Mobilization of hematopoietic progenitor cells for autologous transportation: consensus recommendations

Abstract

SUMMARY Selected patients with certain hematological malignancies and solid tumors have the potential to achieve long-term survival with autologous hematopoietic progenitor cell transplant. The collection of these cells in peripheral blood avoids multiple bone marrow aspirations, results in faster engraftment and allows treatment of patients with infection, fibrosis, or bone marrow hypocellularity. However, for the procedure to be successful, it is essential to mobilize a sufficient number of progenitor cells from the bone marrow into the blood circulation. Therefore, a group of Brazilian experts met in order to develop recommendations for mobilization strategies adapted to the reality of the Brazilian national health system, which could help minimize the risk of failure, reduce toxicity and improve the allocation of financial resources.

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.…”

“…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 .…”

“…Disease characteristic alone cannot predict mobilization outcome, as within high risk group there will be a group of patients who will successfully mobilize with standard approaches and there are patients within low risk group who mobilized poorly 6 . There are many reports on patients who failed to mobilized sufficient numbers of PBSC, however because of the retrospective nature of the study, heterogeneity of studied population, low numbers of patients, use of different mobilization regimes and lack of uniform criteria of poor mobilization led to difficulty in deriving a conclusion 8,20 .…”

“…A minimum CD34+ cell dosage of 2x10 6 cells/kg are required to achieve haematopoietic engraftment 6,7 while some studies suggest that higher dosage, more than 5x10 6 cells/kg are associated with faster neutrophil and platelet engraftment 3,6 . Factors affecting PBSC mobilization had been studied, and beside the PB CD34+ cell count, no other factor has been shown to conclusively predict stem cell mobilizability 1,8 . Furthermore, factors unique to a particular population, may still be a significant determinant affecting stem cell mobilization, and should be studied.…”