An updated single center experience with plerixafor and granulocyte colony-stimulating factor for stem cell mobilization in light chain amyloidosis.
Talha BadarBinod DhakalAniko SzaboAnand PadmanabhanBryon D JohnsonSarah HeidtkeJean EsselmannSaurabh ChhabraMehdi HamadaniParameswaran HariAnita D SouzaPublished in: Journal of clinical apheresis (2019)
The use of granulocyte-colony stimulating factor (G-CSF) with or without chemotherapy to mobilize hematopoietic progenitor cells (HPCs) can result in significant morbidity in light chain (AL) amyloidosis patients. Plerixafor, a strong inducer and mobilizer of HPCs, can be used as an adjunct to G-CSF to improve mobilization efficiency. We describe the outcomes for combined G-CSF/plerixafor mobilized patients with AL amyloidosis. We reviewed data of 53 consecutive AL amyloidosis patients who underwent combined G-CSF/plerixafor HPC mobilization between May 2011 and October 2017 at our institution. We evaluated patients for HPC collection efficiency, perimobilization toxicity and postautologous hematopoietic cell transplantation (autoHCT) outcomes. Median CD34+ cell collection was 12.4 × 106 cells/kg (range 2.5 × 106 to 34.1 × 106 cells/kg) and 45 (85%) patients had collections of ≥5.0 × 106 CD34+ cells/kg. There were no mobilization failures or perimobilization mortality. During mobilization, 37 (70%) patients had weight gain (median 1.3 kg, range 0.1-4) but none >10% body weight, 5 (10%) patients had diarrhea, and one patient each had hypotension and cardiac arrhythmia. Among the 31 patients analyzed for CD34 collection efficiency (CE), the median CD34 CE was 47% (range 36-62). At 5 years follow-up 82% and 84% of patients were progression-free and alive, respectively. Our results suggest that G-CSF/plerixafor mobilization is safe, well tolerated, and effective in AL amyloidosis.
Keyphrases
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- ejection fraction
- stem cells
- prognostic factors
- squamous cell carcinoma
- type diabetes
- atrial fibrillation
- weight gain
- metabolic syndrome
- patient reported outcomes
- cell death
- left ventricular
- peripheral blood
- artificial intelligence
- cell therapy
- radiation therapy
- mesenchymal stem cells
- single cell
- weight loss
- risk factors
- data analysis