Can the stem cell mobilization technique influence CD34+ cell collection efficiency of leukapheresis procedures in patients with hematologic malignancies?

Increasing demand on the apheresis service makes efficient harvesting of peripheral blood stem cells (PBSCs) essential. A total of 168 adult patients with haematological malignancy were primed using low-moderate dose cyclophosphamide (1.5-3 g/m 2 ) with G-CSF 5-10 lg/kg per day. Harvesting was booked and peripheral blood (PB) counts first checked between 6 and 10 days postpriming. One hundred and thirty (77%) patients harvested successfully (total harvest yield X2 Â 10 6 CD34 þ /kg) and the median PBSC collection per procedure was 2.18 Â 10 6 /kg (range 0.1-14.5). Only more lines of prior chemotherapy predicted failure to harvest in multivariate analysis (P ¼ 0.003). The PB CD34 þ cell count correlated significantly with harvest yield (r ¼ 0.8448, Po0.0001). A PB CD34 þ count X10/ll predicted a collection of X2 Â 10 6 /kg (positive-predictive value of 61%, negative-predictive-value 100%). Patients first attending day 9 required significantly fewer visits to achieve a successful harvest than those first attending days 6-8 without increasing the risk of failure. No significant difference in failure rates, number of days attending and total harvest yield was found between days 9 and 10 attendees. Collection from day 9 may however enable higher target yields to be achieved. PB CD34 þ count monitoring should commence and harvesting booked from day 9 to optimize both the harvest and the efficiency of the PBSC harvesting service.

Section: Discussionmentioning

confidence: 99%

“…[23][24][25][26] During the time period of our study, 28 patients (unpublished data) received disease-specific chemotherapy primes with G-CSF and the median time to first harvest was 13 days (range [11][12][13][14][15][16][17][18]. Stem cell recovery is more rapid however following low-dose cyclophosphamide/G-CSF.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the optimal timing of peripheral blood stem cell harvesting following priming with cyclophosphamide and G-CSF

Hill

Buxton

Pearce³

et al. 2007

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] The other factors that influence CD34 þ cell yield are the volume of blood processed and the collection efficiency (CE) of the procedure. 4,5 Many centers use 5 cells per microliter (or even higher) as a minimum PBCD34 threshold to start harvesting stem cells. [6][7][8] Although the logic behind this practice is to avoid the inefficiency and cost of collections with poor yields, it results in the exclusion of a number of patients from harvest-and eventually from potentially life-saving autotransplantation.…”

Section: Introductionmentioning

confidence: 99%

Significance of low peripheral blood CD34+ cell numbers prior to leukapheresis: what should the threshold required for apheresis be?

Gidron

Singh

Egan

et al. 2008

The pre-apheresis peripheral blood CD34 þ cell count (PBCD34) is the strongest predictor of the number of stem cells collected. It is common practice to apherese only when PBCD34 is X5/ll to avoid poor yields. However, in patients with compromised marrow function, the only way to get enough cells is to collect small numbers daily several times. Another pitfall with this practice is not accounting for weight. We studied 285 autologous collections performed with PBCD34 o5/ll. The blood volume processed was 15 l (n ¼ 68) or 20 l (n ¼ 217). A collection of X0.3 Â 10 6 CD34 þ cells per kg ideal body weight (IBW) was considered acceptable as this daily yield over a week could total X2 Â 10 6 /kg-enough for an autograft. Two hundred and four harvests (72%) had yields of X0.3; with 59% being X0.4, 47% being X0.5 and 36% being X0.6. There were 23 patients whose harvests done when PBCD34 was low totaled X2 Â 10 6 /kg. Assuming a 20-l apheresis with 70% collection efficiency, we suggest harvesting if 14 n/w X0.3, where n ¼ PBCD34 and w ¼ IBW. This approach is more logical than using an absolute threshold, and will ensure that patients are not deprived of the opportunity of stem cell collection and autotransplantation.

“…[1][2][3][4] PBCD34 reflects the extent of mobilization of stem cells from the bone marrow into the blood-and depends upon a number of factors including diagnosis, extent of prior therapy, mobilization technique and type and dose of the growth factor used. 3,[5][6][7][8][9] However, PBCD34 is not always immediately available at the planned time of apheresis. Waiting for a PBCD34 result for a few hours may result in a delayed start or even a missed opportunity for a good stem cell collection.…”

Section: Introductionmentioning

confidence: 99%

Correlation between serum lactate dehydrogenase and stem cell mobilization

Egan

Singh

Gidron

et al. 2007

After observing a correlation between elevated serum lactate dehydrogenase (LDH) levels and good stem cell collections, retrospective data from 540 donors undergoing 650 stem cell apheresis procedures (87% autologous, 13% allogeneic) were studied to determine the correlation between preapheresis LDH levels and the absolute peripheral blood CD34 þ cell count (PBCD34). PBCD34 (1-1611/ll; median 40) correlated modestly with leukocytes (0.5-118.2 Â 10 9 /l; median 30.2) (r ¼ 0.16; P ¼ 0.00005) and poorly with platelets (16-660 Â 10 9 /l; median 131) (r ¼ 0.02; P ¼ 0.69). The correlation between LDH (64-1664 IU/l; median 310) and PBCD34 was very strong (r ¼ 0.54; Po10 À48 ). In multivariate regression analysis, serum LDH was the only factor correlating significantly with PBCD34. The correlation between serum LDH and PBCD34 was strong on the first day of collection (n ¼ 517; r ¼ 0.53; Po10 À37 ), weakened on the second day (n ¼ 74; r ¼ 0.37; P ¼ 0.0009) and disappeared beyond day 2 (n ¼ 59; r ¼ 0.09; P ¼ 0.49). PBCD34 was significantly higher (median 53 versus median 11; Po0.00001) when LDH was elevated (n ¼ 511) compared to when LDH was normal (n ¼ 139). The relationship between serum LDH and PBCD34 was strong for autologous (r ¼ 0.54) as well as for allogeneic (r ¼ 0.41) collections. Our data suggest that it is reasonable to assume good stem cell mobilization and start apheresis if the LDH is elevated.