Plerixafor for Autologous Hematopoietic Stem Cell Mobilization and Transplantation for Patients in Ontario

Guideline Objective

To summarize the available data regarding the efficacy of plerixafor in enhancing hamatopoietic stem cell mobilization and collection before autologous stem cell transplantation and to provide recommendations on its use. Evidence on the cost-effectiveness of plerixafor was not considered in this report.

Patient Population

Adult patients considered for autologous stem cell transplantation (SCT) and meeting one of the following criteria:

• Have not been mobilized before (i.e., the case of up front mobilization in naïve patients who may or may not be at risk of being poor mobilizers)
• Are failing initial mobilization (based on peripheral blood CD34+ cells count before first day of apheresis, or the total number of CD34+ cells collected on the first day of apheresis)
• Have failed a prior mobilization attempt (i.e., are poor mobilizers)

Of particular interest are outcomes focused on the ability to mobilize and collect an adequate graft to get patients to autologous SCT, such as total number of CD34+ cells collected during apheresis (the minimal required cell number for a graft is 2.0x106 CD34+ cells/kg), number of apheresis procedures, proportion of patients who proceed to autologous SCT and survival rate post-SCT).

Intended Guideline Users

Healthcare physicians performing SCT in Ontario, as well as for policy makers, program planners and institutions involved in any STC program or team.

Research Question(s)

1. Does the administration of plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) for stem cell mobilization before autologous transplantation improve the outcome of patients who have not been mobilized before, when compared with G-CSF for stem cell mobilization alone or in combination with chemotherapy?
2. Does the administration of plerixafor in combination with G-CSF for stem cell mobilization before autologous transplantation improve the outcome of patients failing mobilization when compared with G-CSF for stem cell mobilization alone or in combination with chemotherapy?
3. Does the administration of plerixafor in combination with G-CSF for stem cell mobilization before autologous transplantation improve the outcome of patients who have failed a prior mobilization regimen when compared with G-CSF for stem cell mobilization alone or in combination with chemotherapy?