Contributions
Type: Publication Only
Background
The successful mobilization of hematopoietic progenitors (CD34+) for autologous stem cell transplantation has been associated with the number of cycles of previous chemotherapy (CT), recent administration of CT (<3 months), prior use of purine analogs or alkylating agents, radiotherapy, age, marrow involvement by the disease, and leukopenia or thrombocytopenia before mobilization.
Aims
Our objective was to analyze our experience on CD34+ cell collection by apheresis in the past 5 years, focusing in what factors are implicated in a better or worse final product.
Methods
We retrospectively analyzed all consecutive mobilization procedures performed in our department between 2009 and 2014. Analyzed data included: age, sex, underlying desease (acute leukemia, plasma cell neoplasm, small cell NHL, aggressive NHL, Hodgkin's lymphoma or solid neoplasm), type of used G-CSF (filgrastim, biosimilar filgrastim or lenograstim), type of mobilization (G-CSF alone, associated with cyclophosphamide or mega-CHOP CT, or disease-specific CT), number of previous CT lines, prior radiotherapy or purine analogs or alkylating agents, marrow involvement at diagnosis, percentage of CD34+ cells and CD34+ cells/μL in blood just before apheresis, and CD34+ cells x 106/kg at the final product. For statistical analysis (SPSS adapted to Windows) we used the Pearson correlation coefficient, ANOVA and Tukey HSD test for multiple comparisons.
Results
We studied 181 patients, mean age 51 years (range 3-71) and 64% males. We found that the type of G-CSF, the number of previous lines, the use of purine analogs or alkylating drugs, and marrow involvement at diagnosis did not influence significantly in the final number of CD34+ cells obtained. In the other hand, we observed a tendency to a poorer final product in older patients (p=0.09) or when there was a history of radiotherapy (p=0.062). Significantly, the richest final product was achieved in patients with Hodgkin's disease compared with poorer in those affected of acute leukemia, plasma cell neoplasm or small cell NHL (p=0.012). Similarly, a higher number of CD34+ cells were collected in patients mobilized with disease-specific CT, compared with the other types of mobilizations (p=0.006). Finally, as expected, the pre-apheresis mononuclear cells and CD34+ cell percentages, and circulating CD34+ cells/μL, were directly related to the achieved final product (p=0.004, p<0.001 and p<0.001, respectively).
Summary
In our experience, the factors that most influenced the amount of CD34+ cells harvested by mobilization and apheresis, are the type of hematologic disease (from most to least favorable: Hodgkin's disease, solid tumors, aggressive NHL, small cell NHL, plasma cell neoplasms and acute leukemia) and type of mobilization scheme used (the best product was obtained with disease-specific CT, and worst with G-CSF alone). To a lesser extent, the patient's age and history of radiotherapy may also influence the final product.
Keyword(s): Autologous stem cell collection, CD34+ cells, G-CSF mobilization, Stem cell mobilization
Session topic: Publication Only
Type: Publication Only
Background
The successful mobilization of hematopoietic progenitors (CD34+) for autologous stem cell transplantation has been associated with the number of cycles of previous chemotherapy (CT), recent administration of CT (<3 months), prior use of purine analogs or alkylating agents, radiotherapy, age, marrow involvement by the disease, and leukopenia or thrombocytopenia before mobilization.
Aims
Our objective was to analyze our experience on CD34+ cell collection by apheresis in the past 5 years, focusing in what factors are implicated in a better or worse final product.
Methods
We retrospectively analyzed all consecutive mobilization procedures performed in our department between 2009 and 2014. Analyzed data included: age, sex, underlying desease (acute leukemia, plasma cell neoplasm, small cell NHL, aggressive NHL, Hodgkin's lymphoma or solid neoplasm), type of used G-CSF (filgrastim, biosimilar filgrastim or lenograstim), type of mobilization (G-CSF alone, associated with cyclophosphamide or mega-CHOP CT, or disease-specific CT), number of previous CT lines, prior radiotherapy or purine analogs or alkylating agents, marrow involvement at diagnosis, percentage of CD34+ cells and CD34+ cells/μL in blood just before apheresis, and CD34+ cells x 106/kg at the final product. For statistical analysis (SPSS adapted to Windows) we used the Pearson correlation coefficient, ANOVA and Tukey HSD test for multiple comparisons.
Results
We studied 181 patients, mean age 51 years (range 3-71) and 64% males. We found that the type of G-CSF, the number of previous lines, the use of purine analogs or alkylating drugs, and marrow involvement at diagnosis did not influence significantly in the final number of CD34+ cells obtained. In the other hand, we observed a tendency to a poorer final product in older patients (p=0.09) or when there was a history of radiotherapy (p=0.062). Significantly, the richest final product was achieved in patients with Hodgkin's disease compared with poorer in those affected of acute leukemia, plasma cell neoplasm or small cell NHL (p=0.012). Similarly, a higher number of CD34+ cells were collected in patients mobilized with disease-specific CT, compared with the other types of mobilizations (p=0.006). Finally, as expected, the pre-apheresis mononuclear cells and CD34+ cell percentages, and circulating CD34+ cells/μL, were directly related to the achieved final product (p=0.004, p<0.001 and p<0.001, respectively).
Summary
In our experience, the factors that most influenced the amount of CD34+ cells harvested by mobilization and apheresis, are the type of hematologic disease (from most to least favorable: Hodgkin's disease, solid tumors, aggressive NHL, small cell NHL, plasma cell neoplasms and acute leukemia) and type of mobilization scheme used (the best product was obtained with disease-specific CT, and worst with G-CSF alone). To a lesser extent, the patient's age and history of radiotherapy may also influence the final product.
Keyword(s): Autologous stem cell collection, CD34+ cells, G-CSF mobilization, Stem cell mobilization
Session topic: Publication Only