Mobilization and collection of CD34+ cells for autologous transplantation of peripheral blood hematopoietic progenitor cells in children: analysis of two different granulocyte-colony stimulating factor doses

Abstract

IntroductionThe use of peripheral hematopoietic progenitor cells (HPCs) is the cell choice in autologous transplantation. The classic dose of granulocyte-colony stimulating factor (G-CSF) for mobilization is a single daily dose of 10 μg/kg of patient body weight. There is a theory that higher doses of granulocyte-colony stimulating factor applied twice daily could increase the number of CD34+ cells collected in fewer leukapheresis procedures.ObjectiveThe aim of this study was to compare a fractionated dose of 15 μg G-CSF/kg of body weight and the conventional dose of granulocyte-colony stimulating factor in respect to the number of leukapheresis procedures required to achieve a minimum collection of 3 × 106 CD34+ cells/kg body weight.MethodsPatients were divided into two groups: Group 10 – patients who received a single daily dose of 10 μg G-CSF/kg body weight and Group 15 – patients who received a fractioned dose of 15 μg G-CSF/kg body weight daily. The leukapheresis procedure was carried out in an automated cell separator. The autologous transplantation was carried out when a minimum number of 3 × 106 CD34+ cells/kg body weight was achieved.ResultsGroup 10 comprised 39 patients and Group 15 comprised 26 patients. A total of 146 apheresis procedures were performed: 110 (75.3%) for Group 10 and 36 (24.7%) for Group 15. For Group 10, a median of three (range: 1–7) leukapheresis procedures and a mean of 8.89 × 106 CD34+ cells/kg body weight (±9.59) were collected whereas for Group 15 the corresponding values were one (range: 1–3) and 5.29 × 106 cells/kg body weight (±4.95). A statistically significant difference was found in relation to the number of apheresis procedures (p-value <0.0001).ConclusionsTo collect a minimum target of 3 × 106 CD34+ cells/kg body weight, the administration of a fractionated dose of 15 μg G-CSF/kg body weight significantly decreased the number of leukapheresis procedures performed.

Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children

“…Additionally the optimal procedure for PBPC mobilization in children has not yet been determined because data on the engraftment are not enough [ 17 – 19 ]. Clinical collection of PBPC by leukapheresis has been more difficult to perform in a child than in an adult, especially after receiving an extensive therapy for their malignancies [ 20 – 22 ]. It has been shown that heavy and prolonged cytotoxic treatments seem to exhaust the mobilizable stem cell pool; therefore PBPC should be collected as early as possible after diagnosis [ 17 , 23 ].…”

Clinical observation of the application of autologous peripheral blood stem cell transplantation for the treatment of diabetic foot gangrene

“…In addition, large quantities of bone marrow (≤500 ml) may be required, and therefore certain patients are physically and psychologically unable to undergo this treatment. In recent years, studies concerning autologous peripheral blood stem cell transplantation have achieved marked progress (27)(28)(29). The autologous peripheral blood stem cell transplantation procedure is simple and readily accepted by patients.…”

Peripheric Stem Cell Collection Practices At Childhood

“…CD34 pozitif hücre sayısı için genel kabul görür bir eşik değer yoktur. Bazı merkezler 20/µL'ye kadar yüksel-mesini önerir ama periferik kanda HPKH'nin yük-sekliği birkaç gün gibi kısa bir süre olduğu için bu dönem kaçırılmamalıdır (1,5,6) .…”

“…Örneğin, Brezilya'dan yapılan bir çalışmada, G-CSF dozunun 15 µ/kg/gün iki dozda verilmesinin aferez sayısını azalttığı belirtilmiştir (6) . Otolog nakiller için toplanması hedeflenen kök hücre sayısı 2-5 x106 CD34 pozitif hücre/kg vücut ağırlığıdır.…”