Optimizing the timing of chemotherapy for mobilizing autologous blood hematopoietic progenitor cells
Article first published online: 16 FEB 2007
Volume 47, Issue 4, pages 629–635, April 2007
How to Cite
Hicks, Michelle L., Lonial, S., Langston, A., Flowers, C., Roback, John D., Smith, Kenneth J., Mossavi Sai, S., Teagarden, D., Hamilton, Ellie S. and Waller, Edmund K. (2007), Optimizing the timing of chemotherapy for mobilizing autologous blood hematopoietic progenitor cells. Transfusion, 47: 629–635. doi: 10.1111/j.1537-2995.2007.01164.x
- Issue published online: 16 FEB 2007
- Article first published online: 16 FEB 2007
- Received for publication July 14, 2006; revision received September 8, 2006, and accepted September 14, 2006.
Vol. 47, Issue 5, 952, Article first published online: 25 APR 2007
BACKGROUND: Postchemotherapy mobilization results were reviewed in patients undergoing apheresis before planned autologous hematopoietic progenitor cell (HPC) transplantation to improve the timing of collection procedures.
STUDY DESIGN AND METHODS: A total of 135 attempts to collect autologous HPC were studied in 132 unique patients with lymphoid malignancies (non-Hodgkin's lymphoma, multiple myeloma, and Hodgkin's disease). Chemotherapy mobilization regimens included cyclophosphamide (n = 59), ICE (n = 46), or other regimens (n = 30). Granulocyte–colony-stimulating factor (CSF) was administered once daily at a dose of 5 μg per kg starting 2 days after the last dose of chemotherapy; granulocyte-macrophage–CSF was added at a daily dose of 5 μg per kg 6 days later. Apheresis was initiated when the blood CD34+ content was more than 20 per μL.
RESULTS: In an initial cohort of 37 patients, 27 percent required apheresis during the weekend. An optimized timing for chemotherapy mobilization was developed based on retrospective data; prospective implementation of the new algorithm reduced the incidence of weekend apheresis to 13 percent in the subsequent 98 consecutive patients (p < 0.05). A median of 9 × 106 (range, 0.4 × 106-96 × 106) CD34+ cells per kg was collected from the entire cohort of 135 patients after a mean of 1.8 days of apheresis. Apheresis was initiated following a median (±SD) of 10 ± 2.7 days of cytokines.
CONCLUSION: In the majority of patients, the first day of apheresis occurred 11 to 13 days after the last dose of chemotherapy with a variety of different chemotherapy regimens. Administering the last dose of chemotherapy on Thursday or Friday versus Monday, Tuesday, or Wednesday was associated with a 77 percent lower incidence in the frequency of weekend apheresis collections (p < 0.001).