title: An algorithm based on peripheral CD34+ cells and hemoglobin concentration provides a better optimization of apheresis than the application of a fixed CD34 threshold.
abstract: BACKGROUND
  Optimization of peripheral blood stem cell (PBSC) collection for autologous bone marrow transplantation is necessary for a good standard of care and cost-effectiveness. An algorithm was validated for prediction of the day of maximum peripheral CD34+ cell concentration after mobilization chemotherapy (Day(CD34peak)).
  
  
  METHODS
  This study compared mobilization and collection variables of a cohort of patients where apheresis was started at the Day(CD34peak) predicted by the algorithm with a patient group where PBSCs were collected when PB CD34+ cell concentration reached 10 per microL per day (Day(CD34threshold)). Day(CD34peak) was calculated according to the equation Day(CD34peak) = -0.41 x Hb(D0) + 0.99 x Day(CD34threshold) + 7.8 (with Hb(D0) representing the hemoglobin value on Day 0).
  
  
  RESULTS
  The mean number of apheresis procedures per patient based on the Day(CD34threshold) was 1.74, but decreased to 1.35 when applying the new method (Day(CD34peak)). For lymphomas, the mean number of apheresis procedures decreased from 1.98 to 1.47 (p = 0.03), while in patients with multiple myeloma it did not change significantly (1.23 and 1.26, respectively). Age and primary disease influenced the number of apheresis procedures needed to achieve the collection target.
  
  
  CONCLUSIONS
  The application of our algorithm can lower the number of apheresis procedures by improving the timing, especially in patients suffering from malignant lymphomas with a poor marrow potential after several chemotherapy lines.
authors.affiliation: Center of Hematology and Hemotherapy, Department of Internal Medicine, Faculty of Medicine, State University of Campinas, Campinas-SP, Brazil.
authors.forename: Márcia T
authors.initials: MT
authors.lastname: Delamain
authors.forename: José F C
authors.initials: JF
authors.lastname: Marques
authors.forename: Carmino A
authors.initials: CA
authors.lastname: de Souza
authors.forename: Irene
authors.initials: I
authors.lastname: Lorand-Metze
authors.forename: Konradin
authors.initials: K
authors.lastname: Metze
mesh_terms: D000328:Adult; D000465:Algorithms; D018952:Antigens, CD34 / Q000378:metabolism*; D001781:Blood Component Removal / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D018952:Antigens, CD34; D006454:Hemoglobins