Patient characteristics associated with successful mobilizing and autografting of peripheral blood progenitor cells in malignant lymphoma

Abstract

For patients with advanced-stage or poor-prognosis malignant lymphoma, high-dose therapy with peripheral blood progenitor cell (PBPC) support may become a first-line treatment. The duration of severe cytopenia in this setting is inversely related to the number of PBPCs autografted. In a retrospective analysis, we therefore looked for factors influencing the yield of PBPCs in 61 patients (16 with high-grade and 29 with low-/intermediate-grade non-Hodgkin's lymphoma [NHL], and 16 with Hodgkin's disease) who received cytotoxic chemotherapy and filgrastim (R-metHuG-CSF, 300 micrograms/d; median, 4.2 micrograms/kg/d; range, 2.7 to 6.6 micrograms/kg/d; subcutaneously). Sixteen patients had active disease, while 45 were in partial remission (PR) or complete remission (CR) after conventional therapy. A median of three leukaphereses (range, one to 10) resulted in a median of 5.7 x 10(6) CD34+ cells/kg (range, 0.03 to 31.1 x 10(6)). Previous cytotoxic chemotherapy and irradiation adversely affected the yield of CD34+ cells. Each cycle of chemotherapy is associated with an average decrease of 0.2 x 10(6) CD34+ cells/kg per leukapheresis in nonirradiated patients, while large-field radiotherapy reduces the collection efficiency by an average of 1.8 x 10(6)/kg CD34+ cells. The collection efficiency was also significantly lower in patients with Hodgkin's disease. However, except for one, all had been previously irradiated. In contrast, age, sex, disease status, bone marrow involvement during mobilization, and the time since the last chemotherapy or radiotherapy were not significantly related to the collection efficiency. Following high-dose conditioning therapy, 42 patients were autografted with filgrastim-mobilized PBPCs. Hematological recovery (neutrophils > or = 0.5 x 10(9)/L and an unsupported platelet count > or = 20 x 10(9)/L) within 2 weeks was observed in patients autografted with > or = 2.5 x 10(6) CD34+ cells/kg. In seven patients, the quantity of CD34+ cells reinfused was below this threshold. They required a median of 17 days (range, 11 to 34) and 31 days (range, 13 to 141) for neutrophil and platelet recovery, respectively. If autografting with PBPCs in malignant lymphoma with poor prognosis is being considered, mobilization and harvesting should be planned early after initial diagnosis to avoid exhaustion of hematopoiesis by cumulative toxicity.

Predictors of unsuccessful mobilization with granulocyte colony‐stimulating factor alone in patients undergoing autologous hematopoietic stem cell transplantation

“…CD34 1 cell/ kg yield was reduced by 1.98 3 10 6 cells/kg per additional chemotherapy regimen given. A decrease in yield of 0.2 3 10 6 CD34 1 cells/kg per cycle of chemotherapy has been previously demonstrated by Haas et al [27]. No specific chemotherapy regimen was associated with higher mobilization failure rates.…”

Novel and rapid enumeration method of peripheral blood stem cells using automated hematology analyzer

“…Secondly, the approximate number of CD34 + cells in the final products may be predicted from the HPC count in preapheresis PB. Moreover, the fact that the change in the number of HPCs closely resembled that of CD34 + cells in the PB during mobilization also suggested that HPCs in the PB may be a good indicator for the optimal timing of PBSC collection, as is CD34 + cell concentration [32,33,36] and SE/XE-determined HPC counts [9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Thirdly, our data also suggested that the final CD34 + cell yield may be predicted from the HPC count in the mid-apheresis product.…”

Poor peripheral blood stem cell mobilization affects long‐term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation

“…[7][8][9][10] Previously established risk factors for poor mobilization include multiple lines of chemotherapy, advanced age, thrombocytopenia, prior radiotherapy, and others. [10][11][12][13][14][15] In MM, multiple studies reported lenalidomide use to be another risk factor for poor mobilization. [16][17][18][19] Most studies use different definitions for poor mobilization in MM patients, mainly due to the practice of collecting upfront adequate numbers of stem cells for two transplants.…”