TRANSPLANTATION AND CELLULAR ENGINEERING: Increasing the economic efficacy of peripheral blood progenitor cell collections by monitoring peripheral blood CD34+ concentrations

Gutensohn, K.; Magens, M. M.; Kuehnl, P.; Zeller, W.

doi:10.1111/j.1537-2995.2009.02466.x

Cited by 16 publications

(9 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[75][76][77] Monitoring of CD34+ concentration proved to potentially reduce the number of apheresis procedures and overall health care costs. 78 In the allogeneic setting, CD34+ cell count helps in predicting the yield of apheresis and, therefore, in tailoring the duration of the procedure. 79 Thus, an early monitoring of peripheral blood CD34+ count could be helpful in optimizing the collection process.…”

Section: Recommendations Daily Monitoring Of Cd34+ Cells In Periphermentioning

confidence: 99%

See 1 more Smart Citation

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

et al. 2011

View full text Add to dashboard Cite

show abstract

Section: Recommendations Daily Monitoring Of Cd34+ Cells In Periphermentioning

confidence: 99%

“…However, PBPC mobilization kinetics effectively predicts the yield of harvested CD34+ cells and thus it may support a tailored and efficient collection 75‐77 . Monitoring of CD34+ concentration proved to potentially reduce the number of apheresis procedures and overall health care costs 78 …”

mentioning

confidence: 99%

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

et al. 2011

View full text Add to dashboard Cite

show abstract

“…111 If the circulating CD34 ϩ cell count is Ն 20/L, 94% of collections performed the following day would be expected to yield Ն 2.0 ϫ 10 6 CD34 ϩ cells/kg. 110 In general terms if the CD34 ϩ cell count is Ͻ 5/L, the yield will be poor; therefore, apheresis not warranted.…”

Section: Optimizing Apheresis To Improve Yield and To Avoid Weekend Amentioning

confidence: 99%

How I treat patients who mobilize hematopoietic stem cells poorly

Levesque

Herbert

2011

Blood

213

235

View full text Add to dashboard Cite

Transplantation with 2-5 ؋ 10 6 mobilized CD34 ؉ cells/kg body weight lowers transplantation costs and mortality. Mobilization is most commonly performed with recombinant human G-CSF with or without chemotherapy, but a proportion of patients/donors fail to mobilize sufficient cells. BM disease, prior treatment, and age are factors influencing mobilization, but genetics also contributes. Mobilization may fail because of the changes affecting the HSC/progenitor cell/BM niche integrity and chemotaxis. Poor mobilization affects patient outcome and increases resource use. Until recently increasing G-CSF dose and adding SCF have been used in poor mobilizers with limited success. However, plerixafor through its rapid direct blockage of the CXCR4/CXCL12 chemotaxis pathway and synergy with G-CSF and chemotherapy has become a new and important agent for mobilization. Its efficacy in upfront and failed mobilizers is well established.To maximize HSC harvest in poor mobilizers the clinician needs to optimize current mobilization protocols and to integrate novel agents such as plerixafor. These include when to mobilize in relation to chemotherapy, how to schedule and perform apheresis, how to identify IntroductionHematopoietic stem cell transplantation (HSCT) has revolutionized the curative approach to a number of malignancies and BM failure syndromes by providing hematopoietic and immune rescue after high-dose cytoreductive therapy and, in allogeneic transplantations, graft-versus-tumor effect. [1][2][3][4] The term "mobilization" was first used to describe a 4-fold increase of circulating myeloid progenitors (granulocyte macrophage CFU [CFU-GM]) after the administration of endotoxin to healthy volunteers in 1977. 5 High levels of CFU-GM after recovery from myelosuppressive chemotherapy in humans was first described in 1976. 6 However, it was not until the 1980s that the use of chemotherapy-mobilized HSCs for transplantation was established. [7][8][9] Subsequently, a single high-dose cyclophosphamide was developed as a generic mobilizer. 10 Prof Metcalf led the study that showed the potential of G-CSF in mobilization. 11 Subsequently, 2 Australian centers in Melbourne and Adelaide showed for the first time the use of G-CSF-mobilized HSCs for transplantation, 12 and reports of combined G-CSF and chemotherapy mobilization soon followed. 13 Now, virtually all autologous and three-quarters of allogeneic transplantations are performed with mobilized HSCs (CIBMTR reports). 14,15 The cell dose effect of HSCT describes a threshold of HSCs that, when transplanted, is associated with rapid and sustained blood count recovery. 16 The benefits of rapid recovery are reduced hospitalization, blood product usage, and infections. 12,17 The minimum threshold for autologous transplantation is currently defined as 2 ϫ 10 6 CD34 ϩ cells/kg body weight (BW). 18 Many centers use a minimum of 3 ϫ 10 6 CD34 ϩ cells/kg BW for myeloablative and nonmyeloablative allogeneic and matched unrelated transplantations. Furthermore, Ͼ 5 ϫ 10 6 CD3...

show abstract

“…Currently, the peripheral blood CD34 + cell count is still considered to be the best predictor of apheresis cell yield and is used to determine the adequate time of apheresis. [38][39] In cases of PBSCs success, we effectively observed a significantly higher level of CD34 + cells in the peripheral blood but also the presence of a high myelemia count (> 200 myelocytes/ mm3), which was highly significant.…”

Section: Discussionmentioning

confidence: 78%

Evaluating The Role And Efficacy Of Plerixafor In Rescue Mobilization Of Autologous Peripheral Blood Stem Cells

Prunier¹,

Caillot

Legouge

et al. 2015

JHOR

View full text Add to dashboard Cite

In autologous hematopoietic stem cell transplantation patients for whom granulocyte-colony stimulating factor fails to mobilize a sufficient number of peripheral blood stem cells, plerixafor proposes an option for successful rescue mobilization. This paper evaluates the efficacy of plerixafor to mobilize peripheral blood stem cells (PBSCs) in patients who failed previous mobilization with G-CSF alone, by retrospectively analysing the PBSC results from lymphoma and myeloma (MM) patients between 2006 and 2011. Patients were classified according to the CD34 + cells/ kg yield collected by apheresis: < 2 x 10 6 CD34 + cells/kg was considered collection failure, whereas ≥ 5 x 10 6 CD34 + cells/ kg was considered good mobilization. 797 patients underwent one or more apheresis. The first mobilization success rate was 82%; 140 patients proved to be poor mobilizers. Suboptimal first mobilization was significantly associated with age >50 years (p=0.005) and the absence of chemotherapy in prior PBSCs stimulation (p=0.04). 149 rescue protocols were used in the 140 poor mobilizers, and 71 patients received plerixafor. In univariate analysis the remobilization rate without plerixafor was 42% and increased to 65% when plerixafor was added. In multivariate analysis, plerixafor administration reduced the PBSC remobilization failure risk by a half (OR=0.47). The median value of CD34 + cells/kg in transplants increased from 1.43 (range, 0-14.03) without plerixafor to 3.85 (range, 0-18.25; p=1 x 10-4) with plerixafor. There were more good mobilizers after plerixafor use (35% with plerixafor versus 15% without plerixafor; p=0.005). Plerixafor efficacy was similar for lymphoma (60% remobilization) and MM (80%; p=0.12). These data show that plerixafor was effective in poor mobilizers and that it synergized with G-CSF to improve the quantity of collected PBSCs. Plerixafor also increased transplant feasibility by 23%. While the clinical results of this study are promising, economic data were not taken into account and there is a need for real work concerning the cost-effectiveness of this treatment. We propose a subsequent study in which the economic efficacy of plerixafor's use is evaluated based on the financial aspects of the treatments received by the cohort evaluated in this paper.

show abstract

TRANSPLANTATION AND CELLULAR ENGINEERING: Increasing the economic efficacy of peripheral blood progenitor cell collections by monitoring peripheral blood CD34+ concentrations

Cited by 16 publications

References 26 publications

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

How I treat patients who mobilize hematopoietic stem cells poorly

Evaluating The Role And Efficacy Of Plerixafor In Rescue Mobilization Of Autologous Peripheral Blood Stem Cells

Contact Info

Product

Resources

About