Clinical UM Guideline

 

Subject: Plerixafor Injection (Mozobil™)
Guideline #: CG-DRUG-76 Publish Date:    12/12/2018
Status: Reviewed Last Review Date:    11/08/2018

Description

 

This document addresses the indications and criteria for the use of plerixafor injection. Plerixafor injection (Mozobil, Genzyme Corporation, Cambridge, MA) is a hematopoietic stem cell mobilizer that is given subcutaneously (SQ) to increase circulating hematopoietic stem cells (HSCs) in the peripheral blood for collection and subsequent autologous hematopoietic stem cell transplantation (HSCT).

 

Clinical Indications

Medically Necessary:

Plerixafor injection is considered medically necessary in combination with granulocyte colony stimulating factor (G-CSF) to mobilize autologous hematopoietic stem cells in adults (greater than or equal to 18 years of age) when the following criteria are met (A, B and C):

  1. The individual has a diagnosis of (Hodgkin or non-Hodgkin) lymphoma, multiple myeloma or testicular carcinoma; and
  2. After stem cell mobilization and collection, a subsequent autologous hematopoietic stem cell transplant is anticipated; and
  3. A maximum of up to four consecutive doses of plerixafor injections per cycle for up to 2 cycles.

Not Medically Necessary:

Plerixafor injection is considered not medically necessary when the criteria above are not met.

Plerixafor injection is considered not medically necessary for all other indications, including but not limited to the following:

  1. As a mobilizing agent for an allogeneic stem cell donor;
  2. As a mobilizer of leukemic cells;
  3. As a component of a conditioning regimen prior to an allogeneic hematopoietic stem cell transplant.
Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

CPT

 

J2562

Injection, plerixafor, 1 mg [Mozobil]

 

 

ICD-10 Diagnosis

 

C62.00-C62.92

Malignant neoplasm of testis

C81.00-C81.99

Hodgkin lymphoma

C82.00-C88.9

Non-Hodgkin lymphomas

C90.00-C90.32

Multiple myeloma and malignant plasma cell neoplasms

Discussion/General Information

Collecting sufficient CD34+ autologous stem cells could enable eligible individuals with specific malignancies to proceed to autologous hematopoietic stem cell transplantation (HSCT). Plerixafor injection is a hematopoietic stem cell mobilizer that is given subcutaneously (SQ) with granulocyte colony stimulating factor (G-CSF). Also known as AMD3100 in early clinical studies, plerixafor injection is the first agent in a class of small molecules that reversibly inhibits the CXCR4 chemokine receptor and blocks binding of the stromal cell-derived factor-1α (SDF-1α). CXCR4 and SDF-1α play a role in the homing of human HSC to the bone marrow (DiPersio, 2009b; Product Information Label, 2013). HSC binding is inhibited with plerixafor injection which releases (mobilizes) CD34+ stem cells from the marrow into the bloodstream where they can be collected through apheresis for subsequent autologous HSCT to treat individuals with multiple myeloma (MM) or non-Hodgkin lymphoma (NHL) (Giralt, 2009).

The U.S. Food and Drug Administration (FDA) approved Mozobil (plerixafor injection) in 2008 to mobilize autologous HSC in individuals with MM and NHL who were anticipating an autologous HSCT. There were two phase III randomized, placebo-controlled trials that studied the use of plerixafor injection in adults with NHL and MM. In both trials, the use of plerixafor injection resulted in a statistically significant increase in the number of CD34+ cells collected, and it was accomplished in fewer number of apheresis sessions compared to the placebo groups (DiPersio, 2009a, 2009b; Product Information Label, 2017).

DiPersio (2009a) reported 59.3% of 150 individuals assigned to the plerixafor injection group achieved the primary endpoint by collecting ≥ 5 X 106 CD34+ cells/kg in ≤ 4 apheresis days versus 19% of individuals in the placebo group who achieved the primary endpoint (p<0.001). The time to collecting ≥ 5 X 106 CD34+ cells was significantly shorter in the plerixafor injection group compared to the placebo group (p<0.001). The median number of CD34+ cells collected for the plerixafor injection group was 5.69 X 106 cells/kg (range, 0.03 to 29.22) versus 1.98 X 106 cells/kg (range, 0.06 to 15.00) for the placebo group. In the NHL trial, 90% (135/150 participants) in the plerixafor treatment cohort and 55% (82/148 participants) in the placebo cohort had an HSCT after mobilization. There was no significant difference in the median time to engraftment between the cohorts. Participants who failed to collect sufficient CD34+ cells (≥ 0.8 X 106 CD34+ cells/kg) after 2 apheresis days or ≥ 2 X 106 CD34+ cells/kg in ≤ 4 apheresis days were eligible to enter an open-label rescue procedure. The rescue procedure with G-CSF and plerixafor 240 µg/kg was initiated after a minimum 7-day rest period. The rescue group consisted of 52 placebo-treated individuals and 10 plerixafor-treated individuals. Thirty-seven (59.7%) of rescue individuals were able to collect sufficient CD34+ cells in ≤ 4 apheresis days with the plerixafor rescue regimen. A total of 52 (84%) participants in the rescue cohort proceeded to transplantation. Fifty-three (85.5%) of 62 rescue participants were alive at 12 months of follow-up. The authors concluded plerixafor and G-CSF resulted in significantly higher proportions of individuals who achieved, “Optimal CD34+ cell target for transplantation in fewer apheresis days compared with C-CSF alone.”

The primary endpoint for the phase III MM trial (DiPersio, 2009b) was the percentage of individuals who collected ≥ 6 X 106 CD34+cells/kg in ≤ 2 apheresis procedures. The group treated with plerixafor and G-CSF had significantly more individuals who met the primary endpoint, with 71.6% (106/148 participants) compared to the placebo group 34.4% (53/154 participants) (p<0.001). Fifty-four percent of the individuals in the treatment group achieved the targeted collection cell dose in 1 day of apheresis. Fifty-six percent of the placebo group required four apheresis sessions to achieve the targeted cell dose.

The two phase III randomized controlled trials (RCT) reported similar overall incidence of adverse events (AE) with most being mild to moderate in severity. The most common AE for plerixafor injection was gastrointestinal disorders and reactions at the injection site.

Additional published literature support the use of plerixafor and G-CSF mobilization to collect sufficient CD34+ cells for autologous HSCT for individuals with Hodgkin lymphoma (HL) and testicular cancer (Calandra, 2008; Cashen, 2008; De Blasio, 2013; Shaughnessy, 2013).

The product information label (2015) notes tumor cells may be released during mobilization with plerixafor injection and G-CSF. The label warns against utilizing plerixafor injection in individuals with leukemia. Additionally, the label states, “The safety and efficacy of Mozobil in pediatric patients has not been established in controlled clinical studies.”

Chambon and colleagues (2013) reported results from a phase IIA study of 1-day mobilization of autologous stem cells with plerixafor injection in children (age 0-18 years) with solid tumors. A single dose of 240 µg/kg of plerixafor injection was given at zero hour (h0) which was scheduled at 8 a.m. Circulating CD34+ cells were monitored at h0 and then hourly from hour 3 (h3) thru hour 11 (h11). Apheresis was initiated at h5 if CD34+ cells were at least 10 X 106/L. If the threshold was not met, apheresis was postponed and if by h10, the threshold was not met, the child was considered a non-responder. The primary endpoint was the percentage of children with optimal mobilization of at least 5 X 106 CD34+/kg during the single apheresis session with less than three blood volumes processed (BVP). All 5 children met the CD34+ threshold after the plerixafor injection and proceeded to apheresis. However, the median number of CD34+ cells/child collected was 1.62 X 106 (0.47-3.5) and none of the participants met the criterion of 5 X 106 CD34+ cells/kg during the standard apheresis session. Therefore, the stopping criteria for the trial were met. The authors noted this was the first study of single-agent plerixafor injection as a mobilizing agent in children as follows:

Data on the use of plerixafor in children remains scarce… CD34+ blood cell content decreased very early after the start of apheresis and collection efficiency was very poor in every child. The data suggest that mobilization was no longer sustained after h5. The use of plerixafor in children should be optimized by further studies addressing dose-effect and Plerixafor-induced mobilization kinetics during hematological recovery.

According to the National Comprehensive Cancer Network® (NCCN) Drugs & Biologic Compendiumfor plerixafor (2018), there is no change to the following recommendations for use in HSCT for:

The NCCN Clinical Practice Guidelines in Oncology for multiple myeloma (MM) provide the following:

There are data indicating successful stem cell harvest with the addition of plerixafor when conventional mobilization methods fail (NCCN, 2018).

The NCCN Clinical Practice Guidelines for myeloid growth factors added the following:

For mobilization of hematopoietic progenitor cells in the autologous setting, effective mobilization regimens include growth factor alone, chemotherapy and growth factor combined, and incorporation of plerixafor with either approach.

Prior indications for plerixafor have been replaced with:
Plerixafor is FDA approved in combination with G-CSF for the purpose of mobilizing autologous hematopoietic stem cells to the peripheral blood in patients with NHL and MM.

Existing literature suggests that a preemptive “Just in time” strategy of adding plerixafor for patients who do not mount a sufficient CD34+ cell count after mobilization with growth factor with or without chemotherapy is highly successful.
There is limited data on parameters for predicting poor mobilization and which patients may benefit from upfront use of plerixafor. Risk factors that have been associated with poor mobilization include older age, extensive prior therapy, prior radiation to marrow containing regions or multiple cycles of certain agents, such as fludarabine or lenalidomide.
Clinical trials of upfront plerixafor, as compared to preemptive use, are needed as parameters defining poor mobilization are not fully understood…Additional studies have suggested that there may be genetic parameters that contribute to mobilization outcome…Randomized trials are needed to verify the parameters proposed in predictive models for poor mobilization (NCCN, 2018).

There are multiple ongoing clinical trials regarding the use of plerixafor injection in combination with other drugs and as a component of treatment regimens for other malignancies, such as breast cancer, leukemia and myelodysplastic syndromes. Additional trials are exploring the use of plerixafor in various dosing schedules, including use beyond the FDA approved use of 4 consecutive days. At the present time, the data on safety, efficacy and long-term effects of plerixafor as a treatment of other malignancies have not been published from prospective clinical trials sufficiently powered to definitively determine that plerixafor injection is as beneficial as established mobilization therapy.

There is an ongoing phase I/II randomized trial that is exploring the use of plerixafor injection as part of a mobilization regimen for children with solid tumors. Although the estimated completion date for the trial was 2017-2018, no study results have been published, to date. There is a paucity of trials regarding the use of plerixafor in the pediatric population, and recognized compendia continue to state, “Safety and efficacy is not established in pediatric patients younger than 18 years” (AHFS, 2018; DrugPoints, 2017; NCCN, 2018).

Plerixafor injection is recommended at 0.24 mg/kg of body weight and is initiated after the individual has received G-CSF once daily for 4 days. The SQ injection is typically given approximately 11 hours prior to initiation of each session of apheresis for up to 4 consecutive days (Product Information Label, 2013).

Plerixafor is primarily excreted through the kidneys and clinical studies showed a correlation between renal function and plerixafor clearance. Recommended dosing is reduced by one-third to 0.16 mg/kg for individuals with moderate to severe renal impairment, defined as creatinine clearance (CLCR) of less than or equal to 50 mL/min. For maximum dosing, the Product Information Label (2013) notes:

There is limited experience with the 0.24 mg/kg dose of plerixafor in patients weighing above 160 kg. Therefore the dose should not exceed that of a 160 kg patient, (i.e., 40 mg/day if the estimated creatinine clearance (CLCR) is > 50 mL/min and 27 mg/day if CLCR is ≤ 50 mL/min).

Adverse Events and Warnings:
The Product Information Label (2015) for plerixafor includes the following warnings and precautions:

Anaphylactic shock and Hypersensitivity reactions
Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening with clinically significant hypotension and shock, have occurred in patients receiving Mozobil. Observe patients for signs and symptoms of hypersensitivity during and after Mozobil administration for at least 30 minutes and until clinically stable following completion of each administration. Only administer Mozobil when personnel and therapies are immediately available for the treatment of anaphylaxis and other hypersensitivity reactions.

Tumor Cell Mobilization in Leukemia Patients
Mozobil may cause mobilization of leukemic cells and subsequent contamination of the apheresis product. Therefore, Mozobil is not intended for HSC mobilization and harvest in patients with leukemia.

Leukocytosis
Administration of Mozobil in conjunction with G-CSF increases circulating leukocytes as well as HSC populations. Monitor white blood cell counts during Mozobil use.

Thrombocytopenia
Thrombocytopenia has been observed in patients receiving Mozobil. Monitor platelet counts in all patients who receive Mozobil and then undergo apheresis.

Potential for Tumor Cell Mobilization
When Mozobil is used in combination with G-CSF for HSC mobilization‚ tumor cells may be released from the marrow and subsequently collected in the leukapheresis product. The effect of potential reinfusion of tumor cells has not been well-studied.

Splenic Enlargement and Potential for Rupture
Higher absolute and relative spleen weights associated with extramedullary hematopoiesis were observed following prolonged (2 to 4 weeks) daily plerixafor SC administration in rats at doses approximately 4-fold higher than the recommended human dose based on body surface area. The effect of Mozobil on spleen size in patients was not specifically evaluated in clinical studies. Evaluate individuals receiving Mozobil in combination with G-CSF who report left upper abdominal pain and/or scapular or shoulder pain for splenic integrity.

Embryo-fetal Toxicity
Mozobil may cause fetal harm when administered to a pregnant woman. Plerixafor is teratogenic in animals. There are no adequate and well-controlled studies in pregnant women using Mozobil. Advise women of childbearing potential to avoid becoming pregnant while receiving treatment with Mozobil. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.

Definitions

Autologous stem cells: Stem cells harvested from the individual's own bone marrow or peripheral blood.

Hematopoietic stem cells: Primitive cells capable of replication and formation into mature blood cells in order to repopulate the bone marrow.

Pheresis: A procedure by which blood is removed from the body, separated into components, manipulated and returned to the individual.

References

Peer Reviewed Publications:

  1.  Bilgin YM, Visser O, Beckers EA, et al. Evaluation of Dutch guideline for just-in-time addition of plerixafor to stem cell mobilization in patients who fail with granulocyte-colony-stimulating factor. Transfusion. 2015; 55(5):1021-1027.
  2. Calandra G, McCarty J, McGuirk J, et al. AMD3100 plus G-CSF can successfully mobilize CD34+ cells from non-Hodgkin's lymphoma, Hodgkin's disease and multiple myeloma patients previously failing mobilization with chemotherapy and/or cytokine treatment: compassionate use data. Bone Marrow Transplant. 2008; 41(4):331-338.
  3. Cashen A, Lopez S, Gao F, et al J. A phase II study of plerixafor (AMD3100) plus G-CSF for autologous hematopoietic progenitor cell mobilization in patients with Hodgkin lymphoma. Biol Blood Marrow Transplant. 2008; 14(11):1253-1261.
  4. Chambon F, Merlin E, Rochette E, et al. Mobilization of hematopoietic stem cells by plerixafor alone in children: a sequential Bayesian trial. Transfus Apher Sci. 2013; 49(3):453-458.
  5. Chen AI, Bains T, Murray S, et al. Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization. Bone Marrow Transplant. 2012; 47(12):1526-1529.
  6. De Blasio A, Rossi L, Zappone E, et al. Plerixafor and autologous stem cell transplantation: impressive result in a chemoresistant testicular cancer patient treated with high-dose chemotherapy. Anticancer Drugs. 2013; 24(6):653-657.
  7. DiPersio JF, Micallef IN, Stiff PJ, et al. Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin's lymphoma. J Clin Oncol. 2009a; 27(28):4767-4773.
  8. DiPersio JF, Stadtmauer EA, Nademanee A, et al.; 3102 Investigators. Plerixafor and G-CSF versus placebo and G-CSF to mobilize hematopoietic stem cells for autologous stem cell transplantation in patients with multiple myeloma. Blood. 2009b; 113(23):5720-5726.
  9. Douglas KW, Parker AN, Hayden PJ, et al. Plerixafor for PBSC mobilization in myeloma patients with advanced renal failure: safety and efficacy data in a series of 21 patients from Europe and the USA. Bone Marrow Transplant. 2012; 47(1):18-23.
  10. Dugan MJ, Maziarz RT, Bensinger WI, et al. Safety and preliminary efficacy of plerixafor (Mozobil) in combination with chemotherapy and G-CSF: an open-label, multicenter, exploratory trial in patients with multiple myeloma and non-Hodgkin's lymphoma undergoing stem cell mobilization. Bone Marrow Transplant. 2010; 45(1):39-47.
  11. Flomenberg N, Comenzo RL, Badel K, Calandra G. Plerixafor (Mozobil) alone to mobilize hematopoietic stem cells from multiple myeloma patients for autologous transplantation. Biol Blood Marrow Transplant. 2010; 16(5):695-700.
  12. Flomenberg N, Devine SM, Dipersio JF, et al. The use of AMD3100 plus G-CSF for autologous hematopoietic progenitor cell mobilization is superior to G-CSF alone. Blood. 2005; 106(5):1867-1874.
  13. Holtan SG, Porrata LF, Micallef IN, et al. AMD3100 affects autograft lymphocyte collection and progression-free survival after autologous stem cell transplantation in non-Hodgkin lymphoma. Clin Lymphoma Myeloma. 2007; 7(4):315-318.
  14. Hübel K, Fresen MM, Apperley JF, et al. European data on stem cell mobilization with plerixafor in non-Hodgkin's lymphoma, Hodgkin's lymphoma and multiple myeloma patients. A subgroup analysis of the European Consortium of stem cell mobilization. Bone Marrow Transplant. 2012; 47(8):1046-1050.
  15. Kobold S, Isernhagen J, Hübel K, et al. Plerixafor is effective and safe for stem cell mobilization in heavily pretreated germ cell tumor patients. Bone Marrow Transplant. 2011; 46(8):1053-1056.
  16. Lefrère F, Mauge L, Réa D, et al. Specific time course for mobilization of peripheral blood CD34+ cells after plerixafor injection in very poor mobilizer patients: impact on the timing of the apheresis procedure. Transfusion. 2013; 53(3):564-569.
  17. Lor KW, Helmons PJ, Belew H, et al. Plerixafor as first- and second-line strategies for autologous stem cell mobilization in patients with non-Hodgkin's lymphoma or multiple myeloma. Pharmacotherapy. 2012; 32(7):596-603.
  18. Maziarz RT, Nademanee AP, Micallef IN, et al. Plerixafor plus granulocyte colony-stimulating factor improves the mobilization of hematopoietic stem cells in patients with non-Hodgkin lymphoma and low circulating peripheral blood CD34+ cells. Biol Blood Marrow Transplant. 2013; 19(4):670-675.
  19. Micallef IN, Stiff PJ, DiPersio JF, et al. Successful stem cell remobilization using plerixafor (mozobil) plus granulocyte colony-stimulating factor in patients with non-hodgkin lymphoma: results from the plerixafor NHL phase 3 study rescue protocol. Biol Blood Marrow Transplant. 2009; 15(12):1578-1586.
  20. Micallef IN, Stiff PJ, Stadtmauer EA, et al. Safety and efficacy of upfront plerixafor + G-CSF vs. placebo + G-CSF for mobilization of CD34+ hematopoietic progenitor cells in patients ≥60 and <60 years of age with non-Hodgkin's lymphoma or multiple myeloma. Am J Hematol. 2013; 88(12):1017-1023.
  21. Nademanee AP, DiPersio JF, Maziarz RT, et al. Plerixafor plus granulocyte colony-stimulating factor versus placebo plus granulocyte colony-stimulating factor for mobilization of CD34(+) hematopoietic stem cells in patients with multiple myeloma and low peripheral blood CD34(+) cell count: results of a subset analysis of a randomized trial. Biol Blood Marrow Transplant. 2012; 18(10):1564-1572.
  22. Ogunniyi A, Rodriguez M, Devlin S, et al. Upfront use of plerixafor and granulocyte-colony stimulating factor (GCSF) for stem cell mobilization in patients with multiple myeloma: efficacy and analysis of risk factors associated with poor stem cell collection efficiency. Leuk Lymphoma. 2017; 58(5):1123-1129.
  23. Pusic I, Jiang SY, Landua S, et al. Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation. Biol Blood Marrow Transplant. 2008; 14(9):1045-1056.
  24. Russell N, Douglas K, Ho AD, et al. Plerixafor and granulocyte colony-stimulating factor for first-line steady-state autologous peripheral blood stem cell mobilization in lymphoma and multiple myeloma: results of the prospective PREDICT trial. Haematologica. 2013; 98(2):172-178.
  25. Schroeder MA, Rettig MP, Lopez S, et al. Mobilization of allogeneic peripheral blood stem cell donors with intravenous plerixafor mobilizes a unique graft. Blood. 2017; 129:2680-2692.
  26. Shaughnessy P, Uberti J, Devine S, et al. Plerixafor and G-CSF for autologous stem cell mobilization in patients with NHL, Hodgkin's lymphoma and multiple myeloma: results from the expanded access program. Bone Marrow Transplant. 2013; 48(6):777-781.
  27. Sheppard D, Bredeson C, Allan D, Tay J. Systematic review of randomized controlled trials of hematopoietic stem cell mobilization strategies for autologous transplantation for hematologic malignancies. Biol Blood Marrow Transplant. 2012; 18(8):1191-1203.
  28. Stiff PJ, Micallef I, Nademanee AP, et al. Transplanted CD34(+) cell dose is associated with long-term platelet count recovery following autologous peripheral blood stem cell transplant in patients with non-Hodgkin lymphoma or multiple myeloma. Biol Blood Marrow Transplant. 2011; 17(8):1146-1153.
  29. Uy GL, Rettig MP, Cashen AF. Plerixafor, a CXCR4 antagonist for the mobilization of hematopoietic stem cells. Expert Opin Biol Ther. 2008; 8(11):1797-1804.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. Brave M, Farrell A, Ching Lin S, et al. FDA review summary: Mozobil in combination with granulocyte colony-stimulating factor to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation. Oncology. 2010; 78(3-4):282-288.
  2. Duong HK, Savani BN, Copelan E, et al. Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2014; 20(9):1262-1273.
  3. Giralt S, Costa L, Schriber J, et al. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant. 2014; 20(3):295-308.
  4. Giralt S, Stadtmauer EA, Harousseau JL, et al.; IMWG. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia. 2009; 23(10):1904-1912.
  5. Hartmann T, Hübel K, Monsef I, et al. Additional plerixafor to granulocyte colony-stimulating factors for hematopoietic stem cell mobilization for autologous transplantation in people with malignant lymphoma or multiple myeloma. Cochrane Database Syst Rev. 2015; (10):CD010615.
  6. Mozobil [Product Information]. Cambridge, MA. Genzyme Corporation; December 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022311s018lbl.pdf. Accessed on October 12, 2018.
  7. National Comprehensive Cancer Network®. NCCN Drugs & Biologic Compendium (electronic version) 2018. For additional information visit the NCCN website: http://www.nccn.org. Accessed on October 12, 2018.
  8. NCCN Clinical Practice Guidelines in Oncology. © 2018 National Comprehensive Cancer Network, Inc. For additional information: http://www.nccn.org/index.asp. Accessed on October 12, 2018.
    • Multiple Myeloma (V.1.2019). Revised July 20, 2018.
    • Myeloid Growth Factors (V.2.2018). Revised August 3, 2018.
  9. Plerixafor. In: DrugPoints® System (electronic version). Truven Health Analytics, Greenwood Village, CO. Updated December 11, 2017. Available at: http://www.micromedexsolutions.com. Accessed on October 12, 2018.
  10. Plerixafor. Lexicomp® Online, American Hospital Formulary Service® (AHFS®) Online, Hudson, Ohio, Lexi-Comp., Inc. Last revised June 26, 2018. Accessed on October 12, 2018.
  11. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology (ASCO). Clinical practice guideline update. J Clin Oncol. 2015; 33(28):3199-3212.
Websites for Additional Information
  1. American Cancer Society. Stem cell transplant (peripheral blood, bone marrow, and cord blood transplants). October 2, 2013. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003215-pdf.pdf. Accessed on October 12, 2018.
  2. National Cancer Institute. Blood-Forming Stem Cell Transplants. Reviewed on August 12, 2013. Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant. Accessed on October 12, 2018.
Index

AMD3100
Mozobil
Plerixafor injection

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

History

Status

Date

Action

Reviewed

11/08/2018

Medical Policy & Technology Assessment Committee (MPTAC) review.

Reviewed

10/31/2018

Hematology/Oncology Subcommittee review. The Discussion and Reference sections were updated.

New

11/02/2017

MPTAC review.

New

11/01/2017

Hematology/Oncology Subcommittee review. Initial document development. Moved content of DRUG.00060 Plerixafor Injection (Mozobil) to new clinical utilization management guideline document with the same title.