Ideal or actual body weight to calculate CD34+ cell doses for autologous hematopoietic stem cell transplantation?

Abstract

Summary:The number of CD34+ cells infused influences the speed of hematologic recovery post-transplant. There are limited data on whether ideal (IBW) or actual (ABW) body weight should be used to calculate CD34+ cell dose. We compared the correlation between recovery to 0.5 Â 10 9 /l neutrophils and the CD34+ cell dose based upon ABW as well as IBW in 87 patients autografted for cancer. ABW was X25% over IBW in 43% of patients. The median number of CD34+ cells administered was 3.6 Â 10 6 /kg ABW and 4.2 Â 10 6 /kg IBW. The time to neutrophil recovery was 8-15 days (median 10). There was a stronger inverse correlation between CD34+ cell dose/IBW and neutrophil recovery (r 2 ¼ 0.308; Po0.0001) than between CD34+ cell dose/ABW and neutrophil recovery (r 2 ¼ 0.267; Po0.0001). The median time to neutrophil recovery was comparable for those receiving X2 Â 10 6 /kg CD34+ cells/kg IBW as well as ABW (10 days) and those receiving X2 Â 10 6 /kg CD34+ cells/kg IBW but o2/kg ABW (10 days), but was significantly slower for those receiving o2 Â 10 6 /kg CD34+ cells/kg IBW (12 days). These data show that the CD34+ cell dose based on IBW is a better predictor of neutrophil recovery after autotransplantation.

Ideal body weight correlates better with engraftment after PBSC autograft than actual body weight, but is under-estimated in myeloma patients possibly due to disease-related height loss

“…Our patient group also differs from that described by Ali et al 3 in that, there is a preponderance of myeloma patients among autografts performed at our centre.…”

“…The ratio of IBW to ABW we saw in our study was remarkably similar but the stem cell doses infused were approximately 25% greater than those used by Ali et al 3 Possibly because of this, despite larger numbers of patients, we were not able to show such close inverse correlations to engraftment by either stem cell dose calculation method. Our patient group also differs from that described by Ali et al 3 in that, there is a preponderance of myeloma patients among autografts performed at our centre.…”

“…1,2 Recent reports have suggested that stem cell doses calculated from ideal body weight (IBW) may correlate better with engraftment than those calculated from actual body weight (ABW). [3][4][5][6] In addition, using IBW may reduce the number of harvesting procedures needed and would remove any concerns over changes in stem cell dose per kg should the patient's weight alter substantially between stem cell collection and transplant. The aims of this study were to show whether stem cell dose correlates better with engraftment when calculated using IBW rather than ABW and to confirm that the use of IBW to calculate stem cell dose is safe in our clinical setting.…”

Difficult stem cell mobilization despite adequate CD34+ cell dose predicts shortened progression free and overall survival after autologous HSCT for lymphoma

“…Previous analyses have demonstrated that the CD34 þ cell dose based on ideal body weight (IBW) is a better predictor of engraftment. 22,23 Reanalysis of our data using IBW reclassified 17 patients as G-CSF Success, but their PFS and OS remained significantly inferior to those categorized as G-CSF Success by actual body weight (not shown). Consequently, when using mobilization as a predictor of HSCT outcome, classification using actual body weight minimizes false positive mobilization success.…”

How long after neutrophil recovery should myeloid growth factors be continued in autologous hematopoietic stem cell transplant recipients?

“…CD34 þ cell doses were calculated on the basis of the ideal body weight (IBW). 10 Patients did not receive trimethoprimsulfamethoxazole routinely in the immediate post transplant period.…”