Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Stem Cell Procurement

Impact of different strategies of second-line stem cell harvest on the outcome of autologous transplantation in poor peripheral blood stem cell mobilizers

Bone Marrow Transplantation volume 36, pages 847–853 (2005)Cite this article

Summary:

The optimal approach to obtain an adequate graft for transplantation in patients with poor peripheral blood stem cell (PBSC) mobilization remains unclear. We retrospectively assessed the impact of different strategies of second-line stem cell harvest on the transplantation outcome of patients who failed PBSC mobilization in our institution. Such patients were distributed into three groups: those who proceeded to steady-state bone marrow (BM) collection (group A, n=34); those who underwent second PBSC mobilization (group B, n=41); those in whom no further harvesting was carried out (group C, n=30). PBSC harvest yielded significantly more CD34+ cells than BM collection. Autologous transplantation was performed in 30, 23 and 11 patients from groups A, B and C, respectively. Engraftment data and transplantation outcome did not differ significantly between groups A and C. By contrast, group B patients had a faster neutrophil recovery, required less platelet transfusions and experienced less transplant-related morbidity, as reflected by lower antibiotics needs and shorter hospital stays. In conclusion, remobilization of PBSC constitutes an effective approach to ensure a rapid hematopoietic engraftment and a safe transplantation procedure for poor mobilizers, whereas unprimed BM harvest does not provide any clinical benefit in this setting.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. To LB, Haylock DN, Simmons PJ, Juttner CA . The biology and clinical uses of blood stem cells. Blood 1997; 89: 2233–2258.

    CAS  Google Scholar 

  2. Schmitz N, Linch DC, Dreger P et al. Randomized trial of filgrastim mobilized peripheral blood progenitor cell transplant versus autologous bone marrow transplantation in lymphoma patients. Lancet 1996; 347: 353–357.

    Article  CAS  Google Scholar 

  3. Damiani D, Fanin R, Silvestri F et al. Randomized trial of autologous filgrastim-primed bone marrow transplantation versus filgrastim-mobilized peripheral stem cell transplantation with lymphoma patients. Blood 1997; 90: 36–42.

    CAS  Google Scholar 

  4. Weaver CH, Potz J, Redmond J et al. Engraftment and outcomes of patients receiving myeloablative therapy followed by autologous peripheral blood stem cells with a low CD34+ cell content. Bone Marrow Transplant 1997; 19: 1103–1110.

    Article  CAS  Google Scholar 

  5. Watts MJ, Ings SJ, Flynn M et al. Remobilization of patients who fail to achieve minimal progenitor thresholds at the first attempt is clinically worthwhile. Br J Haematol 2000; 111: 287–291.

    Article  CAS  Google Scholar 

  6. Bensinger W, Appelbaum F, Rowley S et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J Clin Oncol 1995; 13: 2547–2555.

    Article  CAS  Google Scholar 

  7. Weaver CH, Hazelton B, Birch R et al. An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy. Blood 1995; 86: 3961–3969.

    CAS  Google Scholar 

  8. Dreger P, Kloss M, Petersen B et al. Autologous progenitor cell transplantation: prior exposure to stem cell-toxic drugs determines yield and engraftment of peripheral blood progenitor cell but not of bone marrow grafts. Blood 1995; 86: 3970–3978.

    CAS  Google Scholar 

  9. Tarella C, Di Nicola M, Caracciolo D . High-dose ara-C with autologous peripheral blood progenitor cell support induces a marked progenitor cell mobilization: an indication for patients at risk for low mobilization. Bone Marrow Transplant 2002; 30: 725–732.

    Article  CAS  Google Scholar 

  10. Koumakis G, Vassiolmanolakis M, Hatzichristou H et al. Predictive factors affecting mobilization and peripheral blood stem cell collection using single apheresis for rescuing patients after high-dose chemotherapy in various malignancies. Bone Marrow Transplant 1996; 18: 1065–1072.

    CAS  Google Scholar 

  11. Brugger W, Bross K, Frisch J et al. Mobilization of peripheral blood progenitors by sequential administration of interleukin-3 and granulocyte-macrophage colony-stimulating factor following polychemotherapy with etoposide, ifosfamide and cisplatin. Blood 1992; 79: 1193–1200.

    CAS  Google Scholar 

  12. Haas R, Mohle R, Fruehauf S et al. Patient characteristics associated with successful mobilizing and autografting of peripheral blood progenitor cells in malignant lymphoma. Blood 1994; 83: 3787–3794.

    CAS  Google Scholar 

  13. Zimmerman TM, Michelson GC, Mick R et al. Timing of platelet recovery is associated with adequacy of leukapheresis product yield after cyclophosphamide and G-CSF in patients with lymphoma. J Clin Apheresis 1999; 14: 31–34.

    Article  CAS  Google Scholar 

  14. Kessinger A, Sharp JG . The whys and hows of hematopoietic progenitor and stem cell mobilization. Bone Marrow Transplant 2003; 31: 319–329.

    Article  CAS  Google Scholar 

  15. Fraipont V, Sautois B, Baudoux E et al. Successful mobilization of peripheral blood HPCs with G-CSF alone in patients failing to achieve sufficient numbers of CD34+ cells and/or CFU-GM with chemotherapy and G-CSF. Transfusion 2000; 40: 339–347.

    Article  CAS  Google Scholar 

  16. Carlo-Stella C, Di Nicola M, Milani R et al. Use of recombinant human growth hormone (rhGH) plus recombinant human granulocyte colony-stimulating factor (rhG-CSF) for the mobilization and collection of CD34+ cells in poor mobilizers. Blood 2004; 103: 3287–3295.

    Article  CAS  Google Scholar 

  17. Weaver CH, Tauer K, Zhen B et al. Second attempts at mobilization of peripheral blood stem cells in patients with initial low CD34+ cell yields. J Hematother 1998; 7: 241–249.

    Article  CAS  Google Scholar 

  18. Gazitt Y, Freytes CO, Callander N et al. Successful PBSC mobilization with high-dose G-CSF for patients failing a first round of mobilization. J Hematother 1999; 8: 173–183.

    Article  CAS  Google Scholar 

  19. Lefrère F, Lévy V, Makke J et al. Successful peripheral blood stem cell harvesting with granulocyte colony-stimulating factor alone after previous mobilization failure. Haematologica 2004; 89: 1532–1533 [letter].

    PubMed  Google Scholar 

  20. Bashey A, Corringham S, Gilpin E et al. Simultaneous administration of G-CSF and GM-CSF for re-mobilization in patients with inadequate initial progenitor cell collections for autologous transplantation. Cytotherapy 2000; 2: 195–200.

    Article  CAS  Google Scholar 

  21. Watts MJ, Sullivan AM, Leverett D et al. Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem cell mobilization. J Clin Oncol 1998; 16: 1554–1560.

    Article  CAS  Google Scholar 

  22. Rick O, Beyer J, Kingreen D et al. Successful autologous bone marrow rescue in patients who failed peripheral blood stem cell mobilization. Ann Hematol 2000; 79: 681–686.

    Article  CAS  Google Scholar 

  23. Sugrue MW, Williams K, Pollock BH et al. Characterization and outcome of ‘hard to mobilize’ lymphoma patients undergoing autologous stem cell transplantation. Leuk Lymphoma 2000; 39: 509–519.

    Article  CAS  Google Scholar 

  24. Scott MA, Ager S, Jestice HK et al. Failure to mobilize and harvest PBPC does not necessarily preclude the use of high-dose therapy and autologous stem-cell rescue. Bone Marrow Transplant 1995; 15: 487–488 [letter].

    CAS  PubMed  Google Scholar 

  25. Lemoli RM, de Vivo A, Damiani D et al. Autologous transplantation of granulocyte colony-stimulating factor-primed bone marrow is effective in supporting myeloablative chemotherapy in patients with hematologic malignancies and poor peripheral blood stem cell mobilization. Blood 2003; 102: 1595–1600.

    Article  CAS  Google Scholar 

  26. Elfenbein GJ, Sackstein R . Primed marrow for autologous and allogeneic transplantation: a review comparing primed marrow to mobilized blood and steady-state marrow. Exp Hematol 2004; 32: 327–339.

    Article  CAS  Google Scholar 

  27. Stockerl-Goldstein KE, Reddy SA, Horning SJ et al. Favorable treatment outcome in non-Hodgkin's lymphoma patients with poor mobilization of peripheral blood progenitor cells. Biol Blood Marrow Transplant 2000; 6: 506–512.

    Article  CAS  Google Scholar 

  28. Arbona C, Prosper F, Benet I et al. Comparison between once a day vs twice a day G-CSF for mobilization of peripheral blood progenitor cells (PBPC) in normal donors for allogeneic PBPC transplantation. Bone Marrow Transplant 1998; 22: 39–45.

    Article  CAS  Google Scholar 

  29. Moncada V, Bolan C, Yau YY, Leitman SF . Analysis of PBPC cell yields during large-volume leukapheresis of subjects with a poor mobilization response to filgrastim. Transfusion 2003; 43: 495–501.

    Article  Google Scholar 

  30. Siena S, Schiavo R, Pedrazzoli P, Carlo-Stella C . Therapeutic relevance of CD34+ cell dose in blood cell transplantation for cancer therapy. J Clin Oncol 2000; 18: 1360–1377.

    Article  CAS  Google Scholar 

  31. Stewart DA, Guo D, Luider J et al. The CD34+90+ cell dose does not predict early engraftment of autologous blood stem cells as well as the total CD34+ cell dose. Bone Marrow Transplant 2000; 25: 435–440.

    Article  CAS  Google Scholar 

  32. Carral A, de la Rubia J, Martin G et al. Factors influencing hematopoietic recovery after autologous blood stem cell transplantation in patients with acute myeloblastic leukemia and with non-myeloid malignancies. Bone Marrow Transplant 2002; 29: 825–832.

    Article  CAS  Google Scholar 

  33. Meisenberg B, Brhem T, Schmekel A et al. A combination of low-dose cyclophosphamide and colony stimulating factors is more cost-effective than granulocyte-colony stimulating factors alone in mobilizing peripheral blood stem and progenitor cells. Transfusion 1998; 38: 209–215.

    Article  CAS  Google Scholar 

  34. Narayanasami U, Kanteli R, Morelli J et al. Randomized trial of filgrastim versus chemotherapy and filgrastim mobilization of hematopoietic progenitor cells for rescue in autologous transplantation. Blood 2001; 98: 2059–2064.

    Article  CAS  Google Scholar 

  35. Meldgaard L, Jensen L, Gaarsdal E et al. A comparative study of sequential priming and mobilisation of progenitor cells with rhG-CSF alone and high-dose cyclophosphamide plus rhG-CSF. Bone Marrow Transplant 2000; 26: 717–722.

    Article  Google Scholar 

  36. Milone G, Leotta S, Indelicato F et al. G-CSF alone vs cyclophosphamide plus G-CSF in PBPC mobilization of patients with lymphoma: results depend on degree of previous pre-treatment. Bone Marrow Transplant 2003; 31: 747–754.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all nurses at the departments for the excellent and skillful care to the patients.

Author information

Authors and Affiliations

  1. Hematology and Medical Oncology Service, Hospital Clínico Universitario, University of Valencia, Valencia, Spain

    R Goterris, J C Hernández-Boluda, A Teruel, C Gómez, M J Lis, M J Terol, M Tormo, C Solano & C Arbona

Authors
  1. R Goterris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J C Hernández-Boluda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Teruel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M J Lis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M J Terol
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M Tormo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C Solano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C Arbona
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J C Hernández-Boluda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goterris, R., Hernández-Boluda, J., Teruel, A. et al. Impact of different strategies of second-line stem cell harvest on the outcome of autologous transplantation in poor peripheral blood stem cell mobilizers. Bone Marrow Transplant 36, 847–853 (2005). https://doi.org/10.1038/sj.bmt.1705147

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705147

Keywords

This article is cited by

Search

Advanced search

Quick links