Good and poor CD34+ cells mobilization in acute leukemia: analysis of factors affecting the yield of progenitor cells

Abstract

Summary:The factors possibly affecting the collection of peripheral blood stem cells (PBSC) were evaluated in 104 de novo acute leukemia patients (66 myeloid and 38 lymphoblastic leukemias) in first cytological complete remission (CR); all patients achieved CR after first-line induction chemotherapy. The acute myeloid leukemia patients (AML) were given consolidation-mobilization chemotherapy with cytarabine, and daunoblastin or mitoxantrone or idarubicin; the acute lymphoblastic leukemia patients (ALL) were given consolidation-mobilization chemotherapy with cytarabine and etoposide. In all patients, the collection of PBSC was performed during recovery after giving consolidation chemotherapy and granulocyte colony-stimulating factor (G-CSF). Two main groups were considered according to the CD34 þ cells  10 6 /kg b.w. collected, that is, poor mobilizers (PM), with a collection of o2  10 6 /kg and good mobilizers, with a collection of 42  10 6 /kg. Of 104 patients, 27 (25.9%) were PM; 20/27 had AML and 7/27 had ALL. At multivariate analysis, a lower CD34 þ cells count premobilization chemotherapy (CD34 steady state), the presence of FUO (fever of unknown origin) or infection, and a lower number of CD34 þ cells on the first day of collection correlated with poor mobilization. These results may enable early recognition of patients who may have poor mobilization, and aid selection of patients for different mobilization regimens.

Factors affecting autologous peripheral blood hematopoietic stem cell collections by large-volume leukapheresis: a single center experience

“…Rapid and sustained engraftment depends on the number of HSC infused. A significant correlation between the total number of infused CD34+ cells and successful hematological recovery was previously reported, indicating that the collection of adequate number of these cells is a key factor for safe engraftment (4) . There is evidence to support that reliable and sustained engraftment occur in patients receiving at least 2 x 10 6 CD34+/kg of body weigh (5,6) .…”

“…This result is similar to the recent report from Wuchter et al (23) . The patient age effect on HSC yield was evaluated in numerous studies with contradictory results (4,7,24) . Patient age and gender did not affect CD34+ cell yield in our study.…”

Plerixafor with and without chemotherapy in poor mobilizers: results from the German compassionate use program

“…[2][3][4] In general, hematopoietic growth factors like granulocyte-CSF (G-CSF) or GM-CSF are used for releasing stem cells from the BM into the peripheral blood either alone or in conjunction with chemotherapy ('chemomobilization'). Unfortunately, 5-46% of the patients undergoing mobilization attempts do not reach the required minimum, [5][6][7][8][9] being considered as poor mobilizers. Although poor mobilizers are difficult to identify in advance, the following risk factors for poor mobilization are accepted in general: age 460 years, progressive disease, severe BM involvement, previous chemo-and/or radiotherapy, type of chemotherapy, previously failed mobilization attempts, platelet counts o100 Â 10 9 /L before apheresis and the occurrence of neutropenic fever during mobilization.…”

Prognostic value of CD34+ peak in peripheral blood during mobilization in intermediate-risk AML patients treated in first CR by autologous or allogeneic transplantation

“…In fact, the number of CD34 þ cells collected is a parameter that implicitly selects mobilized patients. This excludes at least 25% of AML patients in whom the process of mobilization fails, [4][5][6] and in whom no apheresis is attempted.…”