A single center’s experience using four different front line mobilization strategies in lymphoma patients planned to undergo autologous hematopoietic cell transplantation

Abstract

In an otherwise eligible patient with relapsed lymphoma, inadequate mobilization of peripheral blood stem cells is a limiting factor to proceeding with an autologous hematopoietic cell transplantation (auto-HCT). Multiple strategies have been used to mobilize an adequate number of hematopoietic stem cells (HSCs) with no obvious front-line strategy. We report a single institutional experience mobilizing HSCs using four different approaches in lymphoma patients. We prospectively collected mobilization outcomes on patients planning to undergo auto-HCT at Ohio State University. We report results of first mobilization attempt for all relapsed or refractory lymphoma patients between 2008–2014. We identified 255 lymphoma patients who underwent mobilization for planned auto-HCT. The 255 lymphoma patients underwent the following front line mobilization strategies: 95 (37%) GCSF alone, 38 (15%) chemomobilization (GCSF+chemotherapy), 97 (38%) preemptive day 4 plerixafor, and 25 (10%) rescue day 5 plerixafor. As expected, there were significant differences between cohorts including age, comorbid indices, histology, and amount of prior chemotherapy. After controlling for differences between groups, the odds of collecting 2×106/kg HSCs on the first day of collection and 5×106/kg HSCs in total was highest in the cohort undergoing chemomobilization. In conclusion, our experience highlights the effectiveness of chemomobilization.

Comparison and cost analysis of three protocols for mobilization and apheresis of haematopoietic progenitor cells

“…Four of the 8 patients who experienced failure with protocol 1 were rescued with protocol 2, and 5 of the 8 patients who experienced failure with protocol 2 were rescued by repeating protocol 2. This finding, together with the fact that protocol 2 had the lowest mean preapheresis CD34+ cell count, suggests the role of plerixafor in the rescue of patients with poor mobilization, as reported by To and Haverkos (who described rescue rates of 70% of patients). The remaining patients who experienced failure with protocols 1 and 2 were rescued with protocol 3.…”

“…The efficacy of plerixafor combined with G‐CSF has been demonstrated, and the possibilities of using this agent are preventively, by identifying those patients who are at risk of mobilization failure, or “on demand” (rescue) when the usual therapy with G‐CSF alone is ineffective. There is some consensus that the most relevant criterion that defines a “poor mobilizer” is a peripheral blood level of CD34+ cells <10 to 15 cells/μL on day 4 or day 5 before the beginning of apheresis .…”

“…Despite the available options to achieve an optimal mobilization protocol, there are many aspects that are not yet clear, such as the timing and indications for plerixafor, the dose of G‐CSF, the use of LVL, the addition of standard chemotherapeutic agents or the introduction of other agents …”

“…2,[6][7][8] Despite the available options to achieve an optimal mobilization protocol, there are many aspects that are not yet clear, such as the timing and indications for plerixafor, the dose of G-CSF, the use of LVL, the addition of standard chemotherapeutic agents or the introduction of other agents. [9][10][11][12][13][14] The aim of this study is to compare three mobilization protocols from clinical and economic points of view: (a) a standard protocol using 10 μg/kg/day of G-CSF, (b) 10 μg/kg/day of G-CSF with plerixafor as preventive or rescue agent, and (c) 20 μg/kg/day of G-CSF with plerixafor as preventive or rescue agent plus LVL.…”

Etoposide-mediated interleukin-8 secretion from bone marrow stromal cells induces hematopoietic stem cell mobilization

“…In clinical practice, mobilization protocols generally include chemotherapy and granulocyte colony-stimulating factor (G-CSF) (chemomobilization), as reduction of the cancer burden during mobilization is crucial. Since G-CSF mobilization was first applied by Dührsen et al in 1988 [1][2][3], cyclophosphamide chemo-mobilization has been commonly used. Cyclophosphamide induces the release of stress signals that cause inflammation, activating the host immune system, which may increase hHSC mobilization [4,5].…”