Characterization and outcome of "hard to mobilize" lymphoma patients undergoing autologous stem cell transplantation

M. W. Sugrue, K. Williams, Bradley H Pollock, S. Khan, S. Peracha, J. R. Wingrad, J. S. Moreb

Research output: Contribution to journalArticle

71 Scopus citations

Abstract

A "hard to mobilize" patient was defined as one in whom ≥ 1×106CD 34+ cells/kg cannot be obtained after two consecutive large volume aphereses. Forty-four consecutive Hodgkin's and non-Hodgkin's lymphoma patients who underwent autologous peripheral blood stem cell (PBSC) transplant treatment between June 1996 and June 1998 were included in this study. Twenty-one patients (48%) met the definition of "hard to mobilize" (Group I). All the rest of the patients (n=23) were the good mobilizers (Group II). The initial mobilization protocol for most patients was 10 μg/kg of G-CSF alone for both groups. For Group I, 7/21 (33%) patients were unable to achieve a minimal dose of ≥ 1×106 CD34+ cells/kg even after a second mobilization attempt and/or bone marrow (BM) harvest (n=5). Overall, 11/21 (52%) required an additional mobilization and/or BM harvest. Only 3/21 (14%) patients were able to meet the target cell dose of ≥ 2.5×106 CD34+ cells/kg (median of 4 apheresis). In contrast, 87% of Group II achieved the target dose with a median of 2 aphereses. Predictors of poor mobilization were greater than two prior treatment regimens (p=0.038) and the WBC count (<25,000/μL) on the first day of apheresis (p=0.053). Nineteen patients in Group I and all Group II completed treatment with a median time of engraftment of ANC>500/μl of 12 and 11 days, and platelet >20×103/μ1 of 31 and 13 days, respectively. Outcome analysis revealed that 6/19 patients in Group I died of relapse within one year from transplant compared with only 2/23 of Group II who died of relapse (p=0.005, log rank test). There were no treatment related deaths in either group. Independent predictive features for "hard to mobilize" patients are a lack of significant increase in WBC count on the first day of apheresis and the number of prior treatment regimens. Poor mobilization appears to predict a worse outcome after autografting for lymphoma patients.

Original languageEnglish (US)
Pages (from-to)509-519
Number of pages11
JournalLeukemia and Lymphoma
Volume39
Issue number5-6
StatePublished - 2000
Externally publishedYes

Keywords

  • Autologous stem cell transplantation
  • Lymphoma
  • Mobilization of stem cells

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Sugrue, M. W., Williams, K., Pollock, B. H., Khan, S., Peracha, S., Wingrad, J. R., & Moreb, J. S. (2000). Characterization and outcome of "hard to mobilize" lymphoma patients undergoing autologous stem cell transplantation. Leukemia and Lymphoma, 39(5-6), 509-519.