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Plerixafor boosts stem cell mobilization in myeloma pts

Plerixafor boosts stem cell mobilization in myeloma pts

ATLANTA—Patients with multiple myeloma are more likely to mobilize sufficient numbers of hematopoietic stem cells (HSCs) when plerixafor (AMD3100) is given with G-CSF (Neupogen) than with G-CSF alone. John F. DiPersio, MD, PhD, of Washington University School of Medicine, presented interim results of a phase III study evaluating this regimen at ASH 2007 (abstract 445).

Plerixafor is a small-molecule competitive antagonist of CXCR4, a receptor that normally binds to the SDF-1 ligand expressed on bone marrow stromal cells and osteoblasts. By inhibiting the interaction between CXCR4 and SDF-1, plerixafor triggers the rapid release of stem cells out of the bone marrow and into the circulating blood (mobilization). This agent works in concert with G-CSF to rapidly expand the pool of available HSCs that can be collected by apheresis for subsequent transplantation.

The multicenter, randomized double-blind, placebo-controlled phase III trial included adults with myeloma who required an autologous HSC transplant and who were in first or second complete or partial remission.

Patients on both arms received G-CSF (10 μg/kg/d) subcutaneously for 4 days. On the evening of day 4 they were given either plerixafor (240 μg/kg) or placebo. Following a morning dose of G-CSF on day 5 and 10 to 11 hours after treatment with study drug, patients underwent apheresis.

This cycle of evening treatment with study drug, morning G-CSF, and apheresis continued for up to four apheresis sessions or until the target cell number (at least 6 106 CD34+ cells/kg) was harvested.

Those patients who were not able to achieve more than 2 106 cells/kg were allowed to receive plerixafor plus G-CSF without unblinding of the study.

Following myeloablative chemotherapy and HSC transplantation, patients were followed for at least 12 months to assess engraftment and survival.


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