Optimal mobilization method and CD34+ dose calculation for autologous PBSC transplant in myeloma patients: two important unresolved questions

Risk factors for unsuccessful peripheral blood stem cell harvesting using granulocyte-colony stimulating factor mobilization in patients with multiple myeloma

The aim of this study was to determine factors that influence unsuccessful peripheral blood stem cell (PBSC) harvesting in patients with multiple myeloma (MM). Retrospective data of 186 MM patients who received G-CSF as mobilization were analyzed. Patients with successful harvest were compared with those who failed (using 2 definitions of failure <2 and <4 CD34 cells×10(6)/mm(3)). The groups were compared regarding age, gender, body weight, baseline platelet count, receipt of radiotherapy, number of prior chemotherapy regimens, PBSC count before collection, processed and collected volume, collect replace, number of sessions and final number of PBSC collected. By multivariate analysis, a baseline platelet count <161,000 cells/mm(3) was associated with PBSC harvest lower than 2×10(6)/kg, and age >58 years was related to PBSC harvest lower than 4×10(6)/kg CD34 cells/kg. Patients with these parameters should not receive mobilization protocols with G-CSF alone. Alternative protocols should be tested in this high risk harvest failure population.

Mobilization and collection of peripheral blood stem cells in multiple myeloma patients older than 65 years

Over the past 10 years, the incidence of multiple myeloma (MM) has been greater among individuals >65 years old than in younger age groups. This retrospective study of peripheral blood stem cell mobilization and harvesting examined patients of various age groups who were afflicted with this pathology. One group of 17 patients ≥65 years of age with MM (group A) were mobilized between 2002 and 2009 and compared with 33 consecutive patients of younger ages with the same diagnosis treated in 2008 and 2009 (group B). The 2 populations had a similar gender distribution; their median ages were 66 and 52 years, respectively. A successful mobilization was defined as a collection of ≥2.5 × 10(6) CD34+/kg body weight. The mobilization used filgrastim (16 μg/kg/d) with the beginning of the harvest on the fifth day. The median number of outpatient apheresis procedures per patient was 2 in group A and 1 in group B. There were no incidents or serious adverse reactions. Patients in group A collected 4.68 × 10(6) CD34+ cells/kg and for group B 3.30 × 10(6)/kg. The group A patients required a greater number of apheresis procedures to collect the appropriate graft. In conclusion, mobilization with growth factors and PHSP harvest by apheresis was safe with reasonable costs for subjects including those aged ≥65 years, resulting in an option for autologous transplantation.