title: Predicting hematopoietic stem cell mobilization failure in patients with multiple myeloma: a simple method using day 1 CD34+ cell yield.
abstract: Early and reliable prediction of the likelihood of achieving adequate stem cell collection for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) would improve collection efficiency, prevent unnecessary aphereses, and permit appropriate treatment alterations. No previous study has reported a threshold CD34+ cell collection quantity on Day 1 or 2 of leukapheresis that could predict successful stem cell collection. We performed a retrospective analysis of all MM patients undergoing first attempt of stem cell collection at our institution from 2001 through 2008. Recursive partitioning analysis was used to identify Day 1 or Day 1+2 CD34+ collection quantity that predicted failure to reach target ≥ 2 × 10(6) CD34+ cells/kg within five days of collection. Totally, 172 patients were included in the analysis. Patients underwent mobilization with G-CSF or G-CSF+ chemotherapy. 23 of 172 patients (13.4%) failed to collect sufficient (≥ 2 × 10(6) CD34+ cells/kg) CD34+ cells after five days of apheresis: 22 of 29 who collected ≤ 0.70 × 10(6) CD34+ cells/kg and 1 of 143 who collected > 0.70 × 10(6) CD34+ cells/kg (75.9% vs. 0.7%, P < 0.001) on Day 1. Collection failure occurred in 23 of 30 patients who collected ≤ 1.54 × 10(6) CD34+ cells/kg and 0 of 142 who collected >1.54 × 10(6) CD34+ cells/kg (76.7% vs. 0%, P < 0.001) on Days 1 + 2. Day 1 CD34+ cell collection quantity identifies patients unlikely to achieve adequate collection for ASCT. Patients who collect ≤ 0.70 × 10(6) CD34+ cells/kg on day 1 could be considered for treatment modifications to improve CD34+ collection, such as early administration of plerixafor or large volume apheresis.
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. duongh@ccf.org
authors.forename: Hien K
authors.initials: HK
authors.lastname: Duong
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Anna
authors.initials: A
authors.lastname: Koo
authors.forename: Eric D
authors.initials: ED
authors.lastname: Hsi
authors.forename: Priscilla
authors.initials: P
authors.lastname: Figueroa
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis*; D001772:Blood Cell Count; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods* / Q000592:standards; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D017211:Treatment Failure
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor