The Use of Stem Cell Mobilization for the Treatment of Blood Related Cancers
Autologous hematopoietic stem cell transplantation (aHSCT) is a well-established treatment for hematologic malignancies such as multiple myeloma (MM) and non-Hodgkin lymphoma (NHL). [1,2] Various changes in the field over the past decade, including the frequent use of tandem aHSCT in MM, the advent of novel therapies for the treatment of MM and NHL, plus the addition of new stem cell mobilization techniques, have led to the need to reassess current stem cell mobilization strategies.
Mobilization failures with traditional strategies are common and result in delays in treatment and increased cost and resource utilization. The mobilization of hematopoietic stem cells fails in approximately 20% of patients with MM and up to 40% of patients with NHL.[3,4] Poor mobilization can lead to poor engraftment, increased morbidity, greater resource utilization, and increased costs.[4,5] The cause of poor mobilization can be partially explained by clinical variables (i.e., age, underlying disease, prior therapies, underlying marrow function) and cannot be predicted.
Methods to increase the circulating concentrations of hematopoietic stem cells (HSCs) have been found to be necessary to ensure adequate and successful collections. Novel mobilization regimens have changed the climate of stem cell transplantation such aHSCT may now be performed in more than 90% of those patients in whom the procedure is indicated, with a minimal need for remobilization strategies. The precise regimen that is most effective remains to be determined, however, and may vary depending on patient population and the specific goal of stem cell collection. [7,8]
1. The NCCN Clinical Practice Guidelines in Oncology for Non-Hodgkin’s Lymphomas. V.1.2015 Accessed May 1, 2015.
2. The NCCN Clinical Practice Guidelines in Oncology for Multiple Myeloma. V.2.2015. Accessed May 1, 2015.
3. DiPersio JF, Micallef IN, Stiff PJ, et al. Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus
granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin's lymphoma. J Clin Oncol. 2009;27(28):4767–4773.
4. Pusic I, Jiang SY, Landua S, et al. Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation. Biol Blood Marrow Transplant. 2008;14(9):1045–1056.
5. Gertz MA, Wolf RC, Micallef IN, Gastineau DA. Clinical impact and resource utilization after stem cell mobilization failure in patients with multiple myeloma and lymphoma. Bone Marrow Transplant.
6. Costa LJ, Nista EJ, Buadi FK, et al. Prediction of poor mobilization of autologous CD34+ cells with growth factor in multiple myeloma patients: implications for risk-stratification. Biol Blood Marrow
Transplant. 2014;20(2):222- 228.
7. Duong HK, Savani BN, Copelan E, et al. Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2014;20(9):1262–1273.
8. Giralt S, Costa L, Schriber J, et al. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Medical College of Wisconsin and Carden Jennings Publishing. The Medical College of Wisconsin is accredited by the ACCME to provide continuing medical education for physicians.
The Medical College of Wisconsin designates this enduring material for a maximum of 3.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Commercially supported by an unrestricted educational grant form Sanofi-Aventis.
This program has been designed for a targeted audience of hematologists, hematologists/oncologists, blood and marrow transplant specialists, and all healthcare professionals in the blood and marrow transplant community involved in the care and treatment of hematologic malignancies.
Upon completion of the program, participants should be able to:
1. Demonstrate improved knowledge of stem cellmobilization strategies in autologous hematopoietic stem cell transplant
2. Identify patients at risk of poor stem cell mobilization
3. Devise and evaluate strategies to increase mobilization success in autologous hematopoietic stem cell transplant
4. Assess the value of pharmaco-economics and resource utilization associated with stem cell mobilization strategies
In accordance with the ACCME® standards for Commercial Support Number 6, all in control of content disclosed any relevant financial relationships. These relationships were reviewed via the MCW conflict of interest resolution process and resolved:
Luciano J. Costa, MD, PhD has received honorarium as a speaker for Sanofi.
John F. DiPersio, MD, PhD has no relevant financial relationships to disclose.
Sergio A. Giralt, MD has received honorarium as a speaker for Sanofi. Johnson & Johnson, and Celgene.
Edmund K. Waller, MD has received honorarium as a consultant from Novartis, Celldex and Seattle Genetics.
The employees of CJP Medical Communications have no financial relationships to disclose.
- 3.00 AMA PRA Category 1 Credit(s)™AMA PRA Category 1 Credit(s)™
- 3.00 Hours of ParticipationHours of Participation credit.