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Home > HSCT Mobilisation - filgrastim and plerixafor

HSCT Mobilisation - filgrastim and plerixafor

Treatment Overview

This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycle 1 - 14 days

Cycle length:
14

filgrastim: Give filgrastim 10 microgram/kg subcutaneously ONCE daily in the morning on Days 1 to 8, or until stem cell harvest complete.


plerixafor: Give plerixafor 0.24 mg/kg subcutaneously ONCE daily in the evening on Days 5 to 7, or until stem cell harvest complete.

  • Prior to doses on Days 6 and 7, assess if adequate stem cells were harvested to determine if a further dose of plerixafor is required.
  • Administer dose 6 to 11 hours before initiation of apheresis.
  • For treatment beyond 3 days, reassess with consideration of funding requirements.

Cycle details

Cycle 1 - 14 days

Medication Dose Route Days Max Duration
filgrastim 10 microgram/kg Once daily subcutaneous injection 1 to 8
plerixafor 0.24 mg/kg Once daily subcutaneous injection 5, 6, 7

filgrastim: Give filgrastim 10 microgram/kg subcutaneously ONCE daily in the morning on Days 1 to 8, or until stem cell harvest complete.


plerixafor: Give plerixafor 0.24 mg/kg subcutaneously ONCE daily in the evening on Days 5 to 7, or until stem cell harvest complete.

  • Prior to doses on Days 6 and 7, assess if adequate stem cells were harvested to determine if a further dose of plerixafor is required.
  • Administer dose 6 to 11 hours before initiation of apheresis.
  • For treatment beyond 3 days, reassess with consideration of funding requirements.

Full details

Cycle 1 - 14 days

Day: 1

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 2

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 3

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 4

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 5

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.
plerixafor 0.24 mg/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the evening until stem cell harvest complete.

  • Administer 6 to 11 hours before initiation of apheresis.

Day: 6

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.
plerixafor 0.24 mg/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the evening if required to complete stem cell harvest.

  • Prior to dose, assess if adequate stem cells were harvested to determine if a further dose of plerixafor is required.
  • Administer 6 to 11 hours before initiation of apheresis.

Day: 7

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.
plerixafor 0.24 mg/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the evening if required to complete stem cell harvest.

  • Prior to dose, assess if adequate stem cells were harvested to determine if a further dose of plerixafor is required.
  • Administer 6 to 11 hours before initiation of apheresis.
  • For treatment beyond 3 days: Reassess with consideration of funding requirements.

Day: 8

Medication Dose Route Max duration Details
filgrastim 10 microgram/kg Once daily subcutaneous injection
Instructions:

Give ONCE daily in the morning until stem cell harvest complete.

  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Supportive Care Factors

No supportive care factors specified

References

DiPersio JF, Micallef IN, Stiff PJ et al. 2009 "Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin's lymphoma".J Clin Oncol. Oct 1;27(28):4767-73., PMID: 19720922

DiPersio JF, Stadtmauer EA, Nademanee A et al. 2009 "Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma".Blood. Jun 4;113(23):5720-6, PMID: 19363221

Calandra, G., J. McCarty, J. McGuirk, et al. 2008. "AMD3100 plus G-CSF can successfully mobilize CD34+ cells from non-Hodgkin's lymphoma, Hodgkin's disease and multiple myeloma patients previously failing mobilization with chemotherapy and/or cytokine treatment: compassionate use data." Bone Marrow Transplant 41(4):331-338., PMID: 17994119

Duarte, R. F., B. E. Shaw, P. Marin, et al. 2011. "Plerixafor plus granulocyte CSF can mobilize hematopoietic stem cells from multiple myeloma and lymphoma patients failing previous mobilization attempts: EU compassionate use data." Bone Marrow Transplant 46(1):52-58., PMID: 20305700

Micallef, I. N., P. J. Stiff, J. F. DiPersio, et al. 2009. "Successful stem cell remobilization using plerixafor (mozobil) plus granulocyte colony-stimulating factor in patients with non-hodgkin lymphoma: results from the plerixafor NHL phase 3 study rescue protocol." Biol Blood Marrow Transplant 15(12):1578-1586., PMID: 19896082

Malard, F., N. Kroger, I. H. Gabriel, et al. 2012. "Plerixafor for autologous peripheral blood stem cell mobilization in patients previously treated with fludarabine or lenalidomide." Biol Blood Marrow Transplant 18(2):314-317., PMID: 22001752

Jantunen, E., T. Kuittinen, E. Mahlamaki, et al. 2011. "Efficacy of pre-emptively used plerixafor in patients mobilizing poorly after chemomobilization: a single centre experience." Eur J Haematol 86(4):299-304., PMID: 21198864

Costa LJ, Alexander ET, Hogan KR et al. 2010. "Development and validation of a decision-making algorithm to guide the use of plerixafor for autologous hematopoietic stem cell mobilization". Bone Marrow Transplant. Apr 12., PMID: 20383210

Costa LJ, Miller AN, Alexander ET al. " Growth factor and patient-adapted use of plerixafor is superior to CY and growth factor for autologous hematopoietic stem cells mobilization". Bone Marrow Transplant. 2010 Jul 12., PMID: 20622909

Milone, G., M. Martino, A. Spadaro, et al. 2014. "Plerixafor on-demand combined with chemotherapy and granulocyte colony-stimulating factor: significant improvement in peripheral blood stem cells mobilization and harvest with no increase in costs." Br J Haematol 164(1):113-123., PMID: 24138497

Afifi, S., N. G. Adel, S. Devlin, et al. 2016. "Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study." Bone Marrow Transplant 51(4):546-552, PMID: 26726942

Micallef, I. N., et al. (2018). "Plerixafor Plus Granulocyte Colony-Stimulating Factor for Patients with Non-Hodgkin Lymphoma and Multiple Myeloma: Long-Term Follow-Up Report." Biol Blood Marrow Transplant 24(6): 1187-1195., PMID: 29410180

Hartmann, T., et al. (2015). "Additional plerixafor to granulocyte colony-stimulating factors for haematopoietic stem cell mobilisation for autologous transplantation in people with malignant lymphoma or multiple myeloma." Cochrane Database Syst Rev(10): CD010615., PMID: 26484982

Sanofi-Aventis. Mozobil New Zealand Datasheet 13 November 2019 https://www.medsafe.govt.nz/profs/datasheet/m/Mozobilinj.pdf (Accessed 19 April 2022).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.