Autologous peripheral blood progenitor cell transplantation with <2 x 10(6) CD34(+)/kg: an analysis of variables concerning mobilisation and engraftment.
BACKGROUND
This study analyses the factors affecting mobilisation and engraftment in autologous peripheral blood progenitor cell transplantation according to the number of CD34(+) re-infused.


METHODS
A total of 190 patients underwent mobilisation with G-CSF alone (n=113) or in combination with chemotherapy (n=77). A total of 116 patients (61%) were autografted with <2 x 10(6) CD34(+) cells/kg and 74 patients were transplanted with >2 x 10(6) CD34(+) cells/kg. Rates of granulocyte and platelet recovery were estimated using the product-limit method of Kaplan-Meier and compared using a log-rank test. The Cox regression model was used for the multivariate analysis of factors influencing engraftment. Differences between cohorts were evaluated by one-way ANOVA or Mann-Whitney tests, and multivariate analysis was performed using a stepwise lineal regression.


RESULTS
Neutrophil and platelet engraftment was significantly longer with <2 x 10(6)/CD34(+)/kg (12 vs 10 days, P=0.014 and 16 vs 13 days, P=0.0001 respectively). Platelet recovery was affected by exposure to alkylating agents (P=0.04), refractory disease (P=0.02) and AML (P=0.0001), but only the last two variables remained significant in Cox regression (P<0.01). Granulocyte engraftment was longer in CML (univariate, P=0.04) and in refractory disease (multivariate, P=0.02). In patients re-infused with >2 x 10(6)/CD34(+)/kg, the Cox model did not identify prognostic factors for haematopoietic recovery.


CONCLUSIONS
Although mobilisation schedules and disease status influenced not only the yield of progenitor cells, but also the engraftment kinetics, the number of CD34(+) re-infused was the main predictor of haematopoietic recovery. While engraftment succeeded in most of the cases, the re-infusion of >2 x 10(6)/CD34(+)/kg resulted in significantly shorter recovery times.
Villalón
L
L
Department of Hematology, Hospital Ramón y Cajal, Ctra de Colmenar k.m 9.1, 28034 Madrid, Spain.
Odriozola
J
J
Laraña
J G
JG
Zamora
C
C
Pérez de Oteyza
J
J
Jodra
M H
MH
López
J
J
Herrera
P
P
Roldán
E
E
Ramos
M L
ML
Ramos
P
P
Navarro
J L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D053456:Caspase 14; D020169:Caspases / Q000008:administration & dosage; D002543:Cerebral Hemorrhage / Q000209:etiology; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D004921:Erythropoietin / Q000494:pharmacology; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007239:Infections / Q000209:etiology / Q000401:mortality; D007937:Leukapheresis / Q000379:methods; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D016016:Proportional Hazards Models; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D014182:Transplantation, Autologous
D018952:Antigens, CD34; D003561:Cytarabine; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D003520:Cyclophosphamide; C506446:CASP14 protein, human; D053456:Caspase 14; D020169:Caspases; D006918:Hydroxyurea