Analysis of remobilization success in patients undergoing autologous stem cell transplants who fail an initial mobilization: risk factors, cytokine use and cost

Bone Marrow Transplant. 2004 May;33(10):997-1003. doi: 10.1038/sj.bmt.1704486.

Abstract

Inadequate stem cell mobilization is seen in approximately 25% of patients undergoing autotransplantation for hematologic malignancies. Remobilization strategies include chemotherapy/cytokine combinations or high-dose cytokines alone or in combination. From 1/1997 to 7/2002, we remobilized 86 patients who failed an initial mobilization (median total CD34=0.72 x 10(6)/kg) in sequential cohorts using high-dose G-CSF (32 microg/kg/day) or G-CSF(10 microg/kg/day)+GM-CSF (5 microg/kg/day). No difference in CD34/kg yields were seen (G-CSF alone: 2.2 x 10(6) and G-CSF+GM-CSF 1.6 x 10(6)) in the median 3 aphereses performed (P=0.333). Of the 86, 23 (27%) failed the second mobilization; 14 were remobilized again (yield=1.5 x 10(6) CD34/kg; three aphereses). Of the 86, 93% went to transplant: three progressed, and three had inadequate stem cells. Significant risk factors for a failed remobilization were: number of stem-cell-damaging regimens (P=0.015), time between last chemotherapy and first mobilization (P=0.028), and higher WBC at initiation of first mobilization (P=0.04). High-dose G-CSF (32 microg/kg/day) was more costly @ USD $9,016, vs $5,907 for the G-CSF+GM-CSF combination (P<0.001). Most patients failing an initial mobilization benefit from a cytokine only remobilization. Lower cost G-CSF+GM-CSF is as effective as high-dose G-CSF.

MeSH terms

  • Adult
  • Aged
  • Antigens, CD34 / biosynthesis
  • Blood Component Removal
  • Cohort Studies
  • Cytokines / biosynthesis
  • Cytokines / therapeutic use*
  • Female
  • Granulocyte Colony-Stimulating Factor / metabolism
  • Granulocyte-Macrophage Colony-Stimulating Factor / metabolism
  • Hematopoietic Stem Cell Mobilization / economics
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / therapy*
  • Retrospective Studies
  • Risk Factors
  • Stem Cell Transplantation / economics
  • Stem Cell Transplantation / methods*
  • Transplantation Conditioning / economics
  • Transplantation, Autologous / economics
  • Transplantation, Autologous / methods*

Substances

  • Antigens, CD34
  • Cytokines
  • Granulocyte Colony-Stimulating Factor
  • Granulocyte-Macrophage Colony-Stimulating Factor