Predicting hematopoietic stem cell mobilization failure in patients with multiple myeloma: A simple method using day 1 CD34+ cell yield

Abstract

Early and reliable prediction of the likelihood of achieving adequate stem cell collection for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) would improve collection efficiency, prevent unnecessary aphereses, and permit appropriate treatment alterations. No previous study has reported a threshold CD34+ cell collection quantity on Day 1 or 2 of leukapheresis that could predict successful stem cell collection. We performed a retrospective analysis of all MM patients undergoing first attempt of stem cell collection at our institution from 2001 through 2008. Recursive partitioning analysis was used to identify Day 1 or Day 1+2 CD34+ collection quantity that predicted failure to reach target ≥ 2 × 10(6) CD34+ cells/kg within five days of collection. Totally, 172 patients were included in the analysis. Patients underwent mobilization with G-CSF or G-CSF+ chemotherapy. 23 of 172 patients (13.4%) failed to collect sufficient (≥ 2 × 10(6) CD34+ cells/kg) CD34+ cells after five days of apheresis: 22 of 29 who collected ≤ 0.70 × 10(6) CD34+ cells/kg and 1 of 143 who collected > 0.70 × 10(6) CD34+ cells/kg (75.9% vs. 0.7%, P < 0.001) on Day 1. Collection failure occurred in 23 of 30 patients who collected ≤ 1.54 × 10(6) CD34+ cells/kg and 0 of 142 who collected >1.54 × 10(6) CD34+ cells/kg (76.7% vs. 0%, P < 0.001) on Days 1 + 2. Day 1 CD34+ cell collection quantity identifies patients unlikely to achieve adequate collection for ASCT. Patients who collect ≤ 0.70 × 10(6) CD34+ cells/kg on day 1 could be considered for treatment modifications to improve CD34+ collection, such as early administration of plerixafor or large volume apheresis.

Factors Associated with Successful Mobilization and Collection of Peripheral Blood Hematopoietic Stem Cells in Autologous and Allogeneic Donors

“…Donors that donated MNC ≤ 0.7 x 10 8 /kg and/or ≤ 0.7 x 10 6 /kg CD34+ cells on the first day of apheresis were strong predictors of poor mobilizers (84.6%) in our study. Similarly to our findings Duong et al determined a cut point of ≤ 0.7 x 10 6 /kg CD34+ cells for the first day of apheresis as a predictor of inadequate CD34+ collection [43]. Early precise prediction of the likelihood of achieving adequate stem cell collection in autologous and allogeneic donors could prevent unsuccessful apheresis and permit appropriate mobilization alteration intended to improve collection of HSC.…”

Clinical experience with a simple algorithm for plerixafor utilization in autologous stem cell mobilization

“…Some have suggested rescue plerixafor (for example, 'salvage' or 'just in time') as the best strategy. 10,11 However, a rescue only approach would result in costly first-day attempts with very low yield. Identification of 'high-risk' patients for pre-emptive usage of plerixafor has also been suggested, 11 but a significant number of high-risk patients will mobilize adequately without plerixafor.…”

Increment of hematopoietic progenitor cell count as an indicator of efficient autologs stem cell harvest in patients with multiple myeloma

“…Infusion of ≥5.0 × 10 6 CD34+ cells/kg patient body weight is generally considered optimal for increasing the probability of rapid engraftment, resulting in reduced use of supportive measures, decreased costs, and shorter hospital stays [5, 6]. Although, peripheral blood CD34+ cell count prior to collection is useful in predicting the yield of collected CD34+ cells, it is costly and time‐consuming and may preclude same day apheresis [7–11]. Determination of hematopoietic progenitor cell (HPC) count using an automated hematology analyzer is a more rapid and inexpensive method than flow cytometry‐based techniques.…”