The role of stem cell mobilization regimen on lymphocyte collection yield in patients with multiple myeloma.
BACKGROUND
The lymphocyte dose (LY-DO) infused during an autograft influences absolute lymphocyte (ALC) recovery and survival following autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. Factors influencing lymphocyte yield (LY-C) during leukapheresis have been poorly studied.


METHODS
Factors that could influence survival, LY-C and CD34(+) cell yield were analyzed in 122 MM patients. Three mobilization regimens were used, granulocyte-colony-stimulating factor (G-CSF) alone (n=13), cyclophosphamide 1-2 g/m(2) plus G-CSF (LD-CY, n=62) and cyclophosphamide 3-4 g/m(2) and G-CSF (ID-CY, n=47).


RESULTS
Using multivariate analysis, age, LY-C, ALC on day 30 (ALC-30) and International Staging System stage significantly influenced overall (OS) and progression-free survival (PFS) following ASCT. PFS (56 versus 29 months, P=0.05) and OS (72 versus 49 months; P=0.07) were longer in the LY-C>or=0.12x10(9)/kg group than the LY-C<0.12x10(9)/kg group. LY-C also influenced ALC on day 15 (ALC-15). Mobilization regimen, lymphocytes on the day of leukapheresis, prior radiotherapy and number of leukaphereses significantly influenced LY-C. Significantly higher LY-C was obtained with G-CSF alone compared with the LD-CY and ID-CY groups. CD34(+) count on the day of leukapheresis, prior chemotherapy with prednisone, cyclophosphamide, adriamycin and BCNU or melphalan, and stem cell mobilization regimen significantly influenced CD34(+) cell yield.


CONCLUSIONS
LY-C influenced ALC-15 and survival following ASCT. Factors that influenced CD34(+) cell yield and LY-C during leukapheresis were different. Mobilization should be tailored to maximize the LY-C and CD34(+) cell yield.
Hiwase
D K
DK
Haematology Department, Institute of Medical and Veterinary Science, Adelaide, South Australia, Australia. devendra.hiwase@imvs.sa.gov.au
Hiwase
S
S
Bailey
M
M
Bollard
G
G
Schwarer
A P
AP
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000096:biosynthesis / Q000235:genetics / Q000276:immunology; D002470:Cell Survival / Q000276:immunology; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D020127:Recovery of Function; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous
D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide