Adverse events related to PBPC collection and mobilization for autologous transplantation in 10 years’ experience: procedures, efficiency, variables related to collection and safety profile
Journal
Bone Marrow Transplatation Journal
Date Issued
2011
Author(s)
DOI
10.1038/bmt.2011.48
Abstract
Objectives: We tried to evaluate the effi ciency, safety and risk
factors of aphaeresis procedures used for autologous PBPC
collections in a 10-year period in our transplant center. Thrombocytopenia,
hypotension and citrate related adverse effects
were evaluated as different biological variables.
Material and methods: A total of 155 patients with hematological
malignancies were analyzed (57 AML in fi rst remission, 33
HD, 37 MM, 20 NHL, 4ALL) that underwent mobilization of
PBPC. The patients were mobilized either with CTX 3gr/m² +
G-CSF 10mcg/kg starting or VP-16 (2gr/m²)+G-CSF 10mcg/
kg. Collections of PBSC were performed using Cobe spectra
Baxter CS3000 aphaeresis system. Target of collection was >2,
0x10(6)/kg CD34+. The procedure was initiated when leukocyte
count reached to 5x10(9)/L.
Results: Both regimens were effective in the progenitor cell
mobilization and almost 84% of analyzed patients reached
at least 2x10(6)/kg CD34+ cells with median 3 (ranges 1-6)
aphaeresis procedures. In 6% of patients adequate cell dose
was not reachable and overall failure rate of mobilization of 17,
5%. Furthermore 15.6% failed to harvest the optimal 4x10(6)/
kgCD34+cells with >1 aphaeresis attempt. 48% patients in the
CT/G-CSF group initiated aphaeresis on day 9, 34% on day 8
and 31% on day 10. Good mobilizers (GM) experienced at least
one adverse event during aphaeresis compared with the no-
GM. The percentage of absolute CD34+ before aphaeresis correlated
with CD34+/cells/kg collected (R2=0, 62). The median
of blood volume processed for body weight and the median time
of aphaeresis was 7215ml (980ml-13450ml) in 202 min for GM
and 8054ml (1450ml-14659ml) and 207min or no-GM. No correlation
was found between CD34+/kg and volume processed.
High correlation was found between the number of CD34+/kg
and volume processed in the GM subject that reached the
target of CD43+cells/kg only with one aphaeresis procedure
(R2=0,87)
We can conclude that the mobilizing regimens were adequate
to achieve PBSC harvest in 84% of pts in our center that underwent
autologous transplantation. The optimal approach to remobilization
strategy remains unclear. Also we did not observe any
signifi cant difference between GM and no-GM subjects in the
adverse effect manifestation in reaching the CD34+cells/kg
target, concerning the number of cells and volume processing.
Maybe volume reducing of aphaeresis technique in future will
shorten the time of achieving CD34+ target in GM subject.
factors of aphaeresis procedures used for autologous PBPC
collections in a 10-year period in our transplant center. Thrombocytopenia,
hypotension and citrate related adverse effects
were evaluated as different biological variables.
Material and methods: A total of 155 patients with hematological
malignancies were analyzed (57 AML in fi rst remission, 33
HD, 37 MM, 20 NHL, 4ALL) that underwent mobilization of
PBPC. The patients were mobilized either with CTX 3gr/m² +
G-CSF 10mcg/kg starting or VP-16 (2gr/m²)+G-CSF 10mcg/
kg. Collections of PBSC were performed using Cobe spectra
Baxter CS3000 aphaeresis system. Target of collection was >2,
0x10(6)/kg CD34+. The procedure was initiated when leukocyte
count reached to 5x10(9)/L.
Results: Both regimens were effective in the progenitor cell
mobilization and almost 84% of analyzed patients reached
at least 2x10(6)/kg CD34+ cells with median 3 (ranges 1-6)
aphaeresis procedures. In 6% of patients adequate cell dose
was not reachable and overall failure rate of mobilization of 17,
5%. Furthermore 15.6% failed to harvest the optimal 4x10(6)/
kgCD34+cells with >1 aphaeresis attempt. 48% patients in the
CT/G-CSF group initiated aphaeresis on day 9, 34% on day 8
and 31% on day 10. Good mobilizers (GM) experienced at least
one adverse event during aphaeresis compared with the no-
GM. The percentage of absolute CD34+ before aphaeresis correlated
with CD34+/cells/kg collected (R2=0, 62). The median
of blood volume processed for body weight and the median time
of aphaeresis was 7215ml (980ml-13450ml) in 202 min for GM
and 8054ml (1450ml-14659ml) and 207min or no-GM. No correlation
was found between CD34+/kg and volume processed.
High correlation was found between the number of CD34+/kg
and volume processed in the GM subject that reached the
target of CD43+cells/kg only with one aphaeresis procedure
(R2=0,87)
We can conclude that the mobilizing regimens were adequate
to achieve PBSC harvest in 84% of pts in our center that underwent
autologous transplantation. The optimal approach to remobilization
strategy remains unclear. Also we did not observe any
signifi cant difference between GM and no-GM subjects in the
adverse effect manifestation in reaching the CD34+cells/kg
target, concerning the number of cells and volume processing.
Maybe volume reducing of aphaeresis technique in future will
shorten the time of achieving CD34+ target in GM subject.
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