title: Predictive factors for poor peripheral blood stem cell mobilization and peak CD34(+) cell count to guide pre-emptive or immediate rescue mobilization.
abstract: OBJECTIVE
  Failure in mobilization of peripheral blood (PB) stem cells is a frequent reason for not performing hematopoietic stem cell transplantation (HSCT). Early identification of poor mobilizers could avoid repeated attempts at mobilization, with the administration of pre-emptive rescue mobilization.
  
  
  METHODS
  Data from the first mobilization schedule of 397 patients referred consecutively for autologous HSCT between 2000 and 2010 were collected. Poor mobilization was defined as the collection of < 2 × 10(6) CD34(+)cells/kg body weight (BW).
  
  
  RESULTS
  The median age was 53 years (range 4-70) and 228 (57%) were males. Diagnoses were multiple myeloma in 133 cases, non-Hodgkin's lymphoma in 114, acute myeloid leukemia or myelodysplastic syndrome in 81, Hodgkin's lymphoma in 42, solid tumors in 17 and acute lymphoblastic leukemia in 10. The mobilization regimen consisted of recombinant human granulocyte-colony-stimulating factor (G-CSF) in 346 patients (87%) and chemotherapy followed by G-CSF (C + G-CSF) in 51 (13%). Poor mobilization occurred in 105 patients (29%), without differences according to mobilization schedule. Diagnosis, previous therapy with purine analogs and three or more previous chemotherapy lines were predictive factors for poor mobilization. A CD34(+)cell count in PB > 13.8/μL was enough to ensure ≥ 2 × 10(6) CD34(+)cells/kg, with high sensitivity (90%) and specificity (91%).
  
  
  CONCLUSIONS
  The prevalence of poor mobilization was high, being associated with disease type, therapy with purine analogs and multiple chemotherapy regimens. The threshold of CD34(+) cell count in PB identified poor mobilizers, in whom the administration of immediate or pre-emptive plerixafor could be useful to avoid a second mobilization.
authors.affiliation: Clinical Hematology Department, ICO-Hospital Universitari Germans Trias i Pujol, José Carreras Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. jsancho@iconcologia.net
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Sancho
authors.forename: Mireia
authors.initials: M
authors.lastname: Morgades
authors.forename: Joan-Ramon
authors.initials: JR
authors.lastname: Grifols
authors.forename: Jordi
authors.initials: J
authors.lastname: Juncà
authors.forename: Ramon
authors.initials: R
authors.lastname: Guardia
authors.forename: Susana
authors.initials: S
authors.lastname: Vives
authors.forename: Christelle
authors.initials: C
authors.lastname: Ferrà
authors.forename: Monsterrat
authors.initials: M
authors.lastname: Batlle
authors.forename: Anna
authors.initials: A
authors.lastname: Ester
authors.forename: David
authors.initials: D
authors.lastname: Gallardo
authors.forename: Fuensanta
authors.initials: F
authors.lastname: Millà
authors.forename: Evarist
authors.initials: E
authors.lastname: Feliu
authors.forename: Josep-Maria
authors.initials: JM
authors.lastname: Ribera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood / Q000276:immunology; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D005434:Flow Cytometry; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34