Autografting with blood progenitor cells: predictive value of preapheresis blood cell counts on progenitor cell harvest and correlation of the reinfused cell dose with hematopoietic reconstitution
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- Schwella, N., Siegert, W., Beyer, J. et al. Ann Hematol (1995) 71: 227. doi:10.1007/BF01744372
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One hundred and nine patients suffering from various malignancies underwent 285 apheresis procedures for PBPC collection. A median of two leukaphereses (range: 2–5) resulted in median numbers of 4.6×108 MNC/kg, 14.1×104 CFU-GM/kg, and 6.0×106 CD34+ cells/kg. Preleukapheresis peripheral blood CD34+ cells correlated significantly with collected CD34+ cells/kg (r=0.94;p<0.0001) and with CFU-GM/kg (r=0.52;p<0.0001). A value >4×104 CD34+ cells/ml was highly predictive for a collection yield >2.5×106 CD34+ cells/kg harvested by a single leukapheresis. Sixty patients were evaluated for hematologic reconstitution and engrafted in a median time of 10 days for WBC >1.0×109/l (range: 7–21 days), 10 days for ANC >0.5×109/l (7–20) and 11 days for PLT >20×109/l (7–62). Reinfused CD34+ cells/kg correlated significantly with hematologic engraftment (r=0.44–0.52 andp<0.006–0.001) as well as CFU-GM/ kg (r=0.36–0.44 andp<0.007–0.001). A progenitor cell dose >2.5×106 CD34+ cells/kg or >8.0×104 CFU-GM/kg led to a significantly faster recovery for WBC, ANC, and PLT when compared with patients receiving <2.5×106 CD34+ cells/kg or < 8.0×104 CFU-GM/kg. We conclude that rapid hematopoietic engraftment after high-dose therapy and PBPC reinfusion correlates well with a progenitor cell dose >2.5×106 CD34+ cells/kg or >8.0×104 CFU-GM/kg, and that above a preleukapheresis threshold of 4×104 CD34+ cells/ml a PBPC autograft containing >2.5×106 CD34+ cells/kg can be collected by a single leukapheresis. We suggest that patients recovering from myelosuppression should be monitored for CD34+ cells in serial blood samples to determine the course of circulating hematopoietic progenitor cells. This issue will help to define the optimal time point to start apheresis and to predict a PBPC autograft harvested by a single leukapheresis, which will lead to rapid and stable hematopoietic reconstitution following transplantation.