TY - JOUR
T1 - G-CSF primed autologous marrow harvest and transplantation in cytapheresis ″mobilization failure″ patients
T2 - A descriptive analysis
AU - Phillips, G. L.
AU - Hale, G. A.
AU - Howard, D. S.
AU - Nath, R.
AU - Munn, R. K.
AU - Marshall, K. W.
AU - Reece, D. E.
AU - Reed, E.
AU - Van Zant, G.
PY - 2000
Y1 - 2000
N2 - Fifteen cancer patients, deemed blood HSC ″mobilization failures″ due to CD34 + cell yields of <0.5x106/kg from two consecutive daily cytaphereses, underwent G-CSF primed autologous bone marrow harvest in an attempt to obtain adequate hematopoietic support for subsequent autotrans-plantation. CD34 + cell yields from the primed marrow harvest were variable; however, some patients had > 5-fold increases in CD34 + cell yields in the marrow compared to cytapheresis, and 4 patients had CD34 + cell yields of >1.0 (i.e., 1.2, 1.44, 1.61 and 2.45) x106/kg from the primed marrow harvest. None of the five patients previously exposed to stem cell toxins or fludarabine achieved > 0.85 x106/kg CD34 + cells with the primed marrow harvest. A significant difference was noted between G-CSF primed blood and marrow for CD34 + cells but not for GM-CFU (p = 0.011 and p = 0.135, respectively, paired t-test). All evaluable patients engrafted; a median ANC >0.5x109/L recovery was achieved on D + 12 (range + 9 to + 17) in 12 of 13 evaluable patients - one died on D + 9 without recovery. The last day of platelet transfusion occurred at a median D + 13 (range + 8 to>+66); only one patient remained platelet transfusion-dependent beyond D + 34. As anticipated, patients with higher numbers of CD34 + cells transplanted had somewhat more rapid recoveries. Although stem cell damage is obviously a key factor in mobilization failure patients, these findings raise the possibility that poor mobilization, at least in some patients, results from a mechanism other than, or in addition to, simple stem cell damage. Moreover, they raise the issue of the minimum number of marrow CD34 + - or more arguably other - cells needed for adequate short- and long-term reconstitution. The role of G-CSF in this situation, especially regarding dose and/or schedule, is intriguing but remains to be clarified. G-CSF primed marrow harvest is a potential option in certain poor mobilizers but, as fully expected, is frequently inadequate. Whether such is preferable to ″steady-state″ marrow harvest, continued or repeated G-CSF primed cytapheresis (with or without chemotherapy), or primed marrow with G-CSF in other schedules - or with other cytokines - is unclear and will be the subject of further study.
AB - Fifteen cancer patients, deemed blood HSC ″mobilization failures″ due to CD34 + cell yields of <0.5x106/kg from two consecutive daily cytaphereses, underwent G-CSF primed autologous bone marrow harvest in an attempt to obtain adequate hematopoietic support for subsequent autotrans-plantation. CD34 + cell yields from the primed marrow harvest were variable; however, some patients had > 5-fold increases in CD34 + cell yields in the marrow compared to cytapheresis, and 4 patients had CD34 + cell yields of >1.0 (i.e., 1.2, 1.44, 1.61 and 2.45) x106/kg from the primed marrow harvest. None of the five patients previously exposed to stem cell toxins or fludarabine achieved > 0.85 x106/kg CD34 + cells with the primed marrow harvest. A significant difference was noted between G-CSF primed blood and marrow for CD34 + cells but not for GM-CFU (p = 0.011 and p = 0.135, respectively, paired t-test). All evaluable patients engrafted; a median ANC >0.5x109/L recovery was achieved on D + 12 (range + 9 to + 17) in 12 of 13 evaluable patients - one died on D + 9 without recovery. The last day of platelet transfusion occurred at a median D + 13 (range + 8 to>+66); only one patient remained platelet transfusion-dependent beyond D + 34. As anticipated, patients with higher numbers of CD34 + cells transplanted had somewhat more rapid recoveries. Although stem cell damage is obviously a key factor in mobilization failure patients, these findings raise the possibility that poor mobilization, at least in some patients, results from a mechanism other than, or in addition to, simple stem cell damage. Moreover, they raise the issue of the minimum number of marrow CD34 + - or more arguably other - cells needed for adequate short- and long-term reconstitution. The role of G-CSF in this situation, especially regarding dose and/or schedule, is intriguing but remains to be clarified. G-CSF primed marrow harvest is a potential option in certain poor mobilizers but, as fully expected, is frequently inadequate. Whether such is preferable to ″steady-state″ marrow harvest, continued or repeated G-CSF primed cytapheresis (with or without chemotherapy), or primed marrow with G-CSF in other schedules - or with other cytokines - is unclear and will be the subject of further study.
KW - Autologous
KW - Blood
KW - G-CSF priming
KW - Marrow
KW - Stem cells
KW - Transplantation
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U2 - 10.1080/10245332.2000.11746511
DO - 10.1080/10245332.2000.11746511
M3 - Article
C2 - 11399617
AN - SCOPUS:0033785851
SN - 1024-5332
VL - 5
SP - 223
EP - 231
JO - Hematology
JF - Hematology
IS - 3
ER -