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

Y. Gazitt, C. O. Freytes, N. Callander, T. W. Tsai, M. Alsina, J. Anderson, L. Holle, J. Cruz, P. Devore, M. McGrath, G. West, R. Alvarez, W. Montgomery

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)173-183
Number of pages11
JournalJournal of Hematotherapy
Volume8
Issue number2
DOIs
StatePublished - 1999

ASJC Scopus subject areas

  • Immunology
  • Hematology

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