1. ¹BMT Program, Loyola University Medical Center, Maywood, IL 60153, USA
2. ²Oncology Institute, Loyola University Medical Center, Maywood, IL 60153, USA

Correspondence: Dr PJ Stiff, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. E-mail: pstiff@lumc.edu

Received 9 June 2003; Accepted 18 December 2003; Published online 5 April 2004.

Abstract

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 g/kg/day) or G-CSF(10 g/kg/day)+GM-CSF (5 g/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 g/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.