1
|
Prisciandaro M, Santinelli E, Tomarchio V, Tafuri MA, Bonchi C, Palazzo G, Nobile C, Marinucci A, Mele M, Annibali O, Rigacci L, Vacca M. Stem Cells Collection and Mobilization in Adult Autologous/Allogeneic Transplantation: Critical Points and Future Challenges. Cells 2024; 13:586. [PMID: 38607025 PMCID: PMC11011310 DOI: 10.3390/cells13070586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Achieving successful hematopoietic stem cell transplantation (HSCT) relies on two fundamental pillars: effective mobilization and efficient collection through apheresis to attain the optimal graft dose. These cornerstones pave the way for enhanced patient outcomes. The primary challenges encountered by the clinical unit and collection facility within a transplant program encompass augmenting mobilization efficiency to optimize the harvest of target cell populations, implementing robust monitoring and predictive strategies for mobilization, streamlining the apheresis procedure to minimize collection duration while ensuring adequate yield, prioritizing patient comfort by reducing the overall collection time, guaranteeing the quality and purity of stem cell products to optimize graft function and transplant success, and facilitating seamless coordination between diverse entities involved in the HSCT process. In this review, we aim to address key questions and provide insights into the critical aspects of mobilizing and collecting hematopoietic stem cells for transplantation purposes.
Collapse
Affiliation(s)
- Michele Prisciandaro
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| | - Enrico Santinelli
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
- Program in Immunology, Molecular Medicine and Applied Biotechnologies, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Valeria Tomarchio
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
| | - Maria Antonietta Tafuri
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
| | - Cecilia Bonchi
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| | - Gloria Palazzo
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| | - Carolina Nobile
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| | - Alessandra Marinucci
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| | - Marcella Mele
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
| | - Ombretta Annibali
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
| | - Luigi Rigacci
- Operative Research Unit of Hematology and Stem Cell Transplantation, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (E.S.); (V.T.); (M.A.T.); (M.M.); (O.A.); (L.R.)
| | - Michele Vacca
- Operative Research Unit of Transfusion Medicine and Cellular Therapy, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy; (C.B.); (G.P.); (C.N.); (A.M.)
| |
Collapse
|
2
|
Moreb JS, Lantos L, Chen F, Elliott K, Dugan J, Skarbnik AP, Kropf PL, Ward K. The effect of mobilizing large numbers of CD34 + cells (super-mobilizers) on the engraftment and survival in patients undergoing autologous stem cell transplantation. Transfus Apher Sci 2023; 62:103787. [PMID: 37704508 DOI: 10.1016/j.transci.2023.103787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
With the use of plerixafor in addition to growth factor for peripheral blood stem cell mobilization, the yield of autologous stem cell harvest has been higher while the length of apheresis days has become shorter. There is still debate whether higher cell collection efficacy in autologous stem cell transplant (ASCT) affect outcomes. In this retrospective study, we defined two groups of patients, group 1, super-mobilizers, with more than double the target cell dose collected (n = 15), while group 2 included all other patients (n = 75). Multiple myeloma (MM) and lymphoma patients were combined. Patients with chemo-mobilization, those needed more than one day apheresis, or with less than 100 days after ASCT were excluded. Correlations were performed between cell collection efficacy and post thaw CD34 cell viability (by 7AAD flow cytometry method), product HCT, and engraftment of neutrophils and platelets. We performed multiple linear regression using the above variables in addition to age, sex and disease type. We used Kaplan Meier's curves to show effect of cell collection efficacy on 1-year overall survival (OS). Our results show that all super-mobilizers received plerixafor in addition to G-CSF, while 83% did in group 2. Correlations between cell collection efficacy and neutrophil and platelet engraftment in group 1 and 2 was modest and better in group 1 (R=0.449 Vs 0.233 for neutrophils; R=0.464 Vs 0.110 for platelets, respectively). However, multiple linear regression showed statistically significant association between cell collection, as a continuous variable, with disease type (P < 0.001), product HCT (P < 0.001), post thaw viability (P = 0.003), and age (P = 0.013). MM patients were more likely to be super-mobilizers, while the product HCT was higher in the super-mobilizers. No significant effect of cell collection efficacy was found on engraftment of neutrophils or platelets. With relatively short post ASCT follow up, 6 patients in group 2 died of any cause while no deaths were recorded in the super-mobilizers group (P = 0.1892 by log-rank test). In conclusion, stem cell collection efficacy in ASCT is more frequent in MM than lymphoma patients, but is not predictive of faster engraftment. On the other hand, 1-year OS was 100% in the super-mobilizers group versus 93% in the other group.
Collapse
Affiliation(s)
- Jan S Moreb
- Hematology, Transplantation and Cellular Therapy, Novant Health Cancer Institute, Winston-Salem, NC, USA.
| | - Lori Lantos
- Transplantation and Cellular Therapy Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Franklin Chen
- Hematology, Transplantation and Cellular Therapy, Novant Health Cancer Institute, Winston-Salem, NC, USA
| | - Kathleen Elliott
- Hematology, Transplantation and Cellular Therapy, Novant Health Cancer Institute, Winston-Salem, NC, USA
| | - James Dugan
- Hematology, Transplantation and Cellular Therapy, Novant Health Cancer Institute, Winston-Salem, NC, USA
| | - Alan P Skarbnik
- Transplantation and Cellular Therapy Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Patricia Lamont Kropf
- Transplantation and Cellular Therapy Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Kimberly Ward
- Transplantation and Cellular Therapy Program, Novant Health Cancer Institute, Charlotte, NC, USA
| |
Collapse
|
3
|
Regalado-Artamendi I, García-Fasanella M, Medina L, Fernandez-Sojo J, Esquirol A, García-Cadenas I, Martino R, Briones J, Sierra J, Novelli S. Age, CD34+ cell dose, conditioning and pre-transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation. Vox Sang 2023; 118:681-689. [PMID: 37356813 DOI: 10.1111/vox.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Autologous stem cell transplant (ASCT) is a widely used therapy for lymphoma patients and can nowadays be performed on an outpatient basis. This study aimed to describe transfusion support in lymphoma patients undergoing ASCT and identify increased or prolonged transfusion requirement predictors. MATERIALS AND METHODS A retrospective study of all consecutive lymphoma patients undergoing ASCT between 2010 and 2020. RESULTS Out of 226 patients, 145 (64%) received red blood cell (RBC) transfusions, whereas all 226 (100%) required platelet transfusion (PT). Transfusions between Day +1 and +30 were higher in patients over 60 (2 [1-4] vs. 2 [0-2] RBC; p = 0.001 and 4 [2-8] vs. 3 [2-4] PT; p < 0.001); patients with pre-transplant anaemia (4 [2.5-6] vs. 2 [0-2] RBC; p < 0.001 and 5 [3-9] vs. 3 [2-4] PT; p = 0.001); pre-transplant thrombocytopenia (2 [1-4] vs. 2 [0-2] RBC; p < 0.001 and 4 [3-8.5] vs. 2 [1-3] PT; p < 0.001) or CD34+ cell dose <4 × 106 /kg (2 [0-4] vs. 2 [0-2] RBC; p = 0.024 and 4 [2-6] vs. 2 [1-3.5] PT; p < 0.001). RBC transfusion independence was reached later in patients receiving carmustine, cytarabine, etoposide and melphalan (BEAM) (hazard ratio [HR] 1.6; confidence interval [CI] 1.1-2.3) and those requiring RBC before infusion and/or with pre-transplant anaemia (HR 2.2; CI 1.4-3.4). Age above 60 (HR 1.4; CI 1.0-1.9), BEAM conditioning (HR 1.4; CI 1.0-2.0) and pre-transplant thrombocytopenia and/or requiring PT before infusion (HR 1.8; CI 1.4-2.5) entailed longer time until PT independence. CONCLUSION These four factors (age ≥60 years; BEAM conditioning, CD34+ dose <4 × 106 /kg and pre-transplant cytopenia and/or Day -10 to 0 transfusion) allowed dividing patients into three groups with significant differences between them regarding the time until transfusion independence.
Collapse
Affiliation(s)
- Isabel Regalado-Artamendi
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Laura Medina
- Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
| |
Collapse
|
4
|
He D, Zhu C, Guo X, Huang X, Han X, Zheng G, Zhao Y, Yang Y, Wu W, Ge J, Zhang E, He J, Cai Z. The efficacy of residual plerixafor for second-day stem cell mobilization in multiple myeloma patients. Transfus Apher Sci 2022:103618. [DOI: 10.1016/j.transci.2022.103618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
|
5
|
Comparison between standard and high dose of G-CSF for mobilization of hematopoietic progenitors cells in patients and healthy donors. Transfus Med Rev 2022; 36:159-163. [DOI: 10.1016/j.tmrv.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/22/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
|
6
|
Antelo ML, Altuna A, Gimeno JJ, Ferreiro JJ, Amunárriz C, Mateos JJ, Zalba S, Alkorta A, Rifón J, Arroyo JL, Uresandi A, Moreno JA, Nájera MJ, Pinzón S, García A, Vallejo JC. Engraftment after autologous hematopoietic stem cell transplantation in patients mobilized with Plerixafor: A retrospective, multicenter study of a large series of patients. Transfus Apher Sci 2021; 60:103130. [PMID: 33840626 DOI: 10.1016/j.transci.2021.103130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022]
Abstract
Plerixafor (PLX) appears to effectively enhance hematopoietic stem-cell mobilization prior to autologous hematopoietic stem cell transplantation (auto-HCT). However, the quality of engraftment following auto-HCT has been little explored. Here, engraftment following auto-HCT was assessed in patients mobilized with PLX through a retrospective, multicenter study of 285 consecutive patients. Information on early and 100-day post-transplant engraftment was gathered from the 245 patients that underwent auto-HCT. The median number of PLX days to reach the stem cell collection goal (≥2 × 106 CD34+ cells/kg) was 1 (range 1-4) and the median PLX administration time before apheresis was 11 h (range 1-18). The median number of apheresis sessions to achieve the collection goal was 2 (range 1-5) and the mean number of CD34+ cells collected was 2.95 × 106/kg (range 0-30.5). PLX administration was safe, with only 2 mild and transient gastrointestinal adverse events reported. The median time to achieve an absolute neutrophil count (ANC) >500/μL was 11 days (range 3-31) and the median time to platelet recovery >20 × 103/μL was 13 days (range 5-69). At 100 days after auto-HCT, the platelet count was 137 × 109/L (range 7-340), the ANC was 2.3 × 109/L (range 0.1-13.0), and the hemoglobin concentration was 123 g/L (range 79-165). PLX use allowed auto-HCT to be performed in a high percentage of poorly mobilized patients, resulting in optimal medium-term engraftment in the majority of patients in whom mobilization failed, in this case mainly due to suboptimal peripheral blood CD34+ cell concentration on day +4 or low CD34+ cell yield on apheresis.
Collapse
Affiliation(s)
- M Luisa Antelo
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Ane Altuna
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - J José Gimeno
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Javier Ferreiro
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - Cristina Amunárriz
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - J José Mateos
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - Saioa Zalba
- Servicio de Hematología, Complejo Hospitalario de Navarra (CHN), IdiSNA, Pamplona, Spain.
| | - Aitziber Alkorta
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | - José Rifón
- Servicio de Hematología, Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain.
| | - J Luis Arroyo
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Amaia Uresandi
- Servicio de Hematología, Hospital Universitario Cruces, Barakaldo, Spain.
| | - J Antonio Moreno
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - M Josefa Nájera
- Servicio de Hematología, Hospital San Pedro, Logroño, Spain.
| | - Sergio Pinzón
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Alejandro García
- Servicio de Hematología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - J Carlos Vallejo
- Servicio de Hematología, Hospital Universitario Donostia, San Sebastián, Spain.
| | | |
Collapse
|