Influence of filgrastim mobilization of HLA identical familiar healthy stem cell donor in allogenic transplant setting

Abstract

Mobilized peripheral blood stem cells (PBSC) have become an increasingly used alternative to bone marrow for allogeneic transplantation. Granulocyte colony-stimulating factor (G-CSF) –primed peripheral stem cells harvesting may result in a graft with increased mononuclear cells collected, increased progenitor cell dose and potential for more rapid engraftment resulting in improved survival. Filgrastrim is not only known to mobilize CD34 + progenitor cells but acts as a pleiotropic immune modulator. So, systematic donor follow-up in healthy donors is needed. The aim of this study is to evaluate safety and feasibility of G-CSF primed hematopoietic peripheral stem cells in familiar HLA-identical donors. The follow-up focused on laboratory testing including reports of adverse event. Granulocyte colony-stimulating factor (G-CSF) is administrated in 49 healthy donors to reach suffi cient mobilization in the period 2000–2009. The donors were characterized as follows: 43 years median; female 60% of the donors. G-CSF was administrated in the dose 10 μg/kg of donor weight in fi ve day and PBSC collections started on the fi fth day using COBE Spectra cell separator. The aim was to collect mononuclear cells 2 × 108/kg of recipient weight. Three donors were mobilized twice (for second transplant). Aphaeresis needed to reach target number of CD34 + cells were: 1 apherese in 50%, more than two apherese need in only 1 patient. The most frequent adverse event that was noted by patients was bone pain associated with increasing number of white blood cells. Better mobilization and higher PBSC yield correlated signifi cantly with younger age. Four years after GCSF –primed peripheral stem cells harvesting, a young female 48 years old was diagnosed with acute myeloblastic leukemia. Four years ago when she was 44 years old, she donated for her HLA identical sister with acute myeloblastic leukemia. G-CSF is safe and very effective for PBSC mobilization in our healthy donors. This method allows certain collections of suffi cient numbers of progenitors in virtually all donors. We demonstrated that fi lgrastim mobilization for peripheral blood stem collection is effective and result with successful engraftment in all the recipients. Daily injection of 10 μg/kg of G-CSF and fi rst aphaeresis preformed at day 5 seems to be the best strategy to obtain the CD34 + cell count required for an allogeneic hematopoietic stem cell graft.