plerixafor: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
plerixafor: clinical details
Prescribing considerations
- Initiate and supervise within an experienced oncology or haematology service working with an apheresis centre.
- Assess renal function because reduced clearance increases exposure and requires product-specific adjustment.
- Review pregnancy status, contraception, cardiovascular history and previous vasovagal reactions.
- Plerixafor is not recommended for stem-cell mobilisation in leukaemia because leukaemic cells may enter and contaminate the collection.
Contraindications and cautions
- Hypersensitivity to plerixafor or any excipient.
- Use particular caution with markedly raised neutrophils, thrombocytopenia, renal impairment, previous injection-related syncope or suspected spleen pathology.
Monitoring
- Renal function and recent body weight before treatment planning.
- Peripheral white-cell count during treatment.
- Platelet count during mobilisation and apheresis.
- Circulating stem-cell counts and collection yield according to the transplant-centre protocol.
- Observe for systemic allergy, vasovagal reactions and symptoms of splenic enlargement or rupture.
Clinical pharmacology
Plerixafor is a selective, reversible CXCR4 antagonist that disrupts CXCR4–CXCL12 retention signalling and mobilises functional CD34-positive cells. It has low CYP-mediated interaction potential and is eliminated mainly unchanged in urine.
Formulation and product differences
- The selected product is a clear, colourless to pale-yellow solution for subcutaneous injection in a single-use vial.
- It is sterile and preservative-free; use aseptic handling and discard unused contents.
- It is essentially sodium-free and should not be used if particles or discolouration are present.
plerixafor preparations and strengths
Injection
Route: Parenteral
Strengths: 20 mg/mL
plerixafor interactions
Formal interaction studies are limited, so the clinical team should review all medicines before mobilisation.
G-CSF medicines
Plerixafor is licensed for use with G-CSF; together they increase circulating white cells and stem cells, requiring blood-count monitoring.
Rituximab
Clinical study data did not indicate an adverse effect on safety or stem-cell yield when rituximab was included in the mobilisation regimen.
Medicines metabolised through CYP450 enzymes
A clinically important metabolic interaction is considered unlikely because plerixafor neither uses nor substantially affects major CYP450 pathways in laboratory studies.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.