Successful PBSC mobilization with high-dose G-CSF for patients failing a first round of mobilization

PBSC are the preferred source of stem cells for autologous transplantation. However, regardless of the mobilization procedure used, 10%- 20% of patients fail to collect an adequate number to ensure prompt engraftment. There is as yet no standard mobilization procedure for patients who fail a first mobilization attempt. Here, we describe a highly efficient strategy to obtain an adequate number of stem cells for patients who failed a first mobilization attempt. Seventy-four patients with various hematologic malignancies underwent initial mobilization with various regimens including hematopoietic growth factors with or without chemotherapy. In 72% of patients, ≥2 x 10⁶ CD34⁺ stem cells/kg were collected in the initial mobilization attempt, and patients engrafted in a median of 10 days for neutrophils and 12 days for platelets. Eighteen patients failed to mobilize adequate numbers of stem cells, defined as the inability to collect 0.2 x 10⁶ CD34⁺ stem cells/kg/day in the first 2-3 days. These patients had their apheresis halted. Patients were immediately given G-CSF (32 μg/kg/day) for 4 days as a second attempt at mobilization. Eighty-eight percent of these patients achieved the target of ≥2 x 10⁶ CD34⁺ cells/kg, with a median duration of apheresis of 5 days (including the first and second mobilizations). The mean CD34⁺ cells/kg/day increased after administration of high-dose G-CSF from 0.16 after the first mobilization attempt to 0.61 (p = 0.0002) after the second mobilization. All patients engrafted in a median of 11 and 13 days for neutrophils and platelets, respectively. We conclude that patients whose apheresis yield is <0.4 x 10⁶ CD34⁺ cells/kg after the first two apheresis collections can be successfully mobilized if high-dose G- CSF is administered immediately and continued until achieving ≥2 x 10⁶ CD34⁺ stem cells/kg.