Peripheral blood progenitor cell (PBPC) counts during steady‐state haemopoiesis enable the estimation of the yield of mobilized PBPC after granulocyte colony‐stimulating factor supported cytotoxic chemotherapy: an update on 100 patients

Abstract

Summary. Peripheral blood progenitor cells (PBPC) can be mobilized using chemotherapy and granulocyte colonystimulating factor (G-CSF). We and others previously reported a correlation of steady-state PBPC counts and the PBPC yield during mobilization in a small group of patients. Here we present data on 100 patients (patients: 25 nonHodgkin's lymphoma (NHL), five Hodgkin's disease, 35 multiple myeloma (MM), 35 solid tumour) which enabled a detailed analysis of determinants of steady-state PBPC levels and of mobilization efficiency in patient subgroups. Previous irradiation (P ¼ 0·0034) or previous chemotherapy in patients with haematological malignancies (P ¼ 0·0062) led to a depletion of steady-state PB CD34 þ cells. A correlation analysis showed steady-state PB CD34 þ cells (all patients: r ¼ 0·52, P < 0·0001; NHL patients, r ¼ 0·69, P ¼ 0·0003; MM patients: r ¼ 0·66, P ¼ 0·0001) and PB colony-forming cells can reliably assess the CD34 þ cell yield in mobilized PB. In patients with solid tumour a similar trend was observed in mobilization after the first chemotherapy cycle (r ¼ 0·51, P ¼ 0·05) but not if mobilization occurred after the second or further cycle of a sequential doseintensified G-CSF-supported chemotherapy regimen, when premobilization CD34 þ counts were 18-fold elevated (P ¼ 0·004). When the patients with MM (r ¼ 0·63, P ¼ 0·0008) or with NHL (r ¼ 0·65, P ¼ 0·006) were analysed separately, a highly significant correlation of the steady-state PB CD34 þ cell count to the mean leukapheresis CD34 þ cell yield was found, whereas no correlation was observed for patients with a solid tumour. For patients with haematological malignancies estimates could be calculated which, at a specific steady-state PB CD34 þ cell count, could predict with a 95% probability a defined minimum progenitor cell yield. These results enable recognition of patients who mobilize PBPC poorly and may assist selection of patients for novel mobilization regimens.

Primary germ cell tumors in the mediastinum

“…However, this high-dose chemotherapy with BMT was not successful in patients who were experiencing a second disease recurrence or who were cisplatin refractory. 31 We used PBSCT 32 to support high-dose chemotherapy in three patients. Three patients treated with high-dose chemotherapy were alive and disease free after 73, 52, and 25 months, respectively (Table 3).…”

Granulocyte colony-stimulating factor (G-CSF) dose-dependent efficacy in peripheral blood stem cell mobilization in patients who had failed initial mobilization with chemotherapy and G-CSF

“…Fruehauf et al 21 reported measuring steady-state peripheral blood progenitors as a means to estimate the yield after combined chemotherapy and G-CSF mobilization. It may be possible to monitor the level of peripheral blood progenitors before and during mobilization as a guide to dose modification of HGF.…”

The whys and hows of hematopoietic progenitor and stem cell mobilization

“…73 Older age was associated with poor autologous mobilization in some patient groups, 30,74,75 but not in others. 74,76 Even though some donors with predictors of poor mobilization respond quite well to mobilizing therapies, 77 poorly mobilizing autologous donors are assumed to have sustained an injury to the hematopoietic stem cell system that is responsible for the poor effect (see Table 4). In support of this premise, autologous donors with breast cancer who had received more chemotherapy and radiation or had tumor metastases in the marrow also had fewer stem/progenitor cells in apheresis products collected during steady state than donors who were less heavily pretreated and had no marrow metastases.…”