Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization.

Plerixafor augments PBSC collection, but the optimal approach for incorporating it into mobilization is uncertain. Forty-nine consecutive patients mobilized with G-CSF alone were analyzed, and a day 4 peripheral blood CD34(+) cell count of 0.015/ml was found to predict for a day 5 apheresis yield of 2 × 10(6) CD34(+) progenitors/kg, our institutional minimum necessary for a single autologous transplant. On the basis of this relationship, a clinical guideline was developed which recommended pre-emptive use of plerixafor if the day 4 peripheral blood CD34(+) cell count was between 0.005 and 0.015/ml. A total of 166 consecutive subjects with lymphoma or plasma cell dyscrasias underwent G-CSF mobilization after adoption of this care pathway, and the mobilization failure rate was only 7% in patients managed per guideline. The median PBSC yield was 6.3 × 10(6) CD34(+) progenitors/kg with G-CSF (day 4 peripheral blood CD34(+) cell > 0.015/ml) and 4.9 × 10(6) CD34(+) progenitors/kg with G-CSF+plerixafor (day 4 peripheral blood CD34(+) cell 0.005-0.015/ml). The median number of days of apheresis was 2 in both groups. This clinical guideline is an effective mobilization algorithm that minimizes mobilization failures, reduces poor apheresis yields, does not require risk factor identification and is simple to implement.

Pruritus in end stage renal disease.

In end stage renal disease (ESRD) clients, pruritus can be so severe and intractable, despite scratching, that sleep deprivation and contemplation of suicide can result. The exact etiology of pruritus in ESRD is unknown, but several possible etiologies have been proposed. Assessment tools are available to nurses and clients to grade the severity, frequency, distribution, and sleep deprivation experienced with the itching. Various treatments have been used to manage pruritus in ESRD with limited success. This article reviews the anatomy and physiology of the skin, describes the pathophysiology of pruritus, discusses proposed etiologies, reviews an assessment for an ESRD client with pruritus, and discusses the collaborative management of pruritus in ESRD.