Factors influencing haemopoietic recovery following chemotherapy-mobilised autologous peripheral blood progenitor cell transplantation for haematological malignancies: a retrospective analysis of a 10-year single institution experience

Abstract

Summary:We retrospectively analysed the factors that influenced rate of haemopoietic recovery (HR) in 243 patients after transplantation with chemotherapy-mobilised autologous peripheral blood progenitor cells (PBPC). Approximately half the patients also received haemopoietic growth factors (HGF) for mobilisation. Conditioning for transplantation was with either chemotherapy alone or chemotherapy plus total body irradiation (TBI). Median time to recovery of granulocytes у0.5 ؋ 10 9 /l was 13 days (range 7-93 days) and of platelets у50 ؋ 10 9 /l 14 days (7-440). Speed of HR was greater, both for neutrophils and platelets for patients who received more rather than less CFU-GM than our median value of 18.9 ؋ 10 4 /kg (P Ͻ 0.0001 in both instances) and more rather than less CD34-positive cells than our median value of 8.8 ؋ 10 6 /kg (P Ͻ 0.0001 and P Ͻ 0.0005, respectively). For granulocyte recovery, in the multivariate analysis the dose of infused CFU-GM (P = 0.05) and the use of HGF for both mobilisation and posttransplantation (P Ͻ 0.0014) were significant positive factors. For platelet recovery in the multivariate analysis the dose of infused CFU-GM (P Ͻ 0.0016) was a positive factor. The use of busulphan and of TBI were significant adverse factors for rate of platelet recovery (P = 0.005 and 0.0004, respectively). When compared with non-HGF-mobilised PBPC, HGF-mobilised PBPC reduced the number of days of hospitalisation (28 vs 24, P = 0.0001) and of treatment with intravenous antibiotics (15 vs 11, P = 0.0004). These findings emphasise the importance of cell dose in accelerating haemopoietic recovery after autologous blood stem cell transplantation.

Factors influencing hematopoietic recovery after autologous blood stem cell transplantation in patients with acute myeloblastic leukemia and with non-myeloid malignancies

“…4 In this report, however, important variables such as the amount of previous chemotherapy or the dose of CFU-GM or CD34 + cells infused were not analyzed. Finally, in a recent study by Lowenthal et al, 5 platelet recovery was slower in patients with acute leukemia than in other diseases. In the multivariate analysis, the conditioning regimen, but not the diagnosis, remained as a significant independent factor influencing HR.…”

“…[3][4][5] In a series of 145 patients, including 31 patients with acute leukemia, Haas et al 3 showed that the leukemia group had delayed HR when compared with other diagnoses. However, in that study, there was a remarkable difference between the patient groups with regard to the amount of CFU-GM Bone Marrow Transplantation infused.…”

“…1,2 Data about patients with acute myeloblastic leukemia (AML) are, however, very limited, with only a few studies addressing this issue specifically. [3][4][5] Improving knowledge of the different factors affecting HR after ABSCT is important to further enhance the safety of this procedure.…”

The impact of CD34+ cell dose on engraftment after SCTs: personalized estimates based on mathematical modeling

“…3,[44][45][46][47][48][49][50][51][52][53] The current results underline that further investigation of this topic Figure 4. Calibration of the model to different clinical scenarios: (a) autologous PBSC with and without post transplant cytokine administration; patient data taken from Lowenthal et al 27 (b) Allogeneic HLA-identical PBSC without post transplant cytokine administration; patient data taken from trials by Vigorito et al 30 and Bensinger et al 31 (c) Allogeneic HLA-identical PBSC with post transplant cytokine administration; patient data taken from different trials. [28][29] (d) Allogeneic HLA-haplo-identical PBSC with and without post transplant cytokine administration; patient data taken from trials by Aversa et al 32 and Kato et al 33 Model has been scaled to the fraction of patients alive and engrafted after 40 days.…”

“…As various diseases are treated by PBSC transplantations (PBSCT), we focus on trial data including different diagnoses. We consider the following scenarios used in current clinical practice: autologous PBSCT with and without post transplant cytokine administration, 19,27 HLA-identical allogeneic PBSCT with 28,29 and without 30,31 post transplant cytokine administration, haplo-identical PBSCT 32,33 and umbilical cord blood transplantation. 34 We also consider the impact of reduced conditioning regimens.…”