Unsuccessful stem cell remobilization for autologous transplantation is predicted by renal impairment and a stem cell yield ≤0.5 × 10 6 CD34 + cells/kg at first mobilization

摘要

PBSC mobilization for planned autologous transplantation fails in 5-40% of cases. Poor mobilization will result in delay or failure to proceed to transplantation and has been associated with worse survival in lymphoma patients. Risk factors for poor mobilization include older age, increased number and type of chemotherapies (for example, platinum compounds, alkylating agents, purine analogues and lenalidomide), prior radiotherapy, disease type, and type of mobilizing regimen but a reproducible model is still lacking. Where successful remobilization is defined by a PBSC dose >=2-2.5 x10 CD34+ cells/kg as the sum of first and second mobilization attempts, reported success rates are: 48% (57/119) and 53% (18/34) with G-CSF +/-chemotherapy; 60% (29/48) with recombinant human SCF +/-chemotherapy; 73% (63/86) and 72% (156/217) with G-CSF or G-CSF +/-GM-CSF. Most recently, the CXCR4 inhibitor plerixafor combined with G-CSF has been found to successfully mobilize 70-85% of patients failing previous mobilization1 and 20/21 patients with advanced renal failure.