A prospective randomized trial of two popular mononuclear cell collection sets for autologous peripheral blood stem cell collection in multiple myeloma.
BACKGROUND
The COBE Spectra AutoPBSC collection set (AUTO-kit; CaridianBCT) is a popular dual-stage collection set for peripheral blood progenitor (PBPC) collection. Although the AUTO-kit is purportedly equivalent to the white blood cell (WBC) collection set (WBC-kit) for PBPC collection, improved CD34 yields after switching from the AUTO-kit to the WBC-kit were anecdotally observed, particularly in patients with higher WBC counts. A prospective, randomized trial of the AUTO- and WBC-kits for PBPC collection in multiple myeloma (MM) patients was therefore designed.


METHODS
Sixty-eight MM patients were prospectively randomly assigned to either the WBC-kit or the AUTO-kit for PBPC collection. Primary study variables included the number of leukapheresis procedures per transplant, CD34/kg yield per procedure, and cumulative CD34/kg yield per mobilization cycle. Results were compared relative to collection kit and mobilization regimen. Statistics and graphics were performed with commercial software.


RESULTS
CD34/kg yields were higher with the WBC-kit, with 94% of chemotherapy-mobilized MM patients collecting 6 million CD34/kg in a single mobilization (p = 0.06). The WBC-kit also had a faster CD34 collection rate relative to peripheral CD34 counts. The AUTO-kit was significantly sensitive to high WBC counts, with a 50% decrease in CD34 collection efficiency and CD34 collection rate. This effect was specific to MM and not observed in lymphoma patients. Granulocyte-colony-stimulating factor mobilization and the AUTO-kit were associated with an increased incidence and severity of infusion reactions.


CONCLUSIONS
The WBC-kit performed consistently better than the AUTO-kit for PBPC collection in chemotherapy-mobilized MM patients, with fewer procedures per mobilization, superior collection rates, and a decreased incidence of infusion reactions.
Cooling
Laura
L
Department of Pathology, University of Michigan Hospitals, Ann Arbor, Michigan, USA. lcooling@med.umich.edu
Hoffmann
Sandra
S
Herrst
Michelle
M
Muck
Charles
C
Armelagos
Heidi
H
Davenport
Robertson
R
D018952:Antigens, CD34 / Q000378:metabolism; D003131:Combined Modality Therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007937:Leukapheresis / Q000379:methods*; D007958:Leukocyte Count; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000188:drug therapy / Q000628:therapy*; D010976:Platelet Count; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018952:Antigens, CD34; D007074:Immunoglobulin G; C051713:antineoplastic agent K 18; D016179:Granulocyte Colony-Stimulating Factor; D008558:Melphalan