{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:08:59Z","timestamp":1781712539872,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Initial hematopoietic stem cell (HSC) mobilization failure remains a critical barrier to autologous stem cell transplantation (ASCT) in patients with lymphoma or multiple myeloma (MM). This retrospective cohort study (August 2015 to March 2023) evaluated the efficacy, safety, and cost\u2010effectiveness of a novel salvage regimen\u2014split\u2010dose cyclophosphamide (CTX: 1.5\u2009g\/m\n                    <jats:sup>2<\/jats:sup>\n                    for 2\u2009days)\u2009+\u2009Mecapegfilgrastim (PEG\u2010rhG\u2010CSF)\u2009+\u2009on\u2010demand plerixafor (PXF)\u2014compared to conventional strategies (CTX\u2009+\u2009granulocyte colony\u2010stimulating factor [G\u2010CSF] or G\u2010CSF\u2009+\u2009PXF) in 118 patients with initial mobilization failure. Patients were stratified into three groups: CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200946), CTX\u2009+\u2009G\u2010CSF (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200934), and G\u2010CSF\u2009+\u2009PXF (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200938). The CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF group achieved superior mobilization efficacy: median CD34\n                    <jats:sup>+<\/jats:sup>\n                    cell yield was 9.2\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    \/kg, which is significantly higher than that of CTX\u2009+\u2009G\u2010CSF group (4.1\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    \/kg;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) and G\u2010CSF\u2009+\u2009PXF group (4.6\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    \/kg;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Rates of achieving the thresholds of \u2265\u20092\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    CD34\n                    <jats:sup>+<\/jats:sup>\n                    cells\/kg and \u2265\u20095\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    CD34\n                    <jats:sup>+<\/jats:sup>\n                    cells\/kg were significantly higher in the CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF group. This superior mobilization efficacy also brought fewer apheresis sessions: only 15.2% of patients in the CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF cohort required \u2265\u20092 sessions, compared to 70.5% in CTX\u2009+\u2009G\u2010CSF group and 57.9% in G\u2010CSF\u2009+\u2009PXF group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Safety profiles were comparable across cohorts: febrile neutropenia occurred in 13% of patients in CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF group (vs. 26.5% in CTX\u2009+\u2009G\u2010CSF;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.33). Severe neutropenia (Grade 3\u20135) was common in CTX\u2010containing groups (91.3% vs. 90.2%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.88) but mostly being transient, with no treatment\u2010related mortality. Neutrophil engraftment times were similar (median 10\u201311\u2009days;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.406) in all groups. Cost analysis revealed that the CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF regimen was more cost\u2010effective than G\u2010CSF\u2009+\u2009PXF regimen (5511 vs. 8761;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05) but more expensive than CTX\u2009+\u2009G\u2010CSF regimen ($3012;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). In conclusion, CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF is a highly effective salvage mobilization strategy for patients with initial HSC mobilization failure, yielding higher CD34\n                    <jats:sup>+<\/jats:sup>\n                    cell counts with fewer aphereses and acceptable safety. With balanced advantages in efficacy, safety, and cost\u2010effectiveness, the CTX\u2009+\u2009PEG\u2010rhG\u2010CSF\u2009+\u2009on\u2010demand PXF regimen can be a preferred salvage option for ASCT candidates with prior mobilization failure.\n                  <\/jats:p>","DOI":"10.1002\/jca.70091","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T13:47:01Z","timestamp":1769608021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety and Efficacy of Cyclophosphamide With Dual Mecapegfilgrastim and On\u2010Demand Plerixafor for Salvage Mobilization in Patients With Initial Mobilization Failure: A Retrospective Cohort"],"prefix":"10.1002","volume":"41","author":[{"given":"Fang","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Hematology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine  Shanghai 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 Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siguo","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Hematology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangbo","family":"Wan","sequence":"additional","affiliation":[{"name":"Department of Hematology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine  Shanghai 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