Successful Stem Cell Mobilization Rescue by AMD3100 (Plerixafor)+G-CSF for Patients Who Failed Primary Mobilization: Results from the Phase III (3101-NHL) Study.
Authors: Micallef Ivana , Stiff Patrick J. , DiPersio John F. , Maziarz Richard Thomas , McCarty John M. , Angell Jennifer , Bridger Gary , Calandra Gary ,   on behalf of the 3101 Investigators7
Published: October 2019

Abstract
Background: AMD3100 (plerixafor)+G-CSF (A+G) was generally safe and more effective in mobilizing CD34+ hematopoietic stem cells compared to placebo+G-CSF (P+G) in a Phase III, multicenter, randomized, double-blind, placebo controlled study conducted in patients with non-Hodgkin’s lymphoma (NHL). In the intent-to-treat analysis, 78/148 (53%) patients in the P+G group and 20/150 (13%) patients in the A+G group failed to mobilize ≥ 2 x 106 CD34+ cells/kg, p<0.0001. Of these failure patients, 52 in the P+G group and 10 in the A+G group consented to enter into the rescue arm of the study. This abstract reports the outcomes of these rescue patients.
Methods: Patients enrolled in the Phase III study who failed to mobilize ≥2 x 106 CD34+ cells/kg could enter into the rescue arm of the study and receive A+G. The patient’s treatment assignment in the study remained blinded. Following a rest period of ≥7 days, patients were given G (10 μg/kg/day) subcutaneously (SQ) for 4 days. In the evening around 10PM on Day 4, patients were given a dose of A (240 μg/kg SQ). On Day 5, all patients returned to clinic to receive a morning dose of G before apheresis. Patients continued to receive the evening dose of A followed by morning dose of G and apheresis the next day for up to a total of 4 aphereses or until ≥5 x 106 CD34+ cells/kg were collected. Pooled cells were allowed for transplantation.
Results: After rescue therapy, 33/52 (63%) patients who previously failed P+G and 4/10 (40%) patients who previously failed A+G collected ≥2 x 106 CD34+ cells/kg. Seven of the 33 patients who previously failed with P+G collected ≥ 5 x 106 CD34+ cells/kg. Six of the ten A+G patients and 46/52 P+G patients were transplanted. Median time to PMN engraftment was Day 10 and Day 11 for the A+G and P+G groups, respectively. Median time to platelet engraftment was Day 22 and Day 20 for the A+G and P+G groups, respectively. One patient in the P+G group never had platelet counts > 50,000 and was counted as a failure to engraft, even though the patient was clinically stable through 6 months post-transplant. In the re-mobilized group, 9 patients died (2 patients were never transplanted and 7 patients had disease progression). Grafts were durable for ≥100 days in all 6 rescued A+G patients and all 41 rescued P+G patients who engrafted. The predominant adverse events were mild gastrointestinal effects (diarrhea, nausea, vomiting, and abdominal pain) and injection site reactions. There were no drug-related serious adverse events reported in these re-mobilized patients.
Conclusions: The addition of AMD3100 to G-CSF successfully mobilized sufficient stem cells for transplant in 63% of NHL patients who previously failed mobilization with G-CSF alone. The high success rate is consistent with the Compassionate Use Protocol experience. AMD3100 was generally well tolerated. The 40% success rate in the patients who previously failed AMD3100+G-CSF suggests that re-mobilization with the same combination is a potentially useful strategy for similar patients.