ≥20 cells/μL