Plerixafor

INTRODUCTION

Indications

Mobilizes hematopoietic stem cells to peripheral blood for collection and use in autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma; used in combination with granulocytecolony stimulation factor (G-CSF).

Action

Inhibits the CXCR-4 chemokine receptor, blocking its binding ability. Inhibition decreases adherence of stem cells to bone marrow, freeing them up to mobilize to peripheral blood. Therapeutic Effects: Mobilization of stem cells to peripheral blood allowing collection.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache, insomnia. GI: SPLENIC RUPTURE, diarrhea, nausea, vomiting, abdominal distention/pain, constipation, dry mouth, dyspepsia, flatulence. Derm: erythema, sweating. Hemat: leukemia/tumor cell mobilization, thrombocytopenia. Local: injection site reactions. MS: musculoskeletal pain. Neuro: oral hypoesthesia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of spleen rupture, including pain and tenderness in the upper left abdomen, light-headedness, dizziness, and confusion. Report these signs to the physician or nursing staff immediately.

• Monitor signs of thrombocytopenia such as bruising, nose bleeds and bleeding gums. Report these signs to the physician or nursing staff immediately.

• Assess any muscle or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor subcutaneous injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

Patient/Client-Related Instruction

Instruct patient to report other bothersome side effects such as severe or prolonged headache, sleep loss, numbness around the mouth, skin reactions (flushing, increased sweating), or GI problems (nausea, vomiting, diarrhea, constipation, abdominal pain, indigestion, flatulence).

Pharmacokinetics

Absorption: Well absorbed following SC administration.

Distribution: Largely confined to extravascular fluid space.

Metabolism and Excretion: Not metabolized by the liver; 70% unchanged in urine.

Half-life: 5.3 hr.

Contraindications/Precautions

Contraindicated in: Leukemia; OB/Lactation: Pregnancy, ...