Characterization and outcome of "hard to mobilize" lymphoma patients undergoing autologous stem cell transplantation

M. W. Sugrue, K. Williams, B. H. Pollock, S. Khan, S. Peracha, J. R. Wingrad, J. S. Moreb

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

A "hard to mobilize" patient was defined as one in whom ≥ 1×106CD 34+ cells/kg cannot be obtained after two consecutive large volume aphereses. Forty-four consecutive Hodgkin's and non-Hodgkin's lymphoma patients who underwent autologous peripheral blood stem cell (PBSC) transplant treatment between June 1996 and June 1998 were included in this study. Twenty-one patients (48%) met the definition of "hard to mobilize" (Group I). All the rest of the patients (n=23) were the good mobilizers (Group II). The initial mobilization protocol for most patients was 10 μg/kg of G-CSF alone for both groups. For Group I, 7/21 (33%) patients were unable to achieve a minimal dose of ≥ 1×106 CD34+ cells/kg even after a second mobilization attempt and/or bone marrow (BM) harvest (n=5). Overall, 11/21 (52%) required an additional mobilization and/or BM harvest. Only 3/21 (14%) patients were able to meet the target cell dose of ≥ 2.5×106 CD34+ cells/kg (median of 4 apheresis). In contrast, 87% of Group II achieved the target dose with a median of 2 aphereses. Predictors of poor mobilization were greater than two prior treatment regimens (p=0.038) and the WBC count (<25,000/μL) on the first day of apheresis (p=0.053). Nineteen patients in Group I and all Group II completed treatment with a median time of engraftment of ANC>500/μl of 12 and 11 days, and platelet >20×103/μ1 of 31 and 13 days, respectively. Outcome analysis revealed that 6/19 patients in Group I died of relapse within one year from transplant compared with only 2/23 of Group II who died of relapse (p=0.005, log rank test). There were no treatment related deaths in either group. Independent predictive features for "hard to mobilize" patients are a lack of significant increase in WBC count on the first day of apheresis and the number of prior treatment regimens. Poor mobilization appears to predict a worse outcome after autografting for lymphoma patients.

Original languageEnglish (US)
Pages (from-to)509-519
Number of pages11
JournalLeukemia and Lymphoma
Volume39
Issue number5-6
DOIs
StatePublished - 2000
Externally publishedYes

Keywords

  • Autologous stem cell transplantation
  • Lymphoma
  • Mobilization of stem cells

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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