Peripheral blood stem cells (PBSCs) collected after recombinant granulocyte colony stimulating factor (rhG‐CSF): an analysis of factors correlating with the tempo of engraftment after transplantation

Abstract

Factors affecting mobilization and engraftment were analysed in 54 patients undergoing transplant using autologous PBSCs mobilized with high-dose recombinant granulocyte stimulating factor (rhG-CSF). Patients received 5-7 d of rhG-CSF, 16 micrograms/kg/d, administered subcutaneously. PBSCs were harvested by leukapheresis using automated continuous-flow blood cell separators beginning on day 4 of rhG-CSF, processing 10 litres of whole blood, for 2-6 consecutive days. Transplants were performed for the following diseases: breast cancer (n = 22), non-Hodgkin's lymphoma (n = 18), multiple myeloma (n = 7) and other (n = 7). Engraftment was rapid with patients reaching a neutrophil count of 1 x 10(9)/l a median of 12 d (range 9-22) after transplant. Platelets > 20 x 10(9)/l independent of transfusion support were achieved a median of day 10 (range 7-60) after infusion. Multiple factors potentially influencing engraftment were examined using a Cox regression model. The number of CD34+ cells per kg was highly correlated with the time to achievement of granulocyte and platelet recovery (P < 0.012, 0.0001). The use of a post-infusion growth factor and a radiation preparative regimen was important for neutrophil recovery, and a diagnosis of breast cancer was important for platelet recovery. In an analysis by linear regression of the logarithm of CD34+ cells collected, lower age, marrow without disease, no prior radiation, and lower number of prior chemotherapy regimens, were important factors influencing larger numbers of CD34+ cells in collections.

High-dose carboplatin, etoposide and melphalan (CEM) with peripheral blood progenitor cell support as late intensification for high-risk cancer: non-haematological, haematological toxicities and role of growth factor administration

“…Most of the patients did not require RBC transfusion and patients treated with growth factors after PBPCT had a less marked decline of Hb levels than patients treated with PBPCT only (Figure 1). The administration of EPO with G-CSF and GM-CSF after PBPCT probably abrogated the previously described detrimental effect of G-CSF and GM-CSF on PLT recovery after PBPCT (Spitzer et al, 1994;Shimazaki et al, 1994;Bensinger et al, 1994), which could be caused by a prevalent potentiation of myelopoiesis with a consensual progenitor cell competition in vivo. Patients treated with growth factors did not require systemic antibiotic therapy with the total abrogation of neutropenic fever in G-CSF plus EPO-treated patients, while GM-CSF plus EPO-treated patients experienced only episodes of intermittent hyperthermia, which did not meet the criteria for the start of systemic antibiotic treatment.…”

CD34+/CD41a+ cells best predict platelet recovery after autologous peripheral blood stem cell transplantation

“…[7][8][9] As for platelet recovery, few studies have been reported; some have shown that the number of CFU-GM and CD34 + cells correlate with platelet recovery, 7-14 but others have not shown a significant correlation. 15,16 Recently, specific markers for megakaryocyte progenitors such as colony-forming unit megakaryocyte (CFU-MK) and CD34 + /CD41 + or CD34 + /CD61 + cells have predicted platelet engraftment in PBSCT.…”

High-dose chemotherapy followed by reinfusion of selected CD34+ peripheral blood cells in patients with poor-prognosis breast cancer: a randomized multicentre study

“…more than 2.5 x 106 CD34+ cells kg-' were collected for most control patients), and the loss of cells during the separation procedure. It is interesting that the number of CD34+ cells that were infused in patients in the study group was below the threshold that we (Faucher et al, 1996) and others (Bender et al 1992;Bensinger et al, 1994: Haas et al, 1994Weaver et al 1995) considered as the minimal number necessary to ensure the quickest haematological recovery with unselected PBSCs; on the other hand, patients in the control group received on average a number of CD34+ cells that was close to or above this threshold. The loss of progenitor cells may explain the delay in platelet recovery observed after transplantation of autologous marrow CD34+ cells, which was previously demonstrated (Shpall et al, 1997).…”

“…regarding the minimal number of CD34+ cells that ensures optimal engrafment (Bender et al, 1992;Bensinger et al 1994: Haas et al 1994van de Wall et al, 1994;Faucher et al 1996). and on the assumption that the yield of the cell separation procedure would be approximately 50%, thus providing for similar numbers of progenitors in both groups.…”

“…The use of rhG-CSF alone in a previously published study (Mahe et al, 1996) resulted in an average number of infused CD34+ cells that was lower than in the present study, especially for the subset of myeloma and lymphoma patients who had already received more than three courses of chemotherapy. Fmally, patients who have a medical history that predicts a poor ability to mobilize blood progenitors -such as a high number of previous chemotherapy cycles (Bensinger et al, 1994;Haas et al, 1994;Chabannon et al, 1995: Mahe et al, 1996 -may not be good candidates for cell selection, unless the yield of CD34+ cells can be improved; although the difference was not statistically significant, there were more patients who had received three or more chemotherapy regimens before inclusion in the group of patients who failed to reach the threshold of 20 circulating CD34+ cells 11-l of blood (non-randomized patients).…”