An optimum approach to the mobilization and collection of autologous blood stem cells has not been defined. In 1999, patients at MSKCC received autologous stem cell transplant (ASCT) for a range of diagnoses: non-Hodgkin's lymphoma (NHL), Hodgkin's disease (HD), multiple myeloma (MM), acute myeloid leukemia (AML), anaplastic oligodendroglioma, and germ cell (GC) and neurectodermal (NE) malignancies. In this heavily pre-treated population, mobilization was usually with chemotherapy and G-CSF. Collections commenced on WBC recovery and the minimum collection target was 2 x 106 CD34+ cells/kg. In 1999, 36% of collections ( 187/523) yielded < 0.5 x l O6 CD34+ cells/kg and marrow harvests were needed in 10% to 15% of patients. Therefore, in an attempt to improve overall collection efficiency, we evaluated the utility of measuring baseline circulating CD34+ cell counts (BLCD34; 1SHAGE cytometrics) prior to leukapheresis and correlated baseline counts with leukapheresis yields of CD34+ cells/kg. In 42 consecutive previously uncollected patients (15NHL, 7HD, 7MM, 1AML, 3GC and 9NE), 100 consecutive leukaphereses were evaluated. Employing our standard criteria, 6 of 42 patients (14%) failed to achieve the target dose in 3 to 5 leukaphereses. BLCD34 predicted leukapheresis yield (R2=0.87, p"0.01 ) and patients with BLCD34 > 20 per ul were highly likely to achieve the target dose in a single leukapheresis (3 blood volumes). In 47% of the leukaphereses BLCD34 was equal to 0 per ul and median yield was 0 CD34+ cells/kg. If leukapheresis had not been performed for BLCD34 = 0 in all cases, 9 of 42 patients (21 %) would have failed to achieve the target dose. Therefore, the use of a BLCD34 measurement would significantly enhance overall collection efficiency if leukapheresis were not performed when BLCD34 = 0. In addition, patients requiring marrow harvest would be spared the side effects of leukapheresis.
|Original language||English (US)|
|Issue number||11 PART II|
|State||Published - Dec 1 2000|
ASJC Scopus subject areas
- Cell Biology