Kinetics of blood CD34(+) cells after chemotherapy plus G-CSF in poor mobilizers: implications for pre-emptive plerixafor use.
Mobilization and collection of stem cells is difficult in a proportion of patients intended for autologous stem cell transplantation (ASCT). We have evaluated mobilization kinetics of blood CD34(+) cells (B-CD34(+)) to form basis for algorithm to facilitate rational pre-emptive plerixafor use. Altogether 390 chemomobilized patients were included.Forty-three patients (11%) did not reach BCD34+count ≥10×10(6)/l. Mobilization kinetics differed according to the mobilization capacity observed. Among those who were very poor or inadequate mobilizers (peak BCD34(+)count ≤5×10(6)/l and 6–10×10(6)/l, respectively), BCD34+counts rarely rose after white blood cells (WBC) >5–10×10(9)/l, whereas in many standard mobilizers a later rise in CD34(+) counts could be observed. Four algorithms based on WBC and CD34(+) counts were constructed. According to this patient series, algorithm II (WBC >5×109/l and BCD34+≤10×10(6)/l) and algorithm IV (WBC >10×10(9)/l andB-CD34(+) ≤10×10(9)/l) were the most applicable. For algorithm II the sensitivity was 0.97 and specificity 1.00, respectively, to identify patients for plerixafor use provided that all patients with B-CD34+ maximum ≤10×10(6)/l would have needed plerixafor.This simple model needs a prospective validation.
University of Eastern Finland/Clinical Medicine, Kuopio, Finland. esa.jantunen@kuh.fi
E
E
Jantunen
V
V
Varmavuo
A
A
Juutilainen
T
T
Kuittinen
E
E
Mahlamäki
P
P
Mäntymaa
T
T
Nousiainen
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage; D018952:Antigens, CD34 / Q000097:blood* / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001596:Benzylamines; D018890:Chemoprevention / Q000379:methods; D000080027:Cyclams; D004334:Drug Administration Schedule; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D007700:Kinetics; D007958:Leukocyte Count; D007962:Leukocytes / Q000187:drug effects / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D017211:Treatment Failure
D019380:Anti-HIV Agents; D018952:Antigens, CD34; D001596:Benzylamines; D000080027:Cyclams; D006571:Heterocyclic Compounds; D016179:Granulocyte Colony-Stimulating Factor; C088327:plerixafor