Plerixafor alone for the mobilization and transplantation of HLA-matched sibling donor hematopoietic stem cells.

Plerixafor, a direct antagonist of CXCR4/stromal-derived factor 1, can safely and rapidly mobilize allografts without the use of granulocyte colony-stimulating factor (G-CSF). We conducted a phase 2, multicenter, prospective study of plerixafor-mobilized HLA-identical sibling allografts for allogeneic hematopoietic cell transplantation in recipients with hematological malignancies. Donors (n = 64) were treated with subcutaneous plerixafor (240 µg/kg) and started leukapheresis (LP) 4 hours later. The primary objective was to determine the proportion of donors who were successfully mobilized: defined as collection of ≥2.0 × 106 CD34+ cells per kilogram recipient weight in ≤2 LP sessions. Recipients subsequently received reduced intensity (RIC; n = 33) or myeloablative (MAC; n = 30) conditioning. Sixty-three of 64 (98%) donors achieved the primary objective. The median CD34+ cell dose per kilogram recipient weight collected within 2 days was 4.7 (0.9-9.6). Plerixafor was well tolerated with only grade 1 or 2 drug-related adverse events noted. Bone pain was not observed. Plerixafor-mobilized grafts engrafted promptly. One-year progression-free and overall survivals were 53% (95% confidence interval [CI], 36% to 71%) and 63% (95% CI, 46% to 79%) for MAC and 64% (95% CI, 47% to 79%) and 70% (95% CI, 53% to 84%) for RIC recipients, respectively. Donor toxicity was reduced relative to G-CSF mobilized related donors. This is the first multicenter trial to demonstrate that, as an alternative to G-CSF, plerixafor rapidly and safely mobilizes sufficient numbers of CD34+ cells from matched sibling donors for HCT. Engraftment was prompt, and outcomes in recipients were encouraging. This trial was registered at clinicaltrials.gov as #NCT01696461.

Blood lead screening among newly arrived refugees in Minnesota.

During the last 10 years, the prevalence rate of elevated blood lead levels (EBLLs) in the general population in the United States has decreased, while the rate of EBLLs among refugee children in this country has remained high. Because of this, national guidelines recommend both an initial and a repeat screening of refugee children. To explore blood lead screening among refugee children in Minnesota, we examined data on 1,256 children who arrived in Minnesota between 2004 and 2007. Our objectives were to describe the characteristics of refugee children who are screened for blood lead; identify the characteristics of refugee children with an EBLL following screening; and describe the characteristics of refugee children who received a repeat blood lead test. Our results showed that approximately 6% of refugee children in Minnesota had an EBLL and fewer than half of all refugee children in the sample received a repeat test. For that reason, primary care providers should be periodically reminded of the importance of repeat lead screening for refugee children.