Efficacy of chemotherapy with G-CSF versus plerixafor with G-CSF in autologous stem cell mobilization for lymphoma patients.

Abstract

Aims: To compare the efficacy, safety, hematological recovery, immune reconstitution, infection rates, and quality of life (QoL) between two stem cell mobilization regimens - granulocyte colony-stimulating factor (G-CSF) plus chemotherapy versus G-CSF plus plerixafor - in patients with lymphoma undergoing autologous stem cell transplantation (ASCT).

Methods: A retrospective cohort study was conducted in 174 lymphoma patients who underwent stem cell transplantation at Shanxi Province Cancer Hospital from 2010 to 2024. Patients were divided into two cohorts: G-CSF plus chemotherapy (n=129) and G-CSF plus plerixafor (n=45). Baseline demographics, CD34+ cell yield and collection efficiency, time to hematopoietic recovery, transfusion requirements, incidence of fever and infections, hematologic abnormalities, immune reconstitution, and patient-reported QoL at 6 months were collected from de-identified medical records and analyzed.

Results: Baseline characteristics were comparable between groups. The G-CSF plus plerixafor group demonstrated significantly higher CD34+ cell counts at the first apheresis, higher total CD34+ cell yields, and a larger proportion of patients achieving ≥ 2 × 10⁶ and ≥ 5 × 10⁶ CD34+ cells/kg within 4 days compared with the G-CSF plus chemotherapy group. Hematological recovery (platelet and neutrophil engraftment) was faster in the plerixafor group. The plerixafor group also had shorter hospital stays, fewer febrile episodes during neutropenia, reduced antibiotic use, and higher lymphocyte counts at day 28 post-transplantion. The incidences of leukopenia, lymphopenia, anemia, and gastrointestinal adverse effects were lower in this group. Immune reconstitution, particularly CD4+ and CD8+ T cell recovery at 30 days, was improved post-transplant, and QoL scores at 6 months post-discharge were higher across physical, emotional, and social domains.

Conclusion: Mobilization with G-CSF plus plerixafor is associated with higher CD34+ cell yields, faster hematologic and immune recovery, lower complication rates, and better QoL outcomes compared with G-CSF plus chemotherapy in lymphoma patients undergoing ASCT.