¹Northwestern University Medical Center, Department of Medicine, Chicago, IL, USA

²George Papanicolaou General Hospital, Department of Hematology, Thessaloniki, Greece

³University Hospital of Leicester, Leicester, UK

⁴St Vincent's Hospital, Sydney, Australia

⁵Leiden University Medical Center, Leiden, The Netherlands

⁶University Hospital Kralovske Vinohrady, Prague, Czech Republic

⁷Universitair Medisch Centrum, Utrecht, The Netherlands

⁸Fred Hutchinson Research Cancer Center, Seattle, WA, USA

⁹National Institutes of Health, National Heart Lung and Blood Institute, Hematology Branch, Bethesda, MD, USA

¹⁰Universitatsklinikum Campus Charite Mitte, Berlin, Germany

¹¹Royal Free and University Medical School, London, UK

¹²Leeds General Infirmary, Leeds, UK

¹³Centro Trapianti di Midollo Osseo, Ospedale San Martino, Genoa, Italy

¹⁴University of Colorado, Denver, CO, USA

Correspondence to: Dr R K Burt, Northwestern University Medical Center, Wesley Pavilion, Room 153, 250 East Superior Street, Chicago, IL 60611-2950, USA

We reviewed data from 24 transplant centers in Asia, Australia, Europe, and North America to determine the outcomes of stem cell collection including methods used, cell yields, effects on disease activity, and complications in patients with autoimmune diseases. Twenty-one unprimed bone marrow harvests and 174 peripheral blood stem cell mobilizations were performed on 187 patients. Disease indications were multiple sclerosis (76 patients), rheumatoid arthritis (37 patients), scleroderma (26 patients), systemic lupus erythematosus (19 patients), juvenile chronic arthritis (13 patients), idiopathic autoimmune thrombocytopenia (8 patients), Behcet's disease (3 patients), undifferentiated vasculitis (3 patients), polychondritis (1 patient) and polymyositis (1 patient). Bone marrow harvests were used in the Peoples Republic of China and preferred worldwide for children. PBSC mobilization was the preferred technique for adult stem cell collection in America, Australia, and Europe. Methods of PBSC mobilization included G-CSF (5, 10, or 16 g/kg/day) or cyclophosphamide (2 or 4 g/m²) with either G-CSF (5 or 10 g/kg/day) or GM-CSF (5 g/kg/day). Bone marrow harvests were without complications and did not affect disease activity. A combination of cyclophosphamide and G-CSF was more likely to ameliorate disease activity than G-CSF alone (P < 0.001). G-CSF alone was more likely to cause disease exacerbation than the combination of cyclophosphamide and G-CSF (P = 0.003). Three patients died as a result of cyclophosphamide-based stem cell collection (2.6% of patients mobilized with cyclophosphamide). When corrected for patient weight and apheresis volume, progenitor cell yields tended to vary by underlying disease, prior medication history and mobilization regimen. Trends in the approaches to, and results of, progenitor cell mobilization are suggested by this survey. While cytokine-based mobilization appears less toxic, it is more likely to result in disease reactivation. Optimization with regard to cell yields and safety are likely to be disease-specific and prospective disease-specific studies of mobilization procedures appear warranted. Bone Marrow Transplantation (2001) 28, 1-12.

hematopoietic stem cell transplantation; mobilization; autoimmune disease