Mobilization of CD34+ cells in elderly patients (>/= 70 years) with multiple myeloma: influence of age, prior therapy, platelet count and mobilization regimen.
The mobilization of peripheral blood stem cells was studied in 984 multiple myeloma patients, including 106 patients aged >/= 70 years. Increasing age correlated inversely with CD34+ yield (P < 0.0001), but also with >/= 12 months of prior standard chemotherapy (P = 0.0001), < 200 x 10(9)/l platelets (P = 0.0006) premobilization and mobilization with growth factors only (P = 0.0001). After controlling for these age covariates, multivariate analysis identified </= 12 months standard therapy and platelet count >/= 200 x 10(9)/l premobilization as favourable variables (both P < 0.0001), while increasing patient age remained an unfavourable factor (P = 0.0009). With both favourable variables, 85% of elderly patients collected >/= 4 x 10(6)/kg CD34+ cells in a median of one collection. The effect of age was incremental with no age threshold showing acceleration in the decline of CD34+ yield. Chemotherapy significantly increased CD34+ yield compared with growth factors only. However, the subgroup of patients with > 12 months prior therapy and premobilization platelet count < 200 x 10(9)/l mobilized as many CD34+ cells with granulocyte colony-stimulating factor (G-CSF) alone as with chemotherapy and haematopoietic growth factors. Increasing patient age had no effect on post-transplant neutrophil recovery, but significantly delayed platelet recovery (>/= 50 x 10(9)/l) if < 2 x 10(6)/kg CD34+ cells were infused, but this effect was eliminated completely with infusion of >/= 4 x 10(6)/kg CD34+ cells. Increasing age adversely affected CD34+ yield even with limited premobilization therapy, indicating that early collection is important in elderly patients.
Morris
Christopher L
CL
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Siegel
Eric
E
Barlogie
Bart
B
Cottler-Fox
Michele
M
Lin
Pei
P
Fassas
Athanasios
A
Zangari
Maurizio
M
Anaissie
Elias
E
Tricot
Guido
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002452:Cell Count; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000628:therapy*; D015999:Multivariate Analysis; D009504:Neutrophils / Q000473:pathology; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D019089:Stem Cell Factor / Q000627:therapeutic use; D016896:Treatment Outcome
D018952:Antigens, CD34; D000970:Antineoplastic Agents; D019089:Stem Cell Factor; D016179:Granulocyte Colony-Stimulating Factor