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Başcı S, Bozan E, Yaman S, Ulu BU, Bakırtaş M, Yiğenoğlu TN, Kılınç A, Özcan N, Dal MS, Çakar MK, Altuntaş F. Is neutropenic fever an obstacle to effective stem cell harvesting? Asian J Transfus Sci 2024; 18:21-26. [PMID: 39036677 PMCID: PMC11259352 DOI: 10.4103/ajts.ajts_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 07/29/2022] [Accepted: 08/07/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Autologous stem cell transplantation (ASCT) is a well-established consolidation treatment for many hematologic cancers which delivers prolonged survival. A subset of patients' adequate stem cell harvest is not achievable with a solitary use of granulocyte colony-stimulating agents (G-CSF). Generally, chemomobilization is employed for patients failing G-CSF and its most feared complication febrile neutropenia (FN). MATERIALS AND METHODS Here, we aimed to investigate the impact of the FN in chemomobilization on apheresis outcomes and engraftment. One hundred and eighty-three patients with the diagnosis of lymphoma or myeloma who underwent chemomobilization between 2015 and 2020 were included in the study. RESULTS Forty-three patients experienced FN. All patients received G-CSF. All myeloma patients were mobilized with 4 g/m2 cyclophosphamide, but it was heterogeneous for lymphoma patients. The precollection blood counts, harvested CD34+ hematopoietic stem cells (HSCs)/kg, apheresis count, and engraftment durations were recorded. Preapheresis leukocyte and platelet were lower in the FN group (P = 0,004 and P = 0,001). Peripheral CD34 HSCs and total harvested CD34 HSCs were similar among groups (P = 0.25 and P = 0.9). More apheresis was needed in the FN group, but it was not significant (P = 0.07). Undergoing ASCT was similar (P = 0.7); however, platelet and neutrophil engraftment durations were slower in the FN group (P = 0.05 and P = 0.001). CONCLUSION Harvesting sufficient CD34+ HSCs from patients with FN is still feasible; however, FN treatment should begin promptly, and further apheresis sessions may be required.
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Affiliation(s)
- Semih Başcı
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Ersin Bozan
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Samet Yaman
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Bahar Uncu Ulu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Mehmet Bakırtaş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Ali Kılınç
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Nurgül Özcan
- Department of Clinical Biochemistry, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, Ankara, Turkey
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Sanikommu SR, Reese ES, He J, Lee C, Ai J, Butler CM, Jacobs R, Hu B, Atrash S, Trivedi J, Bhutani M, Voorhees P, Usmani SZ, Ghosh N, Fasan O, Druhan LJ, Symanowski J, Copelan EA, Avalos BR. Cost saving, patient centered algorithm for progenitor cell mobilization for autologous hematopoietic cell transplantation. J Clin Apher 2021; 36:553-562. [PMID: 33710672 DOI: 10.1002/jca.21892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022]
Abstract
Administration of plerixafor with granulocyte-colony stimulating factor (G-CSF) mobilizes CD34+ cells much more effectively than G-CSF alone, but cost generally limits plerixafor use to patients at high risk of insufficient CD34+ cell collection based on low peripheral blood (PB) CD34+ counts following 4 days of G-CSF. We analyzed costs associated with administering plerixafor to patients with higher day 4 CD34+ cell counts to decrease apheresis days and explored the use of a fixed split dose of plerixafor instead of weight-based dosing. We analyzed 235 patients with plasma cell disorders or non-Hodgkin's lymphoma who underwent progenitor cell mobilization and autologous hematopoietic cell transplantation (AHCT) between March 2014 and December 2017. Two hundred ten (89%) received G-CSF plus Plerixafor and 25 (11%) received G-CSF alone. Overall, 180 patients (77%) collected in 1 day, 53 (22%) in 2 days and 2 (1%) in 3 days. Based on our data, we present a probabilistic algorithm to identify patients likely to require more than one day of collection using G-CSF alone. CD34+ cell yield, ANC and platelet recovery were not significantly different between fixed and standard dose plerixafor. Plerixafor enabled collection in 1 day and with estimated savings of $5000, compared to patients who did not receive plerixafor and required collection for three days. While collection and processing costs and patient populations vary among institutions, our results suggest re-evaluation of current algorithms.
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Affiliation(s)
- Srinivasa Reddy Sanikommu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Emily S Reese
- Department of Translational Science, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jiaxian He
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Carlos Lee
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jing Ai
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Candace M Butler
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Shebli Atrash
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jigar Trivedi
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Manisha Bhutani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Omotayo Fasan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Lawrence J Druhan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - James Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Edward A Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Belinda R Avalos
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
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Practical Aspects of Hematologic Stem Cell Harvesting and Mobilization. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Khouri J, Rybicki L, Majhail N, Kalaycio M, Copelan E, Pohlman B, Hill B, Dean R, Lazaryan A, Hamilton B, Andresen S, Sobecks R, Bolwell B, Liu H. Neutropenic fever during peripheral blood progenitor cell mobilization is associated with decreased CD34+ cell collection and increased apheresis collection days. J Clin Apher 2017; 33:303-309. [PMID: 29134688 DOI: 10.1002/jca.21605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/29/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Peripheral blood progenitor cell (PBPC) mobilization with chemotherapy in addition to Granulocyte-Colony Stimulating Factor (G-CSF) improves cell collection compared to G-CSF alone; however, it is associated with increased risk of neutropenic fever (NF). METHODS We analyzed risk factors for post-priming NF and NF association with autologous stem cell transplant outcomes. Between 1998 and 2008, 593 adult patients with lymphoma underwent PBPC mobilization with etoposide and G-CSF. RESULTS Median age was 51 years (range 18-77) and 372 (63%) were male. Diagnoses were 457 (77%) non-Hodgkin lymphoma and 136 (23%) Hodgkin lymphoma. Of 554 (93%) transplanted patients, majority were in complete or partial remission at time of transplant (88%). Overall, 141 (24%) patients were hospitalized for NF. Nine patients (6%) had bacteremia, 4 (3%) had pneumonia, 2 (<1%) had herpes simplex viral infections, and the remaining 126 (90%) had no identified infection source. NF patients had lower likelihood of proceeding to transplant (86% vs. 96%, P < .001), lower CD34+ cell dose collection (median 7.23 × 106 CD34+ cells/kg vs. 8.98 × 106 CD34+ cells/kg, P = .002), and were more likely to require > 4 days of apheresis (48% vs. 37%, P < .001). NF was associated with a higher 30-day readmission rate following transplant hospitalization (17% vs. 9%, P = .012). CONCLUSION NF during etoposide priming is associated with lower likelihood of proceeding to transplant, lower CD34+ cell dose collection, more apheresis days required for collection and a higher 30-day readmission rate following transplant discharge.
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Affiliation(s)
- Jack Khouri
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Navneet Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matt Kalaycio
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Brad Pohlman
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Hill
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Dean
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aleksandr Lazaryan
- Division of Hematology, Oncology, and Transplantation, Minneapolis, University of Minnesota
| | - Betty Hamilton
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven Andresen
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ronald Sobecks
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Bolwell
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hien Liu
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Moreb JS, Byrne M, Shugarman I, Zou F, Xiong S, May WS, Norkin M, Hiemenz J, Brown R, Cogle C, Wingard JR, Hsu JW. Poor peripheral blood stem cell mobilization affects long-term outcomes in multiple myeloma patients undergoing autologous stem cell transplantation. J Clin Apher 2017; 33:29-37. [DOI: 10.1002/jca.21556] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jan S. Moreb
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Michael Byrne
- Division of Hematology/Oncology and Vanderbilt Ingram Comprehensive Cancer Center; Vanderbilt University; Nashville Tennessee
| | - Ilicia Shugarman
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Fei Zou
- Biostatistics; University of Florida; Gainesville Florida
| | - Sican Xiong
- Biostatistics; University of Florida; Gainesville Florida
| | - William S. May
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Maxim Norkin
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - John Hiemenz
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Randall Brown
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Christopher Cogle
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - John R. Wingard
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
| | - Jack W. Hsu
- Division of Hematology/Oncology; University of Florida; Gainesville Florida
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Combariza JF, Barco G, Estrada Á, Jaramillo S, Arango M. Recuento de células CD34+ en sangre periférica como predictor de adecuada recolección de progenitores hematopoyéticos para trasplante autólogo. IATREIA 2016. [DOI: 10.17533/udea.iatreia.v29n4a04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sorigue M, Sancho JM, Morgades M, Moreno M, Grífols JR, Alonso E, Juncà J, Ferrà C, Batlle M, Vives S, Motlló C, García-Caro M, Navarro JT, Millà F, Feliu E, Ribera JM. Relapse risk after autologous stem cell transplantation in patients with lymphoma based on CD34+ cell dose. Leuk Lymphoma 2016; 58:916-922. [PMID: 27561733 DOI: 10.1080/10428194.2016.1222378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unclear whether higher CD34 + cell doses infused for ASCT have any influence on survival or relapse in patients with lymphoma. We analyzed the correlation of infused CD34 + cell dose with relapse, survival, and hematopoietic recovery in 146 consecutive patients undergoing ASCT for lymphoma. Higher doses (>5 × 106/kg) were significantly correlated with earlier hematopoietic recovery, fewer infectious episodes, lower transfusion needs. No differences were observed in lymphoma outcomes (4-year relapse incidence of 38% [95%CI: 29%-48%] in the lower dose group versus 51% [95%CI: 30%-69%] in the higher dose group, 10-year OS probabilities of 58% [95%CI: 48%-68%] versus 75% [95%CI: 59%-91%], 10-year DFS probabilities of 47% [95%CI: 37%-57%] versus 42% [95%CI: 23%-61%], p = NS for all outcomes). In this series, a higher infused CD34 + cell dose did not correlate with survival or relapse but correlated with earlier hematopoietic recovery and lower resource consumption.
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Affiliation(s)
- Marc Sorigue
- a Department of Hematology , Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Manuel Sancho
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Mireia Morgades
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Miriam Moreno
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Ramon Grífols
- c Banc de Sang i Teixits, Hospital Germans Trias i Pujol , Badalona , Spain
| | - Eva Alonso
- c Banc de Sang i Teixits, Hospital Germans Trias i Pujol , Badalona , Spain
| | - Jordi Juncà
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Christelle Ferrà
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Montserrat Batlle
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Susana Vives
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Cristina Motlló
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Montserrat García-Caro
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Jose-Tomás Navarro
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Fuensanta Millà
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Evarist Feliu
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Josep-María Ribera
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
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De Santis GC, Garcia-Silva AC, Chiaramonte NCG, Orellana MD, Prado BPA, Oliveira LC, Simões BP, Covas DT. Haematological recovery in poor and good haematopoietic stem cell mobilisers. Transfus Med 2016; 26:297-300. [DOI: 10.1111/tme.12324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- G. C. De Santis
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - A. C. Garcia-Silva
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - N. C. G. Chiaramonte
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - M. D. Orellana
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - B. P. A. Prado
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - L. C. Oliveira
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - B. P. Simões
- Haematology Division, Department of Internal Medicine, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | - D. T. Covas
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
- Haematology Division, Department of Internal Medicine, Medical School of Ribeirão Preto; University of São Paulo; São Paulo Brazil
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Stiehl T, Ho AD, Marciniak-Czochra A. The impact of CD34+ cell dose on engraftment after SCTs: personalized estimates based on mathematical modeling. Bone Marrow Transplant 2013; 49:30-7. [DOI: 10.1038/bmt.2013.138] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/05/2013] [Accepted: 08/03/2013] [Indexed: 11/09/2022]
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Autologous hematopoietic stem cell transplantation in multiple myeloma and lymphoma: an analysis of factors influencing stem cell collection and hematological recovery. Med Oncol 2011; 29:2191-9. [DOI: 10.1007/s12032-011-0029-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022]
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