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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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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DOI: https://doi.org/10.1038/s41409-017-0051-y
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