WHA

MOZOBIL (plerixafor)

OFFICE ADMINISTRATION OR SELF ADMINISTRATION - Subcutaneous injection

Indication for Prior Authorization:
  • Indicated in combination with granulocyte-colony stimulating factor (G-CSF) to mobilize hematopoietic stem cells (HSCs) to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM).
Patients must meet the following criteria for the indication(s) above:
  • Patient is 18 years of age or older, AND
  • Chart note documentation is provided documenting one of the following:
    • Patient with non-Hodgkin's lymphoma (NHL) who will be undergoing autologous hematopoietic stem cell (HSC) transplantation, OR
    • Patient with multiple myeloma (MM) who will be undergoing autologous HSC transplantation, AND
  • Prescribed by or in consultation with a hematologist/oncologist, AND
  • Used in combination with granulocyte-colony stimulating factor (G-CSF) [e.g., Granix®, Neupogen®, Zarxio®, Nivestym™]
Dosing:
  • Begin treatment with Mozobil® after the patient has received G-CSF once daily for 4 days.
  • Administer Mozobil® approximately 11 hours prior to initiation of each apheresis for up to 4 consecutive days.
  • Dosing is based on body weight:
    • Weight less than or equal to 83 kg: 20 mg fixed dose or 0.24 mg/kg once daily
    • Weight greater than 83 kg: 0.24 mg/kg once daily
    • Maximum dose: 40 mg/day
  • Each vial delivers 1.2 mL of 20 mg/mL solution, volume to be administered to patients should be calculated from the following equation: 0.012 x patient's actual body weight (in kg) = volume to be administered (in mL)
  • Mozobil® dosing is modified for creatinine clearance 50 mL/min or less:
    • Weight less than or equal to 83 kg: 13 mg fixed dose or 0.16 mg/kg once daily
    • Weight greater than 83 kg and less than 160 kg: 0.16 mg/kg once daily
    • Maximum dose: 27 mg/day
  • Mozobil® dose and treatment of patients weighing more than 175% of ideal body weight have not been investigated.
  • See package insert for full dosing information
  • Administer daily morning doses of G-CSF 10 mcg/kg for 4 days prior to the first evening dose of Mozobil® and on each day prior to apheresis.
Approval:
  • 1 treatment course (up to 4 days)
Review History:
  • 8/18/2020 - Original review
  • 10/12/2020 - Update to administration location