Shaji K. Kumar, MD, professor of medicine, Mayo Clinic, discusses stem cell mobilization multiple myeloma.
Although stem cell mobilization is successful in the majority of patients with multiple myeloma, the use of granulocyte colony-stimulating factor (G-CSF) used alone is associated with up to a 10% failure rate, Kumar explains. This rate increases for patients who receive prolonged treatment exposure with lenalidomide (Revlimid), alkylating agents, or daratumumab (Darzalex).
Additional techniques such as chemomobilization or mobilization using the use of plerixafor (Mozobil), a CXCR4-targeted agent, can be used in patients who fail G-CSF–alone mobilization, says Kumar.
More cells can be collected with chemomobilization compared with G-CSF–alone, and the failure rate is lower, explains Kumar. However, the modality is associated with an increased risk of cytopenia, neutropenic fever that could lead to hospitalization, and longer time to mobilization.
Plerixafor can be used as a risk-adapted strategy based on CD34 counts after G-CSF or on the number of CD34 cells that were gathered in the first collection, says Kumar. The failure rate with this method may be reduced to about 1% to 2% in patients with multiple myeloma.