Comparison of autologous peripheral blood stem cell dosing by ideal vs actual body weight

Abstract

Summary:In this retrospective study, we evaluated the predictability of PBSC dose for hematopoietic engraftment comparing that calculated by ideal body weight (IBW) vs another calculated by actual body weight (ABW) for each patient. Sixty-three consecutive patients treated similarly using one transplant protocol were analyzed. While all patients had data available on CFU-GM and nucleated cells (NC), data on CD34 + enumeration was present only in 34 patients. We found that 49% of the patients were greater than 25% over their IBW. In addition, least-squares linear regression was used to assess the strength of the linear relationship between the inverse of cell dose/kg of ABW or IBW and time to AGC or platelet engraftment and showed no difference in r 2 values for platelet engraftment, while using dose/kg of IBW greatly improved the ability of NC (r 2 improved from 0.19 for ABW to 0.35 for IBW) and CFU-GM (r 2 improved from 0.35 for ABW to 0.53 for IBW) to predict time to AGC engraftment, but did not change the CD34 r 2 . Hazard ratios were estimated using Cox proportional hazards regression and in all instances were found greater than 1.0 indicating that the probability of engraftment increased as cell dose/kg ABW or IBW increased. Finally, our data showed that 10 patients (16%) could have had one less apheresis procedure performed to obtain their set target stem cell dose calculated per kg IBW rather than ABW. In conclusion, PBSC dose per kg IBW is as good or better predictor of engraftment of AGC and may lead to cost savings in a certain subset of patients. Keywords: autologous stem cell transplantation; cell dose; actual body weight; ideal body weight High-dose chemotherapy (HDC) with peripheral blood stem cell (PBSC) rescue is an acceptable form of therapy for high-risk and metastatic breast cancer, relapsed and refractory Hodgkin's or non-Hodgkin's lymphoma, multiple myeloma, and other malignancies. Utilization of HDC with PBSC support has largely replaced bone marrow as the source of autologous hematopoietic stem cells. 1-6 PBSC Correspondence: Dr J Moreb, Division of Hematology/Oncology, PO Box 100277, Gainesville, FL 32610-0277, USA Received 31 July 1998; accepted 2 December 1998 products minimize the chief side-effects of HDC by fast reconstitution of hematopoiesis. In early studies, the PBSC product was evaluated prospectively by total number of nucleated or mononuclear cells and retrospectively by CFU-GM per kilogram of actual body weight, the value of which is known to correlate with days to engraftment of platelets (PLT) and absolute granulocyte counts (AGC). [7][8][9][10][11][12][13][14][15][16] Presently, the stem cell product is characterized in most laboratories by the number of CD34 + , CFU-GM, and total mononuclear cells per kilogram patient actual body weight (ABW). 1,[17][18][19][20] The number of CD34 + cells correlates well with CFU-GM content and serves as a better predictor of engraftment than total mononuclear cells per kilogram of ABW. 21,22 Recent evidence suggests that markers of primi...

Ideal rather than actual body weight should be used to calculate cell dose in allogeneic hematopoietic stem cell transplantation

“…There is evidence that IBW is a better predictor than ABW of cell dose adequacy as measured by recovery of neutrophils after autologous 16,17 as well as allogeneic 18 HSCT. However, there are no data on whether cell dose based on IBW or ABW is a better predictor of TRM and survival -more relevant outcomes than hematologic recovery -after allogeneic HSCT.…”

Difficult stem cell mobilization despite adequate CD34+ cell dose predicts shortened progression free and overall survival after autologous HSCT for lymphoma

“…Previous analyses have demonstrated that the CD34 þ cell dose based on ideal body weight (IBW) is a better predictor of engraftment. 22,23 Reanalysis of our data using IBW reclassified 17 patients as G-CSF Success, but their PFS and OS remained significantly inferior to those categorized as G-CSF Success by actual body weight (not shown). Consequently, when using mobilization as a predictor of HSCT outcome, classification using actual body weight minimizes false positive mobilization success.…”

Actual or ideal body weight to calculate CD34+ cell dose in patients undergoing autologous hematopoietic SCT for myeloma?

“…However, there are data suggesting that ideal body weight (IBW) may be a better basis for calculating cell dose, [1][2][3][4][5][6][7] and this is our standard practice. Cell dose based on IBW correlates better with engraftment after autologous 1,3,6 and allogeneic 4,7 HSCT. Cell dose based on IBW also correlates better with more clinically meaningful measures of outcome after allogeneic HSCT such as the risk of GVHD, TRM and disease-free survival.…”