G-CSF primed autologous marrow harvest and transplantation in cytapheresis ″mobilization failure″ patients: A descriptive analysis

G. L. Phillips, G. A. Hale, D. S. Howard, R. Nath, R. K. Munn, K. W. Marshall, D. E. Reece, E. Reed, G. Van Zant

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3 Scopus citations

Abstract

Fifteen cancer patients, deemed blood HSC ″mobilization failures″ due to CD34 + cell yields of <0.5x106/kg from two consecutive daily cytaphereses, underwent G-CSF primed autologous bone marrow harvest in an attempt to obtain adequate hematopoietic support for subsequent autotrans-plantation. CD34 + cell yields from the primed marrow harvest were variable; however, some patients had > 5-fold increases in CD34 + cell yields in the marrow compared to cytapheresis, and 4 patients had CD34 + cell yields of >1.0 (i.e., 1.2, 1.44, 1.61 and 2.45) x106/kg from the primed marrow harvest. None of the five patients previously exposed to stem cell toxins or fludarabine achieved > 0.85 x106/kg CD34 + cells with the primed marrow harvest. A significant difference was noted between G-CSF primed blood and marrow for CD34 + cells but not for GM-CFU (p = 0.011 and p = 0.135, respectively, paired t-test). All evaluable patients engrafted; a median ANC >0.5x109/L recovery was achieved on D + 12 (range + 9 to + 17) in 12 of 13 evaluable patients - one died on D + 9 without recovery. The last day of platelet transfusion occurred at a median D + 13 (range + 8 to>+66); only one patient remained platelet transfusion-dependent beyond D + 34. As anticipated, patients with higher numbers of CD34 + cells transplanted had somewhat more rapid recoveries. Although stem cell damage is obviously a key factor in mobilization failure patients, these findings raise the possibility that poor mobilization, at least in some patients, results from a mechanism other than, or in addition to, simple stem cell damage. Moreover, they raise the issue of the minimum number of marrow CD34 + - or more arguably other - cells needed for adequate short- and long-term reconstitution. The role of G-CSF in this situation, especially regarding dose and/or schedule, is intriguing but remains to be clarified. G-CSF primed marrow harvest is a potential option in certain poor mobilizers but, as fully expected, is frequently inadequate. Whether such is preferable to ″steady-state″ marrow harvest, continued or repeated G-CSF primed cytapheresis (with or without chemotherapy), or primed marrow with G-CSF in other schedules - or with other cytokines - is unclear and will be the subject of further study.

Original languageEnglish (US)
Pages (from-to)223-231
Number of pages9
JournalHematology
Volume5
Issue number3
DOIs
StatePublished - Jan 1 2000

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Keywords

  • Autologous
  • Blood
  • G-CSF priming
  • Marrow
  • Stem cells
  • Transplantation

ASJC Scopus subject areas

  • Hematology

Cite this

Phillips, G. L., Hale, G. A., Howard, D. S., Nath, R., Munn, R. K., Marshall, K. W., Reece, D. E., Reed, E., & Van Zant, G. (2000). G-CSF primed autologous marrow harvest and transplantation in cytapheresis ″mobilization failure″ patients: A descriptive analysis. Hematology, 5(3), 223-231. https://doi.org/10.1080/10245332.2000.11746511