Optimization of chemo-mobilization of autologous blood hematopoietic progenitor cell grafts

Abstract

Introduction: Autologous blood hematopoietic progenitor cells (HPCs) are typically collected by apheresis following chemotherapy mobilization and growth factor administration. Apheresis performed on the week-end may increase resource utilization compared to apheresis during the week. In order to decrease the likelihood of week-end collections, we analyzed the timing of apheresis with respect to chemotherapy administration and developed an optimized schedule for chemotherapy, growth factors, and apheresis. Methods: A retrospective analysis of mobilization of auto-grafts in 41 patients with lymphoid malignancies (NHL, MM, HD) was performed. Chemotherapy mobilization regimes included cyclophosphamide (n = 14), CHOP, ICE, or VTEPA (n = 15), Hyper CVAD (n = 8), or DT-PACE (n = 4). G-CSF was administered S.Q. once daily at a dose of 5 mcg/kg starting two days after the last day of chemotherapy. GM-CSF was added at a dose of 5 mcg/kg every evening starting on the 8th day after chemotherapy. Apheresis began when the blood CD34+ cells were ≥ 20/uL. Results: The median number of CD34+ cells collected in all 66 patients was 8 × 10E6/kg (range 1 to 79 × 10E6/kg) following a median of 2 days of apheresis. The median number of days between the last day of chemotherapy and the first day of apheresis was not significantly different between the entire cohort of 66 patients (median 12 days, range 8–24 days) or the subsets of patients who received cyclophosphamide (12 days), CHOP, ICE, or VTEPA (11 days), Hyper CVAD (11 days) or DTPACE (15 days). Among the initial 41 patients analyzed, 29% of patients required apheresis during the week-end. Administration of the last dose of chemotherapy on Thursday/Friday versus Tuesday/Wednesday was associated with a reduced rate of week-end apheresis collections (p = 0.009). An optimized schedule of chemotherapy ending on Friday was implemented in order to avoid week-end collections and applied in 25 subsequent patients. Using the new schema for chemo-mobilization the incidence of week-end apheresis was reduced to 14% in the next group of 14 patients. Among 11 patients not treated according to the new schema, the incidence of week-end collections was 27%. Conclusion: The first day of apheresis can be generally predicted as occurring 11–15 days after the last dose of chemotherapy using a combination of G-CSF and GM-CSF treatment when these growth factors are sequentially administered 2 and 8 days after the last dose of chemotherapy. TableRelationship Between Timing of Chemotherapy and Percentage of Patients Pheresed on WeekendsLast Day of ChemoSundayMondayTuesdayWednesdayThursdayFridaySaturday% pheresed Saturday or Sunday11%33%44%50%0%16%25%