Plerixafor is a hematopoietic stem cell mobilizer, specifically a CXCR4 chemokine receptor antagonist. It is used in combination with granulocyte-colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM). It is a critical agent in the apheresis procedure, significantly increasing the yield of CD34+ cells.
Adult: 0.24 mg/kg body weight administered subcutaneously once daily. Maximum recommended dose: 40 mg (or 24 mg per vial as a fixed single dose in many Indian protocols, especially for patients weighing ≥ 83 kg).
Note: Administered by subcutaneous injection in the abdomen (except 2-inch area around navel) or upper thigh. Timing: Administer approximately 10-11 hours prior to each scheduled apheresis procedure. Must be given after the patient has received G-CSF (e.g., filgrastim) once daily for 4 days prior to the first dose of plerixafor. Reconstitution: The 24 mg vial is reconstituted with 1.2 mL of sterile water for injection. Gently swirl, do not shake. Use immediately.
Plerixafor is a reversible antagonist of the CXCR4 chemokine receptor. It blocks the binding of stromal cell-derived factor-1 alpha (SDF-1α/CXCL12) to CXCR4. This SDF-1α/CXCR4 interaction is a key mechanism for retaining hematopoietic stem cells and progenitor cells (HSPCs) within the bone marrow niche. By antagonizing this axis, plerixafor disrupts the retention signals, leading to the rapid mobilization of HSPCs from the bone marrow into the peripheral blood.
Pregnancy: Category D. May cause fetal harm. Based on mechanism, it may affect CXCR4-mediated fetal development. Not recommended. Women of childbearing potential must use effective contraception during treatment.
Driving: May cause dizziness and fatigue. Patients should be cautioned about operating machinery or driving until they know how the drug affects them.
| Drugs that are P-glycoprotein (P-gp) inhibitors (e.g., Erythromycin, Ketoconazole, Itraconazole, Cyclosporine) | May increase plerixafor exposure. Monitor for increased side effects. | Moderate |
| Drugs that are P-glycoprotein (P-gp) inducers | May decrease plerixafor exposure, potentially reducing efficacy. | Moderate |
| Other drugs affecting leukocyte count (e.g., Lithium) | Additive effect on leukocytosis. Monitor white blood cell count. | Moderate |
| Heparin | Plerixafor solution contains sodium chloride; compatibility with heparin in the same syringe is not established. Do not mix. | Significant |