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Autologous Stem Cell Harvest and Transplantation for Hematological Malignancies: Significance of Plerixafor

Naokazu Nakamura

Autologous Ste1m Cell Transplantation (ASCT) is one of the most effective treatment strategies for hematological malignancies. Before ASCT, hematopoietic stem cells must be stimulated to move from the bone marrow to the peripheral blood for harvesting. Plerixafor is used to increase stem cell harvests. No physicians have questions about the power of plerixafor for promoting more efficient harvest. Many studies have examined the optimal strategies for hematopoietic stem cell mobilization, and the clinical criteria for using plerixafor have gradually been elucidated. However, the effects of plerixafor on post-ASCT outcomes remain unclear. Thus, using a dual-center, retrospective, cohort study of 43 adult patients who received ASCT, we compared transplantation outcomes in patients who underwent stem cell mobilization with granulocyte colony-stimulating factor with or without plerixafor. The number of days to neutrophil and platelet engraftment was significantly shorter with plerixafor than without plerixafor, as assessed by univariate, subgroup, and propensity score matching and inverse probability weighting analyses. Although the cumulative incidence of fever was comparable with or without plerixafor that of sepsis was significantly lower with plerixafor than without. Therefore, we concluded that plerixafor leads to earlier neutrophil and platelet engraftment and a reduction of infectious risk.