Study of Plerixafor for Rescue of Poor Mobilizers in Autologous Stem Cell Transplant

• To evaluate if Plerixafor is generally safe. [ Time Frame: 6 months post transplant or until relapse ] [ Designated as safety issue: Yes ]
• To investigate the hematological activity of Plerixafor. [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
• To determine the times of neutrophil and platelet engraftment. [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
• To determine the durability of engraftment. [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]

Plerixafor, administered at a dose of 240 ug/kg, potentiates the effect of granulocyte colony-stimulating factor (G-CSF) to increase peripheral blood progenitor cells in both healthy volunteers and cancer patients. Furthermore, in cancer patients, cells collected via apheresis using Plerixafor and G-CSF have been successfully transplanted. In December 2008, Plerixafor received approval from the Food and Drug administration for use in combination with G-CSF to aid in mobilization of progenitor cells for apheresis. The proposed study is not designed to support approval of a new indication or change in the advertising for Plerixafor. The route of administration and dosage level are identical to that which is listed on the package insert. Although Plerixafor is not approved for patients with Hodgkins Lymphoma, there is no known or theoretic increased risk of the use of this drug in this patient population.

The study hypothesis for this study is that patients with a circulating CD34+ count < 20 cells/ul after 5 days of mobilization with G-CSF alone will achieve > or equal to 2 X 10(6)CD34+ cells/kg within 3 days of apheresis after receiving Plerixafor with G-CSF.

This is a single-center, Phase 2, open-label study. All patients diagnosed with non-hodgkins lymphoma, hodgkins disease or multiple myeloma and candidates for autologous transplantation are eligible to enter into the study. The only change to the standard of care is the addition of 240 ug/kg Plerixafor following 5 days of (G CSF)mobilization. At total of 20 patients will be enrolled. Enrollment will be stratified such that a total of 10 subjects will carry the diagnosis of multiple myeloma and have received prior lenalidomide therapy. The other 10 patients will carry the diagnosis of non-hodgkins lymphoma, hodgkins disease or multiple myeloma and not have prior therapy with lenalidomide.

The results of the study will provide both numeric and categorical estimates of measurements of the safety and efficacy of Plerixafor. The primary efficacy endpoint, Treatment Success, is a binary response variable categorizing whether the patient was able to mobilize at least 2 X 10(6) CD34+ cells/kg within 3 days of apheresis.

The percentage of patients achieving Treatment Success will be summarized. All AEs will be followed for 30 days after the last apheresis or until the first dose of ablative chemotherapy, whichever occurs first. All SAEs will be followed for 6 months post-transplant or until relapse. All patients who receive at least one dose of Plerixafor will be included in all summaries of AEs.

• Multiple Myeloma
• Non-Hodgkins Lymphoma
• Hodgkins Disease

• Drug: Plerixafor
  Patients with NHL, HD and MM who are completing their chemotherapy regimen and are candidates for autologous stem cell transplantation as defined by standard institutional practice. The only change to the standard of care is the addition of 240 ug/kg Plerixafor following 5 days of G CSF mobilization.
  Other Name: Mozobil, AMD3100
• Drug: Plerixafor
  Patients with MM who have been treated with at least 2 cycles of lenalidomide (two concurrent months of therapy) as part of their up-front therapy or as salvage therapy. The only change to the standard of care is the addition of 240 ug/kg Plerixafor following 5 days of G CSF mobilization.
  Other Name: Mozobil, AMD3100

• Experimental: A
  Patients with NHL, HD and MM who are completing their chemotherapy regimen and are candidates for autologous stem cell transplantation as defined by standard institutional practice.
  Intervention: Drug: Plerixafor
• Experimental: B
  Patients with MM who have been treated with at least 2 cycles of lenalidomide (two concurrent months of therapy) as part of their up-front therapy or as salvage therapy.
  Intervention: Drug: Plerixafor

Inclusion Criteria:

• Age 18 to 75 years.
• Diagnosis of NHL, HD or MM (cohort A)
• Diagnosis of MM and have had prior therapy with at least 2 cycles of lenalidomide (cohort B).
• Eligible for autologous transplantation
• CD34+ cell count < 7 cells/ul after 5 days of mobilization with G CSF or CD34+ cell count between 7 and 19 (inclusive) on day 5 of mobilization with G-CSF and < 1.3 x 106 CD34+ cells collected by apheresis on day 5 of G-CSF therapy (Section 6.1).
• < or equal to 5 prior regimens of chemotherapy (Rituxan is not considered chemotherapy for the purpose of this study)
• ≥ 4 weeks since last cycle of chemotherapy and the beginning of G-CSF mobilization (Rituxan is not considered chemotherapy for the purpose of this study)
• Total dose of melphalan < or equal to 200 mg
• ECOG performance status of 0 or 1
• Recovered from all acute toxic effects of prior chemotherapy
• Absolute PMN count > 1.0 X 10(9)/l prior to first dose of G-CSF
• PLT count > 75 X 10(9)/l prior to first dose of G-CSF
• Serum creatinine < or equal to 2.5 mg/dl
• SGOT, SGPT and total bilirubin < 2 X upper limit of normal (ULN) prior to the first dose of G-CSF
• Cardiac and pulmonary status sufficient to undergo apheresis and transplantation as determined by standard institutional practice
• Signed informed consent
• Patients of childbearing potential agree to use an approved form of contraception

Exclusion Criteria:

• A co-morbid condition which, in the view of the investigator, renders the patient at high risk from treatment complications
• Failed previous stem cell collection or collection attempts
• A residual acute medical condition resulting from prior chemotherapy
• Active brain metastases or carcinomatous meningitis
• Active infection requiring antibiotic treatment (excluding controlled catheter-related bacteremia)
• Received prior radio-immunotherapy with Zevalin or Bexxar
• Received thalidomide, dexamethasone, and/or Velcade within 7 days prior to the first dose of G-CSF
• Positive pregnancy test in female patients
• Lactating females
• Patients who previously received experimental therapy within 4 weeks of enrolling in this protocol