• Timothy Swinn and Andrew Butler.
• Christchurch Hospital, Christchurch, New Zealand.
• Intern Med J. 2023 Jun 1; 53 (6): 970977970-977.

BackgroundPlerixafor is used to mobilise CD34-positive stem cells for autologous transplantation to treat haematological malignancy. Funded in New Zealand since 2016, plerixafor can be used 'pre-emptively' to salvage a failing first attempt or as a 'rescue' strategy involving re-mobilising after 4 weeks. The rate of failed mobilisation and plerixafor uptake in New Zealand is not known, while international practice varies widely.AimsTo establish success rates for conditioning regimes used in New Zealand.MethodsWe reviewed 203 consecutive patients with myeloma (n = 122) or lymphoma (n = 81) undergoing stem cell mobilisation between 1 January 2016 and 5 August 2019 at Christchurch hospital. We recorded demographics, conditioning regimens, harvest outcome and apheresis duration. Successful harvest was defined as collection of >2 × 106 CD34+ cells/kg.ResultsSeventeen percent of patients received plerixafor. Harvest success rates for lymphoma and myeloma respectively were 77% and 86% with standard conditioning, 95% and 100% with 'pre-emptive' plerixafor and 71% and 89% with 'rescue' plerixafor. 'Pre-emptive' plerixafor was non-inferior to standard conditioning. Following local guidelines resulted in at least one successful harvest for 96% lymphoma and 99% myeloma patients.ConclusionPlerixafor strategies in New Zealand allow successful stem cell mobilisation for ≥96% of patients. Further research is required to investigate whether increased use would be cost-effective through reduced chemotherapy and apheresis duration, and improved graft quality.© 2022 Royal Australasian College of Physicians.

22 keywords...

hide…