Factors affecting autologous peripheral blood hematopoietic stem cell collections by large-volume leukapheresis: a single center experience

Abstract

Objective: To evaluate factors affecting peripheral blood hematopoietic stem cell yield in patients undergoing large-volume leukapheresis for autologous peripheral blood stem cell collection. Methods: Data from 304 consecutive autologous peripheral blood stem cell donors mobilized with hematopoietic growth factor (usually G-CSF), associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 × 106 CD34+ cells/kg of body weight. Pre-mobilization factors analyzed included patient's age, gender and diagnosis. Post mobilization parameters evaluated were pre-apheresis peripheral white blood cell count, immature circulating cell count, mononuclear cell count, peripheral blood CD34+ cell count, platelet count, and hemoglobin level. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches). Results: Pre-mobilization factors correlating to poor CD34 + cell yield in univariate analysis were acute myeloid leukemia (p = 0.017) and other hematological diseases (p = 0.023). Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001), granulocytes (p = 0.002), hemoglobin level (p = 0.016), and CD34+ cell concentration (p < 0.001) in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001) was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. Conclusion: In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.

Risk Factors for PoorAutologous Peripheral blood Stem Cell Mobilization among Lymphoproliferative Disease Patients

“…Our findings showed agreement with the all the previous study that PB CD34+ cell count is the main important factors for predicting of CD34+ cell dosage 8,20,21 . There was significant strong positive correlation between PB CD34+ cell count and CD34+ cell dosage.…”

“…Although some studies had reported that the diagnosis of lymphoma and advanced disease as risk factor for poor mobilization, but there are a few studies did not demonstrate significant result 4,21 which is consistent with our finding. Although our result showed that the diagnosis and stage of disease were not a risk factor for poor mobilization, but we found that 11 out of 12 poor mobilized patients were lymphoma and majority were NHL (9 patients).…”

“…Our result showed that number of previous chemotherapy and premobilization platelet level had significant association with poor mobilization at univariate analysis, but it was not significant at multivariate analysis and it is concordance to previous study that demostrated there was no significant impact between CD34+ dosage with number of previous chemotherapy 15,26 or platelet level 21,32 . However, many studies reported that premobilization platelet counts and numbers of chemotherapy have been significantly associated with the total CD34+ cell dosage where thrombocytopenia 20,27,28 and increased number of previous chemotherapy were risk factor for poor mobilization 1,18,24,27 .…”

“…Thus, there are no specific well accepted factors to identify potential poor mobilized patient.The most consistent findings for the predictive factors of stem cell mobilization is the PB CD34+ cell count 8,21,22 . Few study had proposed the predicted poor mobilizer included patient who failed a previous mobilization 1,22,23 , diagnosis of NHL 1,15,24 , increasing age 12,20,23 , advanced disease at the time of mobilization 18,23 , BM involvement 23,25,26 , thrombocytopenia before mobilization 12,[26][27][28] , history of radiotherapy 23,25,27 , multiple chemotherapy regime 18,24,27 and increased weight 15,20,26 .…”

“…Beside CD34+ dosage, we also found that advanced age (≥60 year old) was shown to be most important risk factor for poor mobilization as reported by previous study in which younger patients had better CD34+ cell dosage 13,20 and increasing age adversely affected CD34+ cell dosage 1,12,15 . However, some of the study have failed to show independent effect of patient age on mobilization 21,31 . The influence of patient age on autologous stem cell mobilization is unclear.…”