If CD34<10/ОјL after 4 days of G-CSF at 10 Ојg/kg/day, then plerixafor is indicated for initiation to allow successful collection of CD34 stem cells for autologous transplantation. A risk-adapted approach has been designed by the Mayo Clinic to enhance the success of stem cell collection and cost-effectiveness for use of plerixafor. Plerixafor is synergistic with G-CSF for stem cell mobilization ( 3вЂ“6) and has been approved by FDA to be used in combination with G-CSF.

This is a bicyclam molecule which inhibits the SDF-1 alpha/ CXCR4 binding between the CD34+ stem cells and the marrow stroma, resulting in the release of CD34+ stem cells into the blood stream. Plerixafor (formerly known as AMD 3100) has recently become available as a stem cell mobilizing agent. Peripheral blood CD34 >10/ОјL is necessary for an adequate collection most centers will not attempt to collect PBPCs with less than this level. Multiple factors have been shown to be predictors of result of stem cell mobilization and collection, which include age, diagnoses, duration of preceding chemotherapy, the presence of marrow infiltrating disease or history of radiation, low premobilization platelet counts, short intervals from last chemotherapy cycle to mobilization, a low premobilization bone marrow CFU-GM level and inadequate chemopriming regimens and/ or low-dose G-CSF ( 1), and previous treatment with lenalidomide (2). One to four daily leukapheresis sessions are usually required to achieve a sufficient collection (at least 2 Г— 10 6/kg, and preferably 5 Г— 10 6/kg). PBPC are collected after mobilization using apheresis and continuous-flow cell separation.

These are termed peripheral blood progenitor cells (PBPC). Stem cells are normally infrequent in the blood but are mobilized into the blood during the recovery after chemotherapy and following treatment with hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and granulocyte- macrophage colony-stimulating factor (GM-CSF). Hematopoietic stem cells can also be collected from peripheral blood. Ideally, stem cells should be collected while the patient's marrow is normocellular and uninvolved by the malignancy. Bone marrow is collected via multiple aspirations from the posterior-superior iliac crest in a sterile environment (usually a surgical operating room) while the patient is under anesthesia. After patients undergo stem cell collection, the bone marrow or peripheral blood progenitor cells (PBPC) are cryopreserved and stored.

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