title: Management of poor peripheral blood stem cell mobilization: incidence, predictive factors, alternative strategies and outcome. A retrospective analysis on 2177 patients from three major Italian institutions.
abstract: CD34+ peripheral blood hematopoietic stem cells (HSC) are usually collected following mobilization therapy accomplished by using growth factors (GF) such as rHuG-CSF or rHuGM-CSF with or without chemotherapy. A target dose of yielded CD34+ is usually prescribed by the attending physician depending on different protocols, which may include single or double transplantation. HSC collection usually is performed when at least 20 CD34+ HSC/microL are detected by means of flow cytometry. A cumulative dose of at least 2 x 10(6)/Kg/bw CD34+ HSC has been considered as the threshold to allow a prompt and persistent hematopoietic recovery. Unfortunately, this goal is not achieved by the totality of patients undergoing mobilization regimen. In fact, 5-46% of patients who underwent mobilization therapy fail HSC collection due to very low peripheral blood HSC CD34+ count. Patients' characteristics, including age, sex, stage of the underlying disease (complete or partial remission), diagnosis, previously administered radio/chemotherapy regimens, time-lapse from last chemotherapy before mobilization and mobilization schedule (including dose of GF) were considered as possibly predictive of poor or failed mobilization. We performed a retrospective analysis in 2177 patients from three large Italian academic institutions to assess the incidence of poor mobilizers within our patients' series. Therefore, a patient who fails a first mobilization (and when an HLA-compatible related on unrelated donor is not available) could undergo a second attempt either with different mobilization schedule or by using different GF, such as stem cell factor, growth hormone (GH), or more recently newly introduced drugs such as AMD3100, alone or in combination with rHuG- or -rHuGM-CSF. Thus, we investigated the fate of those who failed a first mobilization and subsequently underwent a second attempt or alternative therapeutic approaches.
authors.affiliation: Unità di Aferesi e nuove Tecnologie Trasfusionali-Servizio Trasfusionale, Dipartimento di Patologia Clinica, Ospedale San Gerardo de'Tintori, Monza, Italy. p.perseghin@hsgerardo.org
authors.forename: Paolo
authors.initials: P
authors.lastname: Perseghin
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Terruzzi
authors.forename: Maria
authors.initials: M
authors.lastname: Dassi
authors.forename: Valentina
authors.initials: V
authors.lastname: Baldini
authors.forename: Matteo
authors.initials: M
authors.lastname: Parma
authors.forename: Paola
authors.initials: P
authors.lastname: Coluccia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Accorsi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Confalonieri
authors.forename: Luisa
authors.initials: L
authors.lastname: Tavecchia
authors.forename: Luisa
authors.initials: L
authors.lastname: Verga
authors.forename: Fernando
authors.initials: F
authors.lastname: Ravagnani
authors.forename: Antonio
authors.initials: A
authors.lastname: Iacone
authors.forename: E M
authors.initials: EM
authors.lastname: Pogliani
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000097:blood; D005500:Follow-Up Studies; D006410:Hematopoiesis; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000601:surgery; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000601:surgery; D015470:Leukemia, Myeloid, Acute / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery; D009101:Multiple Myeloma / Q000601:surgery; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D018952:Antigens, CD34