Collection of peripheral blood stem cells

Dr Kacem KarimaDepartment of clinical

haematology -HAOCMH - 26/05/2012

• High-dose chemotherapy with peripheral blood stem cell support: best option for a high risk group of patients

• Mobilized peripheral blood stem cells (PBSC): main source for autologous SCT.

• Successful engraftment relies on CD34+progenitor cell dose.

• Critical step: effective PBSC mobilization but 15-30% of patients fail to mobilize.

Aims of this study:Analysis of mobilized patients profiles.

Review of our strategies for collection of PBSC.

Establish the influence of certain factors on the outcome of PBSC mobilization

Retrospective analysis

Patients with lymphoma (HL , NHL)

January 2005 - December 2011

Haematology department of Aziza OthmanaHospital

RESULTS

H/F 53/41 (sex ratio :1.29)

Median Age 33 (14 – 61)

HL 44

NHL 50

Stage III/IV

Initial BM involvement

74 (78%)

15 (16%)

Nb of patients : 94Nb of mobilizations : 104Criterion for adequate mobilization: at least 2.0 x 106 CD34+ cells/kg of patient.Leukapheresis: Nb CD34+(PB)≥ 20/mm3

Refractory Relapsed Total

CHL 29 15 44

Responsive Relapse or refractory Disease

NHL 44 06 50

Treatment characteristics

Previous RT 6

Median nb of regimens of CT 2 ( 1 – 4 )

Median nb of previous CT courses 5 (2 – 12 )

93 patients: mobilized with a combination of chemotherapy and growth factors (G-CSF)

- 5γ/kg/day 28 pts 30% - 5 puis 10γ/kg/day 62pts 66.6% - 10 γ/kg/day 3 pts 3.2%

One patient with G-CSF only.

Median delay/CTMedian delay /G-CSF

15 days(10-28)9 days (4-22)

Nb median leukapheresis 1.45 (1 – 3)

Nb median collected CD34+ 6 106/kg (1.37- 30.6 106/kg)

% failure 5.3 %

Nb CD34 106/kg p

Age (years) 0.05

> 50 4.96±2.24

< 50 8.54±6.34

Gender 0.34

M 8.59±6.58

F 7.34±5.33

BOM 0.25

Involved 6.2±4.6

Normal 8.34±6.25

RC at mobilization 0.28

Yes 8.91±7.5

No 7.4±4.91

Nb of cycles of CT 0.09

< 6 7.29 ± 5.35

> 6 9.6 ± 7.18

Hb (g/dl) 0.83

< 11 7.86 ± 6.2

> 11 8.15 ± 6.06

• Correlation between dose G-CSF and Nb CD34 collected

Dose (γ/kg/d) p

5 5.81±3.22 0.015

5 then 10 9.1±6.66

• 1st PBSC COLLECTIONLENOGRASTIM FILGRASTIM p

Median nb of CD34+ Cells mobilized

8.86 106/kg 7.74 106/kg 0.2

• Proven poor mobilizer (GITMO)Peak CD34+ circulating cell count < 20/μl with

less than 2 106 harvested CD34+ cells/kg

• Predicted poor mobilizer (GITMO): at least one major criterion or two minor criteria:Major criteria:- Failed previous mobilisation- Prior extensive therapy- Previous therapy: fluda, melphalanMinor criteria- At least 2 prior cytotoxic lines- Refractory disease- Extensive BM involvement at mobilisation- Age > 65 years- BM cellularity < 30% at mobilisation

• Failures: 5 in study period 5 between January and May 2012 /13 pts

Predictive factors of failure

Myelofibrosis 1pt

Refractory Disease 3 pts

Prior lines of CT ≥ 2 3 pts

Nb cycles ≥ 6 3 pts

Previous RT 2 pts

CONCLUSION:

- Peripheral CD34 count is a useful predictor for both harvest timing and successful collection of PBSC.

- Identify poor mobilizers patients

- G-CSF et Plerixafor : suitable combination for failure collection