Plerixafor (Mozobil®)

Plerixafor is used to mobilize, or move, stem cells from the bone marrow to the bloodstream in some patients with non-Hodgkin’s lymphoma or multiple myeloma. Plerixafor is used with a granulocyte-colony stimulating factor (G-CSF) before an autologous stem cell transplant. The G-CSF is given first for 4 days to help your bone marrow make more stem cells and white blood cells. You will then receive plerixafor daily for up to 4 days to make these stem cells easier to collect so they can be transplanted back into your body.

Plerixafor is not a chemotherapy medication but is used in preparation for some autologous stem cell transplants. Talk with your care team about whether plerixafor will be used prior to your transplant.

How to Take Plerixafor

Plerixafor is given as a subcutaneous injection (SQ, given under the skin). It will be given about 11 hours before you are scheduled to have your blood drawn to collect your cells before transplant (called apheresis).

Be sure to tell your healthcare provider about all medications and supplements you take. Tell your care team if you have leukemia.

Your blood work will be monitored as you prepare for your autologous stem cell transplant. Your team will pay close attention to your white blood cells.

Possible Side Effects

There are a number of things you can do to manage the side effects of plerixafor. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Diarrhea

Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. 

Nausea and/or Vomiting

Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms.

Tell your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Injection Site Reactions

Plerixafor may cause redness, swelling, pain, itchiness, numbness, a rash, a hardened area, or bruising where it is injected. If these symptoms do not get better after a few days, tell your care team.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Headache

Your healthcare provider can recommend medications and other strategies to help relieve pain.

Important but Less Common Side Effects

• Allergic Reaction: In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include shortness of breath or having a hard time breathing, chest pain, rash, flushing or itching or a decrease in blood pressure. If you notice any changes in how you feel during or after the injection, let your nurse know right away. If you have any of these symptoms after the infusion while at home, call 911 or go to the ER right away.
• Low Platelet Count (Thrombocytopenia): Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
  • Do not use a razor (an electric razor is fine).
  • Avoid contact sports and activities that can result in injury or bleeding.
  • Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding the use of these agents and all over the counter medications/supplements while on therapy.
  • Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
• Enlarged or Ruptured Spleen: This medication may cause your spleen to swell and/or rupture. Let your care team know right away if you have new or worsening pain in your upper left abdomen (belly), or pain in your shoulder or shoulder blade.

Sexual & Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so women should not become pregnant while on this medication. Effective birth control is necessary during treatment and for 1 week after your last dose. Even if your menstrual cycle stops, you could still be fertile and conceive. You should not breastfeed while taking this medication and for 1 week after your last dose.