Guidelines for Peripheral Blood Progenitor Cell Mobilization

There are many ways to mobilize peripheral blood progenitor cells, including growth factor or chemotherapy in combination with growth factor, both of which can be enhanced with plerixafor, a fairly new option. Historically, hospitals have applied different protocols and algorithms depending on what resources they had available specifically because mobilization requires coordination between different departments (apheresis, transfusion medicine, flow cytometry) and not every hospital has similar access/availability to these departments.

Because of the imperative need to collect progenitor cells safely, adequately, and cost-effectively and for transplant and to attempt to standardize practices, The American Society of Blood and Marrow Transplantation (ASBMT) set a task force, led by Hien K. Duong, MD, Hematology and Oncology, Cleveland Clinic, to publish evidence-based guidelines for peripheral blood progenitor cell mobilization.

Impact of Plerixafor

With the FDA approval of plerixafor as a mobilizing agent in 2008, a large body of papers and abstracts detailed mobilization and improved efficiency in collection under varied circumstances. Dr. Duong and the ASBMT Practice Guidelines Committee began the process with a thorough literature review of these publications. Dr. Duong and the ASBMT Committee defined evidence-based recommendations to hopefully improve practices throughout the country, whether for small or large hospitals with varying resources.

They address clinical questions such as which growth factor is optimal, what chemotherapy and dose is most effective and when to initiate leukapheresis. The detailed guidelines were peer reviewed by a national expert base representing small and large hospitals and approved by the American Society of Blood and Marrow Transplantation before published in Biology of Blood and Marrow Transplantation.

“We lay out the known risks and benefits, advantages and disadvantages, of each mobilization strategy. We also recommend target cell doses for collection and infusion for transplant. We present data on how cell collection can most safely and effectively be done,” says Dr. Duong. The standardized algorithms address the optimal resource accessibility, and may help smaller transplant programs justify investment in necessary service enhancements. The guidelines even include a list of frequently asked questions, as part of the goal to provide comprehensive guidance.

Photo by Russell Lee.