title: Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem-cell mobilization.
abstract: OBJECTIVE
  To assess hematologic recovery and procedure-related mortality in patients who received high-dose therapy with stem-cell support, in whom the peripheral-blood stem-cell (PBSC) collection fails (CD34+ cells < 1 x 10(6)/kg). The predictive value of granulocyte-monocyte colony-forming cell (GM-CFC) measurements and the value of bone marrow obtained after PBSC collection failure was assessed.
  
  
  METHODS
  The study group comprised 324 consecutive patients mobilized with granulocyte colony-stimulating factor (G-CSF) and cyclophosphamide (273 patients), G-CSF with other chemotherapy (37 patients), and G-CSF alone (14 patients). Between one and four aphereses were performed.
  
  
  RESULTS
  In 51 of 324 patients, there was failure to obtain 1 x 10(6)/kg CD34+ cells. Twenty-three patients had greater than 1 x 10(5)/kg GM-CFC; 22 patients proceeded to high-dose therapy. Neutrophil recovery occurred within 21 days, but platelet independence was delayed (> 28 days) in eight patients. Of 28 patients with less than 1 x 10(5)/kg GM-CFC, six received high-dose therapy with PBSC alone and five had delayed engraftment. Twelve patients with less than 1 x 10(5)/kg GM-CFC received high-dose therapy supported by bone marrow collected after PBSC collection failure. Eleven patients were assessable for engraftment; four patients had slow (> 21 days) or delayed (> 28 days) neutrophil recovery and eight patients had delayed platelet recovery. In the group of patients who received less than 1 x 10(5)/kg GM-CFC, there were five procedure-related deaths.
  
  
  CONCLUSIONS
  This study shows that delayed hematologic recovery is frequent if less than 1 x 10(6)/kg CD34+ cells are infused after high-dose therapy, particularly with GM-CFC less than 1 x 10(5)/kg. The procedure-related mortality in this latter group is high. In most patients whose PBSC collection contains less than 1 x 10(5)/kg GM-CFC, the use of bone marrow cells does not improve engraftment, which suggests that poor PBSC mobilization usually indicates poor marrow function.
authors.affiliation: University College London Hospitals, United Kingdom. michael.watts@ucl.ac.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Watts
authors.forename: A M
authors.initials: AM
authors.lastname: Sullivan
authors.forename: D
authors.initials: D
authors.lastname: Leverett
authors.forename: A J
authors.initials: AJ
authors.lastname: Peniket
authors.forename: A R
authors.initials: AR
authors.lastname: Perry
authors.forename: C D
authors.initials: CD
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Devereux
authors.forename: A H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: D C
authors.initials: DC
authors.lastname: Linch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D001803:Blood Transfusion; D001853:Bone Marrow / Q000378:metabolism*; D002330:Carmustine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015925:Cryopreservation; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000532:radiotherapy / Q000628:therapy*; D011034:Podophyllotoxin / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D018952:Antigens, CD34; D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine