Successful Stem Cell Mobilisation with Plerixafor in a Patient with Multiple Myeloma and Dialysis-Dependant Renal Failure

The aim of this case report is to describe the use of plerixafor in a patient with multiple myeloma and dialysis-dependant renal failure. A 43-year-old man with multiple myeloma and dialysis-dependent renal failure was evaluated for an autologous stem cell transplant (ASCT). Following Stem cell mobilisation with cyclophosphamide 1.5g/m2 and 9 doses of granulocyte colony-stimulating factor (G-CSF) 10mcg/kg/day the patient's pre apheresis CD34+ count was inadequate at 2.18 cells/µL. Perixafor was prescribed to achieve stem cell mobilisation. There is no dose recommendation for plerixafor in patients with CrCl< 20mL/min or those on dialysis. In this patient we used 0.16mg/kg/day dose, which is the dose recommended for patients with CrCl 20-50mL/min. The first plerixafor dose was given subcutaneously post-dialysis 8 hours before apheresis and the second dose was given the next day 9 hours prior to second apheresis session. The pre-apheresis CD34+ count was 11.99 and 8.82 cells/µL with a total White cell count of 22.2 and 17.3 x 10^9/L after the first and second doses respectively. The patient underwent stem cell collection via the Spectra Optia cell separator with a total yield of 2.4 x 106 cells/kg. There were no observed toxicities with plerixafor. In May 2012, 6 weeks after stem cell collection, the patient underwent ASCT with reduced dose of Melphalan 140mg/m2. Neutrophil engraftment occurred at day +11, the patient was discharged at day +16. To date the patient remains well and in remission. This case report illustrates that plerixafor can safely and effectively be used to mobilise adequate stem cells in multiple myeloma patients with end stage renal failure. Information regarding dosing and safety of plerixafor in dialysis patients remains limited, we hope that information provided by this report would be useful for other clinicians who are considering the use of plerixafor in this setting.