Mobilizing hematopoietic stem cells to bloodstream
PHARMACOLOGIC CLASS: Hematopoietic stem cell mobilizer
ACTIVE INGREDIENT: Plerixafor 20mg/mL; soln for SC inj; preservative-free.
INDICATION: In combination with granulocyte colony stimulating factor (G-CSF): To mobilize hematopoietic stem cells to the peripheral blood for collection and autologous transplantation in patients with non-Hodgkin’s lymphoma or multiple myeloma.
PHARMACOLOGY: Patient with non-Hodgkin’s lymphoma or multiple myeloma may be candidates for autologous hematopoietic stem cell transplantation as part of their treatment. Before the transplant can take place, a minimum number of stem cells, generally about 2 million/kg, must be collected. For some patients, this may be a lengthy process or may not occur satisfactorily at all. Plerixafor is a CXCR4 chemokine receptor antagonist that is designed to mobilize hematopoietic stem cells from the bone marrow to the bloodstream where they can be harvested, enabling certain patients to proceed to transplant. It blocks the binding of stromal cell-derived factor-1a, which, with CXCR4, plays a role in the homing and trafficking of stem cells in the bone marrow. Treatment with plerixafor causes increases in circulating leukocytes and stem cells.
CLINICAL TRIALS: Two placebo-controlled studies were conducted to evaluate the safety and efficacy of plerixafor in combination with G-CSF for stem cell mobilization. In the first study, conducted in patients with non-Hodgkin’s lymphoma, 59% of 150 patients given plerixafor + G-CSF collected >5 x 106 CD34+ cells/kg in four or fewer apheresis sessions, compared to 20% of 148 patients given placebo + G-CSF. In the second study, conducted in patients with multiple myeloma, 72% of 148 patients who were treated with plerixafor + G-CSF collected >6 x 106 CD34+ cells/kg from the peripheral blood in two or fewer apheresis sessions, compared with 34% of 154 patients given placebo + G-CSF. The target numbers of stem cells in the studies were chosen based on literature that suggests that reaching these targets can help to facilitate engraftment. Updated 12-month follow-up findings showed that graft durability rates for patients in the plerixafor + G-CSF and placebo + G-CSF arms were comparable.
ADULTS: Start after 4 days’ treatment with G-CSF. Give approximately 11 hours before starting apheresis. Repeat up to 4 consecutive days. Base dose on actual body weight. 0.24mg/kg SC; max 40mg/day. Renal impairment (CrCl≤50mL/min): 0.16mg/kg; max 27mg/day.
CHILDREN: Not recommended.
PRECAUTIONS: Not for use in leukemia. May cause mobilization of tumor cells. Monitor blood and platelet counts (esp. neutrophils). Monitor for splenic rupture (eg, left upper quadrant/scapular or shoulder pain). Pregnancy (Cat.D); avoid. Nursing mothers: not recommended.
INTERACTIONS: May be potentiated by drugs that reduce renal function or compete for active tubular secretion.
ADVERSE REACTIONS: GI upset, fatigue, injection site reactions, headache, arthralgia, dizziness; tumor cell mobilization, increased circulating neutrophils, decreased platelet counts, enlarged spleen, vasovagal reaction may occur.
HOW SUPPLIED: Single-use vials (1.2mL)—1
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