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Progenitor Cell Mobilization

Analysis of remobilization success in patients undergoing autologous stem cell transplants who fail an initial mobilization: risk factors, cytokine use and cost

Bone Marrow Transplantation volume 33, pages 997–1003 (2004)Cite this article

Summary:

Inadequate stem cell mobilization is seen in approximately 25% of patients undergoing autotransplantation for hematologic malignancies. Remobilization strategies include chemotherapy/cytokine combinations or high-dose cytokines alone or in combination. From 1/1997 to 7/2002, we remobilized 86 patients who failed an initial mobilization (median total CD34=0.72 × 106/kg) in sequential cohorts using high-dose G-CSF (32 μg/kg/day) or G-CSF(10 μg/kg/day)+GM-CSF (5 μg/kg/day). No difference in CD34/kg yields were seen (G-CSF alone: 2.2 × 106 and G-CSF+GM-CSF 1.6 × 106) in the median 3 aphereses performed (P=0.333). Of the 86, 23 (27%) failed the second mobilization; 14 were remobilized again (yield=1.5 × 106 CD34/kg; three aphereses). Of the 86, 93% went to transplant: three progressed, and three had inadequate stem cells. Significant risk factors for a failed remobilization were: number of stem-cell-damaging regimens (P=0.015), time between last chemotherapy and first mobilization (P=0.028), and higher WBC at initiation of first mobilization (P=0.04). High-dose G-CSF (32 μg/kg/day) was more costly @ $9,016, vs $5,907 for the G-CSF+GM-CSF combination (P<0.001). Most patients failing an initial mobilization benefit from a cytokine only remobilization. Lower cost G-CSF+GM-CSF is as effective as high-dose G-CSF.

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Acknowledgements

We acknowledge the Loyola BMT team including the NP and nursing staffs, the apheresis team, headed by Catherine Shipp RN, our BMT coordinators, Pamela Schumaker, RN and Sheila Wojtowicz, RN, our BMT social worker, Shari Lichtenstein MSW, our BMT laboratory staff including Mala Parthasarathy and David Oldenberg, and the physician attending staff including Drs Amir Toor, Robert Bayer and Deepak Malhotra.

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  1. BMT Program, Loyola University Medical Center, Maywood, 60153, IL, USA

    S Boeve, J Strupeck & P J Stiff

  2. Oncology Institute, Loyola University Medical Center, Maywood, 60153, IL, USA

    S Creech

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Correspondence to P J Stiff.

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Boeve, S., Strupeck, J., Creech, S. et al. Analysis of remobilization success in patients undergoing autologous stem cell transplants who fail an initial mobilization: risk factors, cytokine use and cost. Bone Marrow Transplant 33, 997–1003 (2004). https://doi.org/10.1038/sj.bmt.1704486

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