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Acute Myeloid Leukemia (AML) blasts express the chemokine receptor CXCR4, which interacts with the bone marrow microenvironment and contributes to evasion of chemotherapy and apoptosis. Plerixafor, an inhibitor of CXCR4, have been reported to mobilize AML blasts and enhance the anti-leukemic efficacy of chemotherapy. Additionally, administration of Granulocyte-Colony Stimulating Factor (G-CSF) along with chemotherapy has been shown to improve outcomes of AML patients.
In a Letter to the Editor of Blood Cancer Journal on 10th March 2017, Geoffrey L. Uy, from the Washington University School of Medicine, St Louis, USA, and colleagues discuss results from their phase 1/2 study (NCT00906945), which aimed to assess the combination of G-CSF and plerixafor in conjunction with mitoxantrone, etoposide, and cytarabine (MEC) for chemosensitization in adult patients with Relapsed or Refractory (R/R) AML.
Thirty-five R/R AML patients (median age = 56 years) were administered G-CSF (10 mcg/kg daily for 8 days), plerixafor (administered on days 3–8) Intravenous Infusion (IV), and MEC (administered on days 4–8). To determine the effect of G-CSF and plerixafor on leukemic cell mobilization, peripheral blood samples were collected either at baseline, after G-CSF only on day 3, or at 2, 4, 6, and 24 hours after IV plerixafor.
In summation, plerixafor amplifies the mobilization of AML blasts by G-CSF. However, the authors highlighted that the combination of plerixafor and G-CSF with chemotherapy “did not improve remission rates compared with historical controls”. As a result, “the study was terminated for futility”.
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