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Transplants and Mobilization

Hematopoietic cell transplantation (HCT) is part of an established treatment course for patients with MM or NHL.1-3

The Primary Goal of Mobilization

Because only a small number of hematopoietic stem cells (HSCs) circulate in the peripheral blood, mobilization is necessary to release sufficient numbers of HSCs from the bone marrow to the peripheral circulation for collection by apheresis.4

The primary goal of mobilization is to collect sufficient CD34+ stem cells to allow the patient to proceed to HCT in a timely fashion.5,6

Optimal Collection Goal

≥ 5 to 6 x 106 cells/kg collected per patient5,7-9 (Minimum effective dose: 2 x 106 cells/kg for MM or NHL)9

NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) Recommendation for Patients with MM

Collect sufficient PBSCs for 2 HCTs for all potentially eligible patients10

Harvest PBSCs early in the course of primary treatment, especially in patients receiving lenalidomide10

  • Increased duration of lenalidomide treatment significantly decreased day 1 collection yields and increased mobilization failure rates compared with those who did not receive lenalidomide11,12

Goals of a mobilization regimen

  • Collection of sufficient number of stem cells5
  • Minimal number of apheresis sessions5
  • Efficient use of resources5
  • Faster time to transplant13
  • Low mobilization failure rate5

Mobilization Failure Is Common With Traditional Mobilization Strategies5

Potential Consequences of Not Achieving CD34+ Target Levels

Impact on Treatment
  • Ineligible for transplant14
  • Potential for subsequent relapse14
  • Switch to treatments other than HCT9
Impact on Apheresis
  • Repeated apheresis sessions9
  • Need for remobilization9,15
  • Increased resource utilization for center4,14
  • Added cost of remobilization attempts4
Unmeasured Costs to Patients/Caregivers14
  • Transportation to/from apheresis center
  • Cost of housing /sustenance
  • Psychological strain
  • Missed work time
Unmeasured Costs to Center14
  • Weekend apheresis sessions
  • Delays in treatment
  • Disruption of patient flow
  • Inability to proceed to transplant

About Mozobil

See the data behind the addition of Mozobil to granulocyte-colony stimulating factor (G-CSF) in mobilization regimens.

SEE STUDY RESULTS

Dosing and Administration

Our dosing table tells you how.

learn proper dosing

NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
Abbreviations: G-CSF, granulocyte-colony stimulating factor; HCT, hematopoietic cell transplantation; HSCs, hematopoietic stem cells; MM, multiple myeloma; NCCN, National Comprehensive Cancer Network® (NCCN®); NHL, non-Hodgkin's lymphoma; PBSCs, peripheral blood stem cells.

References:

  1. Attal M, Lauwers-Cances V, Hulin C, et al. Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma. N Engl J Med. 2017;376(14):1311-1320.
  2. Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med. 1995;333(23):1540-1545.
  3. Vose JM, Sharp G, Chan WC, et al. Autologous transplantation for aggressive non-Hodgkin’s lymphoma: results of a randomized trial evaluating graft source and minimal residual disease. J Clin Oncol. 2002;20(9):2344-2352.
  4. Bensinger W, DiPersio JF, McCarty JM. Improving stem cell mobilization strategies: future directions. Bone Marrow Transplant. 2009;43(3):181-195.
  5. Giralt S, Costa L, Schriber J, et al. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant. 2014;20(3):295-308.
  6. Costa LJ, Miller AN, Alexander ET, et al. Growth factor and patient-adapted use of plerixafor is superior to CY and growth factor for autologous hematopoietic stem cells mobilization. Bone Marrow Transplant. 2011;46(4):523-528.
  7. DiPersio JF, Micallef IN, Stiff PJ, 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(28):4767-4773.
  8. DiPersio JF, Stadtmauer EA, Nademanee A, et al; for the 3102 Investigators. Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma. Blood. 2009;113(23):5720-5726.
  9. Lemoli RM. New strategies for stem cell mobilization. Mediterr J Hematol Infect Dis. 2012;4(1):e2012.066. doi:10.4084/MJHID.2012.066.
  10. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Multiple Myeloma V.3.2021. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed October 28, 2020. To view the most recent and complete version of the guideline, go online to www.NCCN.org.
  11. Kumar S, Dispenzieri A, Lacy MQ, et al. Impact of lenalidomide therapy on stem cell mobilization and engraftment post-peripheral blood stem cell transplantation in patients with newly diagnosed myeloma. Leukemia. 2007;21(9):2035-2042.
  12. Popat U, Saliba R, Thandi R, et al. Impairment of filgrastim-induced stem cell mobilization after prior lenalidomide in patients with multiple myeloma. Biol Blood Marrow Transplant. 2009;15(6):718-723.
  13. Costa LJ, Alexander ET, Hogan KR, et al. Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization. Bone Marrow Transplant. 2011;46(1):64-69.
  14. Shaughnessy P, Chao N, Shapiro J, et al. Pharmacoeconomics of hematopoietic stem cell mobilization: an overview of current evidence and gaps in the literature. Biol Blood Marrow Transplant. 2013;19(9):1301-1309.
  15. Pusic I, Jiang SY, Landua S, et al. Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation. Biol Blood Marrow Transplant. 2008;14(9):1045-1056.