Plerixafor (Subcutaneous)

Plerixafor, sold under the brand name Mozobil, is used in conjunction with other drugs in order to harvest stem cells from the body that are later transplanted back to the patient to aid in the treatment of non-Hodgkin's lymphoma and multiple myeloma.

Overview

Plerixafor is marketed under the name Mozobil. It is an injectable form of drug that is only used in a medical setting. Plerixafor is always used in combination with a drug known as a granulocyte-colony stimulating factor. This is usually shortened to the intials G-CSF. Plerixafor in combination with a G-CSF allows hematopoietic stem cells to move out of the bone marrow and into a patient's blood. These stem cells are then harvested from the patient's blood with the purpose of transplanting the stem cells back to the patient at a later date.

When a patient is undergoing treatment for certain types of cancer, the chemotherapy agents and/or the radiation therapies that are being used often destroy many, if not most, of the stem cells in a given area. After the chemotherapeutic doses, the stem cells that were harvested from the patient can be reintroduced to help the patient continue his or her fight against the cancer for which treatment is being received.

Plerixafor is indicated for aid in the treatment of non-Hodgkin's lymphoma and multiple myeloma. It is currently not indicated for the treatment of other types of cancer. In fact, patients with leukemia should absolutely not be placed on the drug as it has been demonstrated that the use of plerixafor may actually cause leukemia to become more virulent in the body.

As with most drugs, there are a number of side effects that patients may experience when using this drug. Because this drug is used to treat a serious and life-threatening disease, the nature and severity of the side effect must be measured against the benefit of using the drug to provide a higher-quality of life and a longer life.

Conditions Treated

Type Of Medication

  • Hematopoeitic Stem Cell Mobilizer

Side Effects

Plerixafor is a powerful drug. There are numerous side effects associated with the use of this product. The most common side effects associated with this drug relate to the gastrointestinal tract and to side effects in and around the injection site.

As many as 37 percent of the patients using plerixafor reported that they developed diarrhea while using the drug. Often, this was a mild to moderate side effect which did not result in the drug having to be discontinued. Several other gastrointestinal side effects were noted. Thirty-four percent of patients reported nausea while 10 percent of patients reported vomiting that accompanied nausea. A further 7% of patients reported flatulence as a result of taking plerixafor.

There were additional gastrointestinal side effects that were not as common. Some of these type of side effects include pain in the abdomen, constipation, excessive gas, bloating and dry mouth.

The second greatest level of side effects was related to the site where the drug was injected. As many as 34 percent of patients reported injection site side effects. These type of side effects were usually mild to moderate in intensity. Some of the injection site side effects included itching, soreness, redness, hematoma, rash, paresthesia, and urticaria.

About 27 percent of those using plerixafor reported fatigue and another 13% reported that they experienced arthritis type pain in their joints. Some experienced muscle pain as well.

Dizziness and headache were also frequent complaints. 22% of patients experienced a headache while using the drug, and as many as 11% of patients experienced dizziness.

In about 1% of patients, there was a mild to moderate allergic reaction. This normally manifests as hives, swelling around the eyes and difficulty when breathing. An allergic reaction of this nature normally occurs about 30 minutes following the administration of the drug. These type of allergic reactions are treated by the medical staff administering the drug. In most cases, antihistamines and/or corticosteroids alleviated any symptoms.

There have been a few other more minor side effects observed. Some have reported bleeding gums while using plerixafor. There have been reports of sleep disturbances including trouble getting to sleep and trouble staying asleep. Some have reported an increase in sweating.

There are two major and life-threatening side effects that patients need to be aware of. There have been reports of anaphylactic shock in those using this drug. Those having swelling of the airways or difficulty in breathing should report this to their physician immediately.

Any severe pain in the abdomen and upper back should be reported right away. Patients on plerixafor have reported damage to the spleen and spleen rupture.

Dosage

Plerixafor is not a drug that is used on its own. Before this drug is given, the patient will receive several doses of the G-CSF. The G-CSF is administered at a dosage of 10 micrograms per kilogram of body weight. This injection is given to the patient once per day for four days before the first dosage of plerixafor. The G-CSF is also given on each day prior to the stem cells being harvested from the patient's system.

After this four-day course of the G-CSF is given, plerixafor may be administered. The dose of plerixafor is 0.24 milligrams per kilogram of body weight given by means of a subcutaneous injection. Plerixafor should be given 11 hours before the stem cells are taken. The drug may be used for up to four days.

There is a different dosage regimen for patients that have kidney function issues. Patients with renal impairment do not receive the same dose as it will take longer for the drug to clear out of the patient's system. The dose of plerixafor should be reduced by one-third in patients with impaired renal function.

Interactions

There are no known drug interactions between plerixafor and other medications. It is important that patients notify their healthcare provider regarding any medication that they are currently taking whether it is a prescription or a nonprescription drug. The healthcare professional should also be notified of any supplements that are being taken by the patient.

Warnings

There are several blood tests that need to be performed after this medication has been used. Thrombocytopenia has been reported after the harvesting of the stem cells. A patient's platelet count should be checked on an ongoing basis to make sure that this is not occurring. Blood tests will also be necessary to make sure that the drug is having the desired effect in the patient's bone marrow.

Those who have had or do have leukemia should not use plerixafor. The use of this drug may actually make leukemia more virulent in the system.

The use of this drug may cause the cancer in the body to spread. There is also the threat that the stem cells that are later transplanted back into the patient's body may contain some cancerous material. The patient must be carefully monitored for any cancer spread or recurrence.

Some patients have developed problems with the spleen as long as four weeks from the time that plerixafor was first used. Any abdominal are back pain needs to be reported to the doctor immediately.

Plerixafor is listed as Pregnancy Category D. This means that the drug can cause harm to the unborn child. Any woman who is pregnant or thinks that she may be pregnant should consult with her physician about these dangers and whether or not plerixafor is the drug of choice. This drug is also excreted in breast milk. Mothers should not breastfeed if plerixafor has been used.

This product has not been tested in pediatric patients. Caution is advised.

Storage

The vials of plerixafor may be stored at room temperatures between 59 and 86 degrees Fahrenheit.

Summary

Plerixafor is a drug that is used in combination with a G-CSF in order to remove stem cells from the body. These stem cells are transplanted back to the patient at a later date in order to assist in the treatment of non-Hodgkin's lymphoma and multiple myeloma. This drug allows the stem cells to be released by the bone marrow into the patient's bloodstream where they may be more readily obtained.

There are some serious side effects possible in those using plerixafor. Patients have reported severe allergic reactions as well as spleen ruptures after this drug has been used. Most of the side effects of the drug are mild to moderate and do not require that use of the drug be discontinued.

The most often reported side effects are diarrhea, vomiting, headache, dizziness, and flatulence. Side effects related to the drug's injection site are also fairly common. These usually include redness, pain, and swelling.

Those who have had or have leukemia should not use this drug. This drug also has the potential to cause a spread of the existing cancer being treated.

Pregnant women should be advised that this drug may harm their unborn child. Mothers should not breastfeed while using plerixafor.