Development of a quantitative prediction model for peripheral blood stem cell collection yield in the plerixafor era

Abstract

Background aims: Predicting autologous peripheral blood stem cell (PBSC) collection yield before leukapheresis is important for optimizing PBSC mobilization and autologous stem cell transplantation (ASCT) for treating hematological malignancies. Although guidelines for plerixafor usage based on peripheral blood CD34 + (PB-CD34 + ) cell count are available, their predictive performance in the real world remains unclear. Methods: This study retrospectively analyzed 55 mobilization procedures for patients with non-Hodgkin lymphoma or multiple myeloma and developed a novel quantitative prediction model for CD34 + cell collection yield that incorporated four clinical parameters available the day before leukapheresis; namely, PB-CD34 + cell count the day before apheresis (day À1 PB-CD34 + ), number of prior chemotherapy regimens, disease status at apheresis and mobilization protocol. Results: The effects of PB-CD34 + cell counts on CD34 + cell collection yield varied widely per patient characteristics, and plerixafor usage was recommended in patients with poorly controlled disease or those with a history of heavy pre-treatments even with abundant day À1 PB-CD34 + cell count. This model suggested a more proactive use of plerixafor than that recommended by the guidelines for patients with poor pre-collection condition or those with a higher target number of CD34 + cells. Further, the authors analyzed the clinical outcomes of ASCT and found that plerixafor use for stem cell mobilization did not affect short-or long-term outcomes after ASCT. Conclusions: Although external validations are necessary, the results can be beneficial for establishing more effective and safer mobilization strategies.

Day -1 CD34+ Cells and Platelet Count Predict the Number of Apheresis in Poor-Mobilizer Patients Rescued by Plerixafor

“…Ishii et al developed a quantitative model to predict CD34+ cell yield after up-front plerixafor and G-CSF administration. The model incorporates the CD34+ cell count on the day before the apheresis, the number of prior chemotherapy regimens, and the disease status [ 32 ]. Even if CD34+ cell count correlated significantly with collection yield on the first day, the coefficient of determination was very low and was remarkably improved by adding the other variables [ 32 ].…”

“…When plerixafor is used as an upfront strategy, clinical variables related to the disease status and previous chemo- or radiotherapy can influence the success of collection [ 32 ]. Nevertheless, it remains to be elucidated whether these variables might predict mobilization also when plerixafor is used as a rescue of CT and G-CSF mobilization.…”

Hematopoietic Stem Cell Gene-Addition/Editing Therapy in Sickle Cell Disease

“…However, G-CSF is contraindicated in SCD patients as it induces VOCs, multi-organ failure, and even death. The plerixafor/G-CSF combination increased CD34+ cell collection yields ~2-fold, compared with G-CSF alone [ 27 , 28 ]. However, this combination is also contraindicated in SCD.…”

“…Recently, a new multivariate model was developed to estimate the total CD34+ cell yield on the first day of apheresis [ 27 ]. This model allows practitioners to predict poor mobilization conditions with 85.7% accuracy [ 27 ].…”

“…Recently, a new multivariate model was developed to estimate the total CD34+ cell yield on the first day of apheresis [ 27 ]. This model allows practitioners to predict poor mobilization conditions with 85.7% accuracy [ 27 ]. In addition to plerixafor, other novel, unapproved mobilization agents, such as POL6326 [ 30 , 31 ], BKT140 [ 32 ], parathormone, and BIO5192 [ 33 ] are being tested.…”