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Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score

Bone Marrow Transplantation volume 53, pages 461–473 (2018)Cite this article

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Abstract

Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63–0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76–0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9–24.8); specificity was 98% (95%CI: 97–98.7%), sensitivity 31.7% (95%CI: 24.9–39%); positive predictive value in our sample was 71.3% (95%CI: 60–80.8%). Simplified pPM-score can “rule in” patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure.

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Acknowledgements

The authors are very grateful to Giuseppe Ausoni, Paola Brambilla, Saveria Capria, Gloria Margiotta Casaluci, Michele Cimminiello, Annarita Conconi, Carmela Cuomo, Katia Codeluppi, Mario Delia, Roberta Distefano, Annalisa Di Marco, Luca Facchini, Salvatore Gattillo, Maria Gozzer, Svitlana Gumenyuk, Francesco Marchesi, Giovanna Meloni, Angela Melpignano, Luca Nassi, Domenico Pastore, Giuseppe Pietrantuono, Michele Pizzuti, Giovanni Quarta, Azzurra Anna Romeo, Federica Sorà, Andrea Spadaro and Stefania Trinca for their contribution to this study.

Author contributions

J.O. performed the statistical analysis and wrote the manuscript; A.O. contributed to study design, interpreted the results, contributed to manuscript writing, reviewed, and approved the manuscript; E.D.N. contributed to study design and to the statistical analysis; F.S. contributed to data collection and interpretation of the results, approved and edited the manuscript; I.A., M.C., M.P., P.P., P.E.P. contributed to data collection and interpretation of the results; P.C., L.F., G.G., L.N., S.S., N.P., M.M., T.M., M.P., F.Z., F.C., S.M., A.M., P.M., S.C., F.M., K.C., G.M., F.L., G.S., D.P., G.M. contributed to contributed to patient care and data collection.

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Authors and Affiliations

  1. Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy

    Jacopo Olivieri, Martina Chiarucci, Monica Poiani & Attilio Olivieri

  2. UOC Medicina Interna ed Ematologia, ASUR—AV3, Civitanova Marche, Italy

    Jacopo Olivieri

  3. Ematologia-Azienda Ospedaliera San Carlo, Potenza, Italy

    Immacolata Attolico, Roberta Nuccorini & Sara Pasquina Pascale

  4. Dipartimento di Ematologia e Oncoematologia pediatrica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    Paolo Corradini & Lucia Farina

  5. Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy

    Gianluca Gaidano & Luca Nassi

  6. UOC Ematologia, Università Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Roma, Italy

    Simona Sica & Nicola Piccirillo

  7. Clinica Ematologica, A.O. San Gerardo, Monza, Italy

    Pietro Enrico Pioltelli & Paolo Perseghin

  8. Hematology and Stem Cell Transplant, Azienda Ospedaliera BMM, Reggio Calabria, Italy

    Massimo Martino & Tiziana Moscato

  9. Ematologia, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Massimo Pini & Francesco Zallio

  10. Ospedale San Raffaele, Haematology and BMT, Milano, Italy

    Fabio Ciceri & Sarah Marktel

  11. Ematologia—IFO Istituto Nazionale Tumori Regina Elena, Roma, Italy

    Andrea Mengarelli

  12. IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy

    Pellegrino Musto

  13. Ematologia, Università sapienza, Roma, Italy

    Saveria Capria

  14. Arcispedale Santa Maria Nuova—IRCCS, Reggio Emilia, Italy

    Francesco Merli & Katia Codeluppi

  15. UOC di Ematologia e Unità Trapianti, Osp. Antonio Perrino, Brindisi, Italy

    Giuseppe Mele

  16. Hematology and Stem Cell Transplant, Ravenna Hospital, Ravenna, Italy

    Francesco Lanza & Francesco Saraceni

  17. UO Ematologia con Trapianto, AOU Policlinico Consorziale, Bari, Italy

    Giorgina Specchia & Domenico Pastore

  18. Dipartimento di Ematologia, Unità Trapianto di Midollo Osseo, Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy

    Giuseppe Milone

  19. Dipartimento di matematica “G. Peano”, Università di Torino, Torino, Italy

    Elvira Di Nardo

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  1. Jacopo Olivieri
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Correspondence to Attilio Olivieri.

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Olivieri, J., Attolico, I., Nuccorini, R. et al. Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score. Bone Marrow Transplant 53, 461–473 (2018). https://doi.org/10.1038/s41409-017-0051-y

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