Mozobil
(plerixafor)Dosage & Administration
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Mozobil Prescribing Information
Mozobil is indicated in combination with filgrastim to mobilize hematopoietic stem cells (HSCs) to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma (NHL) or multiple myeloma (MM).
Recommended Dosage and Administration
Begin treatment with Mozobil after the patient has received filgrastim once daily for 4 days [see Dosage and Administration (2.2)]. Administer Mozobil approximately 11 hours prior to initiation of each apheresis for up to 4 consecutive days.
The recommended dose of Mozobil by subcutaneous injection is based on body weight:
- 20 mg fixed dose or 0.24 mg/kg of body weight for patients weighing less than or equal to 83 kg. [see Clinical Pharmacology (12.3)]
- 0.24 mg/kg of body weight for patients weighing greater than 83 kg
Use the patient's actual body weight to calculate the volume of Mozobil to be administered. Each vial delivers 1.2 mL of 20 mg/mL solution, and the volume to be administered to patients should be calculated from the following equation:
- 0.012 × patient's actual body weight (in kg) = volume to be administered (in mL)
In clinical studies, Mozobil dose has been calculated based on actual body weight in patients up to 175% of ideal body weight. Mozobil dose and treatment of patients weighing more than 175% of ideal body weight have not been investigated.
Based on increasing exposure with increasing body weight, the Mozobil dose should not exceed 40 mg/day [see Clinical Pharmacology (12.3)].
Vials should be inspected visually for particulate matter and discoloration prior to administration and should not be used if there is particulate matter or if the solution is discolored.
Discard unused portion.
Recommended Concomitant Medications
Administer daily morning doses of filgrastim 10 mcg/kg for 4 days prior to the first evening dose of Mozobil and on each day prior to apheresis [see Clinical Studies (14)].
Dose Modifications in Renal Impairment
In patients with moderate and severe renal impairment (estimated creatinine clearance (CLCR) less than or equal to 50 mL/min), reduce the dose of Mozobil by one-third based on body weight category as shown in Table 1. If CLCR is less than or equal to 50 mL/min the dose should not exceed 27 mg/day, as the mg/kg-based dosage results in increased plerixafor exposure with increasing body weight [see Clinical Pharmacology (12.3)]. Similar systemic exposure is predicted if the dose is reduced by one-third in patients with moderate and severe renal impairment compared with subjects with normal renal function [see Clinical Pharmacology (12.3)].
| Estimated Creatinine Clearance (mL/min) | Dose | |
|---|---|---|
| Body Weight less than or equal to 83 kg | Body Weight greater than 83 kg and less than 160 kg | |
| greater than 50 | 20 mg or 0.24 mg/kg once daily | 0.24 mg/kg once daily (not to exceed 40 mg/day) |
| less than or equal to 50 | 13 mg or 0.16 mg/kg once daily | 0.16 mg/kg once daily (not to exceed 27 mg/day) |
The following (Cockcroft-Gault) formula may be used to estimate CLCR:
Males:
Creatinine clearance (mL/min) = weight (kg) × (140 – age in years)
72 × serum creatinine (mg/dL)
Females:
Creatinine clearance (mL/min) = 0.85 × value calculated for males
There is insufficient information to make dosage recommendations in patients on hemodialysis.
Injection: 24 mg/1.2 mL (20 mg/mL) sterile, clear, colorless to pale-yellow solution in a single-dose vial.
Pregnancy
Risk Summary
Limited available data with Mozobil use in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes. In animal reproduction studies, subcutaneous administration of plerixafor to pregnant rats during organogenesis at doses 10-times the maximum recommended human doses resulted in embryo-fetal mortality, structural abnormalities, and alterations to growth [see Data].
Advise pregnant women of the potential risk to the fetus.
Advise women of reproductive potential to avoid becoming pregnant while receiving treatment with Mozobil [see Warnings and Precautions (5.6)].
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. The background risk of major birth defects and miscarriages for the indicated population is unknown.
Data
Animal data
Plerixafor administered to pregnant rats induced embryo-fetal toxicity, including fetal death, increased resorptions and postimplantation loss, decreased fetal weights, anophthalmia, shortened digits, cardiac interventricular septal defect, ringed aorta, globular heart, hydrocephaly, dilatation of olfactory ventricles, and retarded skeletal development. Embryo-fetal toxicities occurred mainly at a dose of 90 mg/m2 (approximately 10 times the recommended human dose of 0.24 mg/kg when compared on a mg/m2 basis).
Lactation
Risk Summary
There are no data on the presence of plerixafor in human milk, the effect on the breastfed child, or the effect on milk production. Because of the potential serious adverse reactions in the breastfed child, advise females that breastfeeding is not recommended during treatment with Mozobil and for one week after the final dose.
Females and Males of Reproductive Potential
Pregnancy Testing
Verify pregnancy status in females of reproductive potential prior to initiating Mozobil [see Use in Specific Populations (8.1)].
Contraception
Females
Mozobil can cause embryo-fetal harm when administered to pregnant women [see Use in Specific Populations (8.1)]. Advise females of reproductive potential to use effective contraception during treatment with Mozobil and for one week after the final dose.
Males
Males treated with Mozobil should use effective contraception during treatment and for one week after cessation of treatment.
Pediatric Use
The safety and effectiveness of Mozobil have not been established in pediatric patients. Effectiveness was not demonstrated in a single phase 1/2 randomized, open-label, comparative study of Mozobil plus standard regimens for mobilization of hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation. Forty-five pediatric patients ages 1 to <17 years with solid tumors or lymphoma were randomized 2:1 to Mozobil in addition to standard mobilization regimens (N=30) or standard mobilization regimens alone (N=15) (comparator arm). No new safety signals were observed in pediatric patients in this trial.
The day prior to the first apheresis, median peripheral blood CD34+ counts were 35 × 106 cells/L in the comparator arm and 15 × 106 cells/L in the Mozobil arm. On the day of the first apheresis, median peripheral blood CD34+ counts were 64 × 106 cells/L in the comparator arm and 77 × 106 cells/L in the Mozobil arm.
Plerixafor exposure, shown as AUC, in pediatric patients aged 12 to 18 years was within the range of values previously observed in adults, while the AUC of plerixafor in pediatric patients aged 2 to 12 years was 67% to 87% of that observed in adults, given the same adult dose (0.24 mg/kg).
Geriatric Use
Of the total number of subjects in controlled clinical studies of Mozobil, 24% were 65 and over, while 0.8% were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
Since plerixafor is mainly excreted by the kidney, no dose modifications are necessary in elderly individuals with normal renal function. In general, care should be taken in dose selection for elderly patients due to the greater frequency of decreased renal function with advanced age. Dosage adjustment in elderly patients with CLCR less than or equal to 50 mL/min is recommended [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3)].
Renal Impairment
In patients with moderate and severe renal impairment (CLCR less than or equal to 50 mL/min), reduce the dose of Mozobil by one-third to 0.16 mg/kg [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3)].
Mozobil is contraindicated in patients with a history of hypersensitivity to plerixafor [see Warnings and Precautions (5.1)]. Anaphylactic shock has occurred with use of Mozobil.
Anaphylactic Shock and Hypersensitivity Reactions
Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening with clinically significant hypotension and shock have occurred in patients receiving Mozobil [see Adverse Reactions (6.2)]. Observe patients for signs and symptoms of hypersensitivity during and after Mozobil administration for at least 30 minutes and until clinically stable following completion of each administration. Only administer Mozobil when personnel and therapies are immediately available for the treatment of anaphylaxis and other hypersensitivity reactions.
In clinical studies, mild or moderate allergic reactions occurred within approximately 30 minutes after Mozobil administration in less than 1% of patients [see Adverse Reactions (6.1)].
Tumor Cell Mobilization in Leukemia Patients
For the purpose of HSC mobilization, Mozobil may cause mobilization of leukemic cells and subsequent contamination of the apheresis product. Therefore, Mozobil is not intended for HSC mobilization and harvest in patients with leukemia.
Hematologic Effects
Leukocytosis
Administration of Mozobil in conjunction with filgrastim increases circulating leukocytes as well as HSC populations. Monitor white blood cell counts during Mozobil use [see Adverse Reactions (6.1)].
Thrombocytopenia
Thrombocytopenia has been observed in patients receiving Mozobil. Monitor platelet counts in all patients who receive Mozobil and then undergo apheresis.
Potential for Tumor Cell Mobilization
When Mozobil is used in combination with filgrastim for HSC mobilization‚ tumor cells may be released from the marrow and subsequently collected in the leukapheresis product. The effect of potential reinfusion of tumor cells has not been well-studied.
Splenic Enlargement and Rupture
Higher absolute and relative spleen weights associated with extramedullary hematopoiesis were observed following prolonged (2 to 4 weeks) daily plerixafor SC administration in rats at doses approximately 4-fold higher than the recommended human dose based on body surface area. The effect of Mozobil on spleen size in patients was not specifically evaluated in clinical studies. Cases of splenic enlargement and/or rupture have been reported following the administration of Mozobil in conjunction with filgrastim. Evaluate individuals receiving Mozobil in combination with filgrastim who report left upper abdominal pain and/or scapular or shoulder pain for splenic integrity.
Embryo-Fetal Toxicity
Based on findings from animal reproduction studies, Mozobil can cause fetal harm when administered to a pregnant woman. Plerixafor administration to pregnant rats during organogenesis resulted in embryo-fetal mortality, structural abnormalities, and alterations to growth at exposures approximately 10 times the exposure at the recommended human dose.
Advise pregnant women of the potential risk to the fetus. Advise females of reproductive potential to use an effective form of contraception during treatment with Mozobil and for one week after the final dose [see Use in Specific Populations (8.1)].