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ARTICLES
Introduction
Autologous transplantation of hematopoietic pro-
genitor cells from peripheral blood is a well-established
therapy for some hematological malignancies, such as
multiple myeloma, non-Hodgkin’s and Hodgkin’s lym-
phoma, as well as for some solid neoplasms, such as germ
cell tumors.1,2 Mobilization and collection are crucial steps
in this procedure, which aim not only at obtaining enough
stem cells for transplantation but also at minimizing the
number of apheresis sessions, reducing the risk of compli-
cations, preventing failure and optimizing resource alloca-
tion.3 The choice of the mobilization regimen should take
into account factors such as efficacy, safety, convenience
and cost-effectiveness.4 Even though they are well estab-
lished in everyday practice of Hematology and Transplant
centers, mobilization regimens can vary greatly from one
institution to another and differ in terms of clinical and
pharmacoeconomic outcomes.5-7
Of the currently available regimens, the one most
commonly used involves the isolated use of the granu-
locyte-colony stimulating factor (G-CSF), which has the
advantages of being well tolerated and allowing the pro-
gramming of apheresis procedures.8,9 The combination
of chemotherapy and G-CSF has shown to improve the
collection of CD34 + cells and reduce tumor activity, but
at the expense of increased risk of complications such
as fever and neutropenia. In turn, the combination of
G-CSF and plerixafor has been shown to result in redu-
ced risk of mobilization failure, improves the collection
of CD34 + cells and a favorable tolerability profile, but
at a higher cost.
Thus, the combination of G-CSF and plerixafor has
been used as the initial regimen for patients with risk fac-
tors for poor mobilization, preemptively in patients with
early signs of mobilization failure, as well as a rescue stra-
tegy in cases of failed mobilization with other regimens.9-12
Other currently available rescue strategies include the
re-mobilization with the same regimen used previously,
the segmentation of the G-CSF doses and collection of
cells directly from bone marrow.13
Recently, the American Society for Blood and Marrow
Transplantation4 and a panel of US experts3 published their
guidelines and recommendations to optimize the mobili-
zation of hematopoietic stem cells from peripheral blood.
Considering the peculiarities of the Brazilian public health
system and the need for more standardized approaches in
our country, a panel of national experts was summoned
to meet and develop consensus recommendations adapted
Mobilization of hematopoietic progenitor cells for
autologous transportation: consensus recommendations
Fernando Barroso D uarte1*, Benedito de P ina Almeida Prado2, Garles Miller Matias Vieira3, L uciano J. C osta4
1Service of Hematology and Hematopoietic Cell Transplantation – Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Brazil
2Service of Apheresis of Centro Regional de Hemoterapia do HCFMRP-USP, Brazil
3Department of Clinical Oncology and BMT Unit of AC Camargo Cancer Center, Brazil
4Department of Medicine and UAB-CCC, Department of Bone Marrow Transplantation and Cell Therapy Program, Birmingham, AL, USA
Meeting in Valencia,
Spain, April 2016
*Correspondence to:
Address: Rua Capitão Francisco Pedro,
1290
Rodolfo Teófilo, Fortaleza - CE
CEP:60430-370
Telephone: 55 85 99984-8251
E-mail:
SUMMARY
Selected patients with certain hematological malignancies and solid tumors have
the potential to achieve long-term survival with autologous hematopoietic progeni-
tor cell transplant. The collection of these cells in peripheral blood avoids mul-
tiple bone marrow aspirations, results in faster engraftment and allows treatment
of patients with infection, fibrosis, or bone marrow hypocellularity. However, for
the procedure to be successful, it is essential to mobilize a sufficient number of
progenitor cells from the bone marrow into the blood circulation. Therefore, a
group of Brazilian experts met in order to develop recommendations for mobiliza-
tion strategies adapted to the reality of the Brazilian national health system, which
could help minimize the risk of failure, reduce toxicity and improve the allocation
of financial resources.
Keywords: Hematopoietic stem cell mobilization; Autologous transplantation;
Plerixafor; G-CSF
10 Anais do XX Congresso Brasileiro da Sociedade Brasileira de Transplante de Medula Óssea | Rev. Assoc . Med . Bra. 2016; 62 (suppl . 1):10-15