P2 3-year observation study of Plerixafor use in New Zealan

Introduction Plerixafor, a novel CXCR4 pathway antagonist, is used to mobilise CD34-positive stem cells for autologous stem cell transplantation to treat haematological malignancy. Data regarding the rates of failure to mobilise and frequency of use of Plerixafor vary widely. Methods This retrospective study reviewed 203 consecutive patients with myeloma (n = 122) or lymphoma (n = 81) undergoing peripheral blood stem cell mobilisation between 1/1/2016 and 5/8/2019 at a New Zealand hospital using data from an institution transplant database and the electronic medical record. Patients with myeloma were mobilised using cyclophosphamide and G-CSF after induction chemotherapy with cyclophosphamide, bortezomib and dexamethasone. Patients with lymphoma were mobilised with G-CSF after induction or salvage chemotherapy according to disease type. Patients failing to mobilise sufficient stem cells either received “pre-emptive” Plerixafor added to G-CSF +/- chemotherapy during the 1st attempt or were re-mobilised after a 4-week break with Plerixafor and G-CSF alone. Results The success rate of mobilisation for lymphoma and myeloma patients at first attempt was 79% and 87% respectively. Plerixafor allowed successful harvest for 5 of 7 lymphoma patients and 8 of 9 myeloma patients who failed to harvest at first attempt, resulting in 88% and 94% of all patients having a successful harvest on either first or second attempt, respectively. Age greater than 60 years was a risk factor for failed mobilisation in lymphoma patients. Conclusion This study shows that an approach using pre-emptive and rescue Plerixafor is effective and allows haematopoietic stem cell mobilisation for ≥88% of patients. Further research is required to establish the optimal strategy for its use.

Methicillin-resistant Staphylococcus aureus (MRSA) panniculitis in a patient undergoing stem cell mobilisation

Methicillin-resistant Staphylococcus aureus (MRSA) can cause a wide range of skin infections, however MRSA panniculitis without bacteremia is a rare manifestation. Here, we report a woman in her 20s with relapsed Hodgkin lymphoma undergoing stem cell mobilisation who presented with bilateral subcutaneous nodules over her shins. Ultrasound scan of one nodule showed non-specific inflammatory changes. Punch biopsy of a nodule showed lobular panniculitis with Gram-positive cocci. Blood cultures were negative but a culture from the biopsy grew MRSA. She was started on doxycycline with improvement in her symptoms. This case serves as a reminder to consider infections as a cause of panniculitis in immunocompromised patients.