title: PBSC mobilization in lymphoma patients: analysis of risk factors for collection failure and development of a predictive score based on the kinetics of circulating CD34+ cells and WBC after chemotherapy and G-CSF mobilization.
abstract: Autologous stem cell transplantation (ASCT) is a potentially curative treatment of lymphoma, but peripheral blood stem cell (PBSC) mobilization fails in some patients. PBSC mobilizing agents have recently been proved to improve the PBSC yield after a prior mobilization failure. Predictive parameters of mobilization failure allowing for a preemptive, more cost-effective use of such agents during the first mobilization attempt are still poorly defined, particularly during mobilization with chemotherapy + granulocyte colony-stimulating factor (G-CSF). We performed a retrospective analysis of a series of lymphoma patients who were candidates for ASCT, to identify factors influencing PBSC mobilization outcome. Premobilization parameters-age, histology, disease status, mobilizing protocol, and previous treatments-as well as white blood cell (WBC) and PBSC kinetics, markers potentially able to predict failure during the ongoing mobilization attempt, were analyzed in 415 consecutive mobilization procedures in 388 patients. We used chemotherapy + G-CSF in 411 (99%) of mobilization attempts and PBSC collection failed (<2 × 10(6) CD34+ PBSC/kg) in 13%. Multivariable analysis showed that only a low CD34+ PBSC count and CD34+ PBSC/WBC ratio, together with the use of nonplatinum-containing chemotherapy, independently predicted mobilization failure. Using these three parameters, we established a scoring system to predict risk of failure during mobilization ranging from 2 to 90%, thus allowing a selective use of a preemptive mobilization policy.
authors.affiliation: Division of Hematology, Spedali Civili, Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Bone Marrow Transplant Unit, Spedali Civili, University of Brescia, Brescia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Skert
authors.affiliation: Division of Hematology, Spedali Civili, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Morello
authors.affiliation: Stem Cell Collection Unit, Spedali Civili, Brescia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Almici
authors.affiliation: Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Arcaini
authors.affiliation: Division of Hematology, Niguarda Hospital, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Basilico
authors.affiliation: Division of Hematology, Spedali Civili, Brescia, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Cavalli
authors.affiliation: Division of Hematology, AOU San Giovanni Battista, Turin, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Botto
authors.affiliation: Division of Hematology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Castelli
authors.affiliation: Division of Hematology/BMT Unit, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
authors.forename: Gianmatteo
authors.initials: G
authors.lastname: Pica
authors.affiliation: Division of Hematology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ripamonti
authors.affiliation: Division of Hematology, Ospedale Civile, Alessandria, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Salvi
authors.affiliation: Division of Hematology/BMT Unit, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
authors.forename: Angelo M
authors.initials: AM
authors.lastname: Carella
authors.affiliation: Division of Hematology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
authors.affiliation: Division of Hematology, Ospedale Civile, Alessandria, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.affiliation: Division of Hematology, Niguarda Hospital, Milan, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.affiliation: Bone Marrow Transplant Unit, Spedali Civili, University of Brescia, Brescia, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.affiliation: Division of Hematology, AOU San Giovanni Battista, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D000069585:Filgrastim / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006801:Humans; D007962:Leukocytes / Q000166:cytology*; D008223:Lymphoma / Q000097:blood* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013234:Stem Cells / Q000166:cytology*; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim
keywords: G-CSF; autologous stem cell transplantation; chemotherapy; lymphoma; peripheral blood stem cell mobilization