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

Abstract

Mobilization of hematopoietic stem cells is achieved with hematopoietic growth factors with or without chemotherapy or other agents. Although studies comparing granulocyte colony-stimulating factor (G-CSF) alone to combined regimens demonstrate an increase in stem cell yield in the latter, mobilization with G-CSF alone is still effective and has been widely practiced. We conducted a retrospective cohort study of consecutive patients at our institution who underwent at least one mobilization attempt with G-CSF between January 2000 and December 2008 to identify the proportion of patients failing one or more mobilization attempts and the potential predictors of mobilization failure with this regime. Out of 293 patients, 251 (86.6%) were successfully mobilized and 244 (83.6%) underwent hematopoietic stem cell transplantation. Median yield was 3.55 × 10⁶ CD34⁺ cells/kg. On univariate analysis, mobilization success was influenced by degree of previous treatment and underlying diagnosis (P < 0.001 each) but not by age (P = 0.114), sex (P = 0.860), or radiotherapy (P = 0.454). A diagnosis of non-Hodgkin's lymphoma (NHL) and number of previous chemotherapy regimens were predictors of failure on multivariate analysis. CD34⁺ yield was influenced by diagnosis and previous chemotherapy (P < 0.001 each). Mobilization with G-CSF alone yields adequate collections for most patients; however, heavily pretreated NHL patients with one failed attempt had high rates of remobilization failure and should be considered for alternative regimens.

Peripheral stem cell collection: From leukocyte growth factor to removal of catheter

“…Using chemotherapy and G‐CSF instead of G‐CSF only is not a guarantee that a donor will collect adequate numbers of CD34+ cells. A small number of donors will not collect adequate numbers of stem cells for HSCT . Out of 165 patients who were mobilized and collected, 27 were classified as poor mobilizers, 25.4% had lymphoma and 9.6% had multiple myeloma .…”

“…Lymphoma diagnosis ( P = 0.001), advanced age ( P = 0.007), and increased weight ( P = 0.03) were identified as potential risk factors for poor mobilization . (Table ) A larger study by Chow et al , retrospectively evaluated 293 donors of which 251 were successfully mobilized. By univariate analysis, underlying disease, mobilization attempts, and number of previous chemotherapy regimens were risk factors for poor mobilization.…”

Predictive factors for successful peripheral blood stem cell mobilization and collection in children

“…Factors that predict poor mobilization include underlying disease, involvement of bone marrow by metastatic disease and relapse . Treatment related factors include multiple lines of previous therapy, in particular marrow toxic agents such as purine analogs, mid‐cycle vincristine chemotherapy given prior to apheresis, and previous exposure to radiation . Factors related to the mobilization regimen include a higher yield with chemotherapy + G‐CSF than with G‐CSF alone and total G‐CSF dose .…”

High dose therapy and autologous hematopoietic stem cell transplantation in septuagenarians with non-Hodgkin lymphoma: Feasible, but for which patients?

“…Some studies have suggested that older age is associated with poorer stem cell mobilization 4 whereas others have found no influence of age on mobilization success. 5 …”