Abstract
Mobilization and collection of stem cells is difficult in a proportion of patients intended for autologous stem cell transplantation (ASCT). We have evaluated mobilization kinetics of blood CD34+ cells (B-CD34+) to form basis for algorithm to facilitate rational pre-emptive plerixafor use. Altogether 390 chemomobilized patients were included. Forty-three patients (11%) did not reach B-CD34+ count ≥10 × 106/l. Mobilization kinetics differed according to the mobilization capacity observed. Among those who were very poor or inadequate mobilizers (peak B-CD34+ count ≤5 × 106/l and 6–10 × 106/l, respectively), B-CD34+ counts rarely rose after white blood cells (WBC) >5–10 × 109/l, whereas in many standard mobilizers a later rise in CD34+ counts could be observed. Four algorithms based on WBC and CD34+ counts were constructed. According to this patient series, algorithm II (WBC >5 × 109/l and B-CD34+ ≤10 × 106/l) and algorithm IV (WBC >10 × 109/l and B-CD34+ ≤10 × 109/l) were the most applicable. For algorithm II the sensitivity was 0.97 and specificity 1.00, respectively, to identify patients for plerixafor use provided that all patients with B-CD34+ maximum ≤10 × 106/l would have needed plerixafor. This simple model needs a prospective validation.
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Dr. Jantunen has received honoraria from Genzyme and has participated in EU Leadership meeting organized by Genzyme as well as Medical Advisory Board meeting organized by Genzyme.
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Jantunen, E., Varmavuo, V., Juutilainen, A. et al. Kinetics of blood CD34+ cells after chemotherapy plus G-CSF in poor mobilizers: Implications for pre-emptive plerixafor use. Ann Hematol 91, 1073–1079 (2012). https://doi.org/10.1007/s00277-012-1411-8
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DOI: https://doi.org/10.1007/s00277-012-1411-8