Stem Cell Mobilization Efficiency and Engraftment Kinetics in Patients with Hematologic Malignancies Undergoing Autologous Stem Cell Transplantation: A Retrospective Cohort Study

Abstract

Objective: This study aimed to conduct a retrospective evaluation of clinical findings on patients undergoing autologous hematopoietic stem cell transplantation. Materials and Methods: A total of 167 consecutive patients who were diagnosed with multiple myeloma (MM) and lymphoma and then underwent autologous hematopoietic stem cell transplantation (AHSCT) between August 2010 and May 2013 were included in our study. Demographic, disease, mobilization, apheresis, and transplantation data were reviewed from patient files. Results: In 121 patients (72%), mobilization was achieved solely with granulocyte colony stimulating factor (G-CSF). There was no relationship between peripheral CD34+ cell count and age, disease type, or previous treatment features. The total CD34+ cell count postapheresis was 3.3 ± 3.1 × 106 /kg. Only nine patients could not achieve successful mobilization with any regimen. The median day of neutrophil and platelet engraftment among the entire patient group was 11 days. As the number of CD34+ cells infused into patients increased, neutrophil and platelet engraftment time decreased. Conclusion: Mobilization was achieved in most MM cases and at least two-thirds of lymphomas using G-CSF alone. Age and body weight did not affect mobilization success. Clinicians should increase successful mobilizations on the first day of the apheresis and prescribe AHSCT at appropriate times to avoid excessive cycles of chemotherapy.

Keywords

• Mobilization
• apheresis
• autologous stem cell transplantation
• high-dose chemotherapy

References

1. 1. Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol 2022; 97(8): 1086107. google scholar
2. 2. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127(20): 2375-90. google scholar
3. 3. Palumbo A, Cavallo F, Gay F, Di Raimondo F, Ben Yehuda D, Petrucci MT, et al. Autologous transplantation and maintenance therapy in multiple myeloma. N Engl J Med 2014; 371(10): 895-905. google scholar
4. 4. Dunleavy K, Fanale MA, Abramson JS, Noy A, Caimi PF, Pittaluga S, et al. Dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) in untreated aggressive diffuse large B-cell lymphoma with MYC rearrangement: a prospective, multicentre, single-arm phase 2 study. Lancet Haematol 2018; 5(12): e609-e17. google scholar
5. 5. Herrera AF, Chen L, Nieto Y, Holmberg L, Johnston P, Mei M, et al. Brentuximab vedotin plus nivolumab after autologous haematopoietic stem-cell transplantation for adult patients with high-risk classic Hodgkin lymphoma: a multicentre, phase 2 trial. Lancet Haematol 2023; 10(1): e14-e23. google scholar
6. 6. Lanza F, Marchetti M, Zannetti BA. Overview on novel strategies and current guidelines for hematopoietic stem cell mobilisation and collection. Transfus Apher Sci 2023: 103830. google scholar
7. 7. Maitta RW. Current state of apheresis technology and its applications. Transfus Apher Sci 2018; 57(5): 606-13. google scholar
8. 8. Hopman RK, DiPersio JF. Advances in stem cell mobilization. Blood Rev 2014; 28(1): 31-40. google scholar

9. 9. Whitby A, Whitby L, Fletcher M, Reilly JT, Sutherland DR, Keeney M, et al. ISHAGE protocol: are we doing it correctly? Cytometry B Clin Cytom 2012; 82(1): 9-17. google scholar
10. 10. Sarıcı A, Erkurt MA, Bahçecioğlu Ö F, Gök S, Kuku İ, Biçim S, et al. Filgrastim alone versus cyclophosphamide and filgrastim for mobilization in multiple myeloma patients. Transfus Apher Sci 2021; 60(4): 103159. google scholar
11. 11. Dhakal B, Zhang MJ, Burns LJ, Tang X, Meyer C, Mau LW, et al. Efficacy, safety, and cost of mobilization strategies in multiple myeloma: a prospective, observational study. Haematologica 2023; 108(8): 2249-54. google scholar
12. 12. Wei X, Wei Y. Stem cell mobilization in multiple myeloma: challenges, strategies, and current developments. Ann Hematol 2023; 102(5): 995-1009. google scholar
13. 13. Demiroğlu H, Çiftçiler R, Büyükaşık Y, Göker H. Prediction of stem cell mobilization failure in patients with Hodgkin and Non-Hodgkin Lymphoma. Turk J Haematol 2021; 38(3): 204-10. google scholar
14. 14. Dolai TK, De R, Sen A, Baul SN, Mitra S, Bhattacharya S, et al. Pattern of autologous stem cell transplants at a tertiary care government hospital, with emphasis on transplant outcomes with pre-harvest CD34+ level. Blood Cell Ther 2022; 5(1): 16-26. google scholar
15. 15. Moreb JS, Lantos L, Chen F, Elliott K, Dugan J, Skarbnik AP, et al. The effect of mobilizing large numbers of CD34 + cells (super-mobilizers) on the engraftment and survival in patients undergoing autologous stem cell transplantation. Transfus Apher Sci 2023: 103787. google scholar
16. 16. Sahin U, Demirer T. Current strategies for the management of autologous peripheral blood stem cell mobilization failures in patients with multiple myeloma. J Clin Apher 2018; 33(3): 357-70. google scholar
17. 17. Holmberg LA, Linenberger M, Connelly-Smith L. successful mobilization of autologous hematopoietic peripheral blood stem cells after salvage chemotherapy in patients with low CD34 blood cell counts. Transplant Cell Ther 2022; 28(11): 754-9. google scholar