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rHuG-CSF in Peripheral Blood Progenitor Cell Transplantation

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Twenty Years of G-CSF

Part of the book series: Milestones in Drug Therapy ((MDT))

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Abstract

The ability of rHuG-CSF to mobilize progenitor cells to the peripheral blood was unexpected when the possibility was first raised by Professor Don Metcalf. Initial scepticism was overcome when groups from Adelaide and Melbourne conclusively demonstrated the efficacy of rHuG-CSF mobilized peripheral blood transplantation in both the autologous and allogeneic settings. Today, progenitor cells mobilized by means of rHuG-CSF constitute the predominant source for transplantation worldwide.

The mechanisms by which rHuG-CSF mobilizes stem cells is an area of active research. Multiple pathways are involved, including disruption of the interaction between CXCR4 and SDF-1, and suppression of trophic macrophages within the stem cell niche. Peripheral blood CD34+ cell counts increase in a predictable manner following rHuG-CSF administration, and minimal and optimal CD34+ cell collections have been defined based on engraftment studies. Despite considerable optimization of regimens, inadequate CD34+ cell mobilization occurs in approximately 20% of attempts due to various clinical and genetic factors. rHuG-CSF remains an important component of remobilization strategies, including use in combination with the partial CXCR4 agonist plerixafor. Ex vivo efforts to expand the progenitor cell compartment, or to purge contaminating tumour cells in the case of autologous transplantation, remain experimental. Recent research has begun to unravel complex immunological differences between mobilized peripheral blood and bone marrow stem cell sources. It is hoped that these insights will lead to further improvements in stem cell transplantation.

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  1. Royal Adelaide Hospital and Institute of Medical and Veterinary Science, Adelaide, Australia

    Ashanka Beligaswatte

  2. Royal Adelaide Hospital, Institute of Medical and Veterinary Sciences, and University of Adelaide, Frome Rd, Adelaide, SA, 5000, Australia

    Ian Lewis & Luen Bik To

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    Graham Molineux

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Beligaswatte, A., Lewis, I., To, L.B. (2012). rHuG-CSF in Peripheral Blood Progenitor Cell Transplantation. In: Molineux, G., Foote, M., Arvedson, T. (eds) Twenty Years of G-CSF. Milestones in Drug Therapy. Springer, Basel. https://doi.org/10.1007/978-3-0348-0218-5_14

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