Successful autologous bone marrow rescue in patients who failed peripheral blood stem cell mobilization

Abstract

We assessed autologous bone marrow (BM) harvest and hematologic recovery after high-dose chemotherapy (HDCT) in patients who failed to achieve peripheral blood stem cell (PBSC) mobilization. One hundred and ninety-three patients with germ cell tumor, malignant lymphoma, sarcoma or medulloblastoma were scheduled for HDCT. In 123 patients, PBSC were mobilized by disease-specific chemotherapy plus granulocyte colony-stimulating factor (G-CSF). In 110/ 123 patients (89%) with circulating CD34+ cell counts 2 > or = 10/microl, sufficient hematopoietic autografts were collected (group A). In 13/123 patients (11%) with peripheral CD34 + cell counts < 10/microl, PBSC harvesting was not performed (group B). These latter patients were classified as "poor mobilizers" and underwent second-line BM harvest at a median of 46 (range 10-99) days after mobilization failure. Seventy patients with first-line BM harvest (group C) acted as historical controls. Ten patients from group B proceeded to HDCT and nine were evaluable for hematopoietic reconstitution. Recovery to neutrophils >0.5 x 10(9)/l was comparable with group C patients: 16 (range 9-34) days vs 13 (range 8-98) days. However, platelet (PLT) reconstitution >20 x 10(9)/l was significantly slower, with a median of 35 (range 13-50) days as compared with 19 (range 9-148) days (P = 0.0106) for control patients. Supportive care requirements, febrile days and length of hospital stay were not significantly different between the two groups of patients. We conclude that patients who fail to mobilize PBSC should be evaluated for second-line BM harvest. This approach may preserve the therapeutic option of HDCT for these patients.

Impact of different strategies of second-line stem cell harvest on the outcome of autologous transplantation in poor peripheral blood stem cell mobilizers

“…In this sense, the infusion of additional BM progenitors was not associated with any significant benefit regarding the rapidity of the engraftment, the transfusional requirements or the duration of hospital stay. Previous experiences on the use of unprimed BM in this setting are limited, [21][22][23][24] but their findings are in line with the present ones. Thus, Watts et al 21 reported a delayed engraftment and a high transplant-related morbidity and mortality in 12 patients in whom rescue BM progenitors were collected after PBSC mobilization failure (defined as o1 Â 10 6 CD34 þ cells/kg).…”

“…14 Remobilization of PBSC using hematopoietic cytokines alone [15][16][17][18][19][20] or in combination with chemotherapy 5,17 has proved to be a valid option in this situation. Alternatively, autologous BM progenitors can be harvested at steady state [21][22][23][24] or following growth factor priming, 25 but this approach has been associated with variable results. 26 Finally, the infusion of grafts containing low CD34 þ cell contents may be considered in certain circumstances, though assuming the potential risks of a delayed engraftment.…”

Difficult stem cell mobilization despite adequate CD34+ cell dose predicts shortened progression free and overall survival after autologous HSCT for lymphoma

“…Although some patients have poor mobilization with G, 14 Several analyses have looked at the impact of repeated mobilization attempts in patients with poor mobilization. [15][16][17][18][19] Some suggest that stem cells can be adequately harvested using alternate mobilization techniques such as high-dose cytokines, combination cytokines, chemotherapy mobilization or bone marrow harvest. 15,17,18 In our study, GM-CSF mobilized bone marrow harvest yielded adequate salvage grafts but the Poor Mobilization cohort still had inferior PFS and OS despite an adequate graft and prompt neutrophil engraftment.…”

The whys and hows of hematopoietic progenitor and stem cell mobilization

“…Nine were transplanted with the marrow after high-dose therapy and experienced delayed platelet recovery compared to a group of autologous marrow transplant patients that served as a historical control. 100 Whether a suitable graft product could have been collected from the peripheral blood of those patients is unknown, but the marrowderived graft product was inferior. Autologous bone marrow harvests with good cellularity but unknown numbers of CD34+ cells were harvested from another group of patients who had mobilized poorly.…”