Plerixafor and Abbreviated-Course Granulocyte Colony–Stimulating Factor for Mobilizing Hematopoietic Progenitor Cells in Light Chain Amyloidosis

•Plerixafor plus granulocyte colony–stimulating factor mobilization is safe and effective in light chain amyloidosis.•Plerixafor plus granulocyte colony–stimulating factor mobilization leads to significantly less weight gain and granulocyte colony–stimulating factor exposure in light chain amyloidosis.

Cytokine-based mobilization in light chain (AL) amyloidosis is frequently complicated by fluid overload, weight gain, cardiac arrhythmias, and peri-mobilization mortality. We analyzed hematopoietic progenitor cells (HPC) mobilization outcomes in 49 consecutive AL amyloidosis patients at our institution between 2004 and 2013 with granulocyte colony–stimulating factor (G) (10 μg/kg/day) (n = 25) versus an institutional protocol to limit G exposure using plerixafor (P) (.24 mg/kg s.c. starting day 3 of G 10 μg/kg) (n = 24). G+P strategy yielded higher total CD34+ cells/kg (12.8 × 106 versus 6.3 × 106; P < .001) and CD34+ cells/kg collected on day 1 (10.8 × 106 versus 4.9 × 106, P = .004) compared with the G cohort. More G+P patients collected ≥5 × 106 CD34+ HPCs/kg (22 versus 16, P = .02) and ≥ 10 × 106 CD34+ HPCs/kg (13 versus 5, P = .01). Four patients (16%) had mobilization failure with G; none with G+P. Peri-mobilization weight gain was lower with G+P strategy (median weight gain 1 versus 7 pounds, P = .009). Numbers of apheresis sessions (median, 1 versus 1, P = .52), number of hospitalization days (median, 1.1 versus 1.6, P = .52), transfusions, use of intravenous antibiotics, and cardiac arrhythmias were similar. In conclusion, our study demonstrates that upfront use of G+P as a mobilization strategy results in superior HPC collection, no mobilization failures, and less weight gain than G alone.