scholarly journals Stem Cell Mobilization Using Parathyroid Hormone Analog: A Single Institutional Review

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-23
Author(s):  
Okechukwu Nwogbo ◽  
Thuy Le ◽  
James Shikle ◽  
Juan Cintron Garcia ◽  
Sheila Tinsley
Keyword(s):  
Stem Cell ◽  
Parathyroid Hormone ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Stem Cell Mobilization ◽  
Hematopoietic Stem ◽  
Peripheral Blood Cd34 ◽  
Cell Mobilization ◽  
Stem Cell Collection ◽  
Poor Mobilizers

Objective: Hematopoietic stem cell mobilization increases the release of immature and maturing hematopoietic cells from the marrow into the blood circulation. For successful hematopoietic stem cell transplantation an adequate number of stem cells must be mobilized and collected. For autologous stem cell transplants, a product bag CD34+ count of > 5.0 x 106 CD34/kg is a target; however, patients have been successfully transplanted with doses as low as 2.0 x 106 CD34/kg. Some patients are "poor mobilizers" and standard protocols do not result in adequate numbers of circulating CD34 cells to collect. Risk factors associated with poor stem cell mobilization include increasing age, underlying diagnosis, low premobilization platelet count, history of increasing cycles, and regimens of chemotherapy. Teriparatide, a parathyroid hormone (PTH) analog has been used in "poor mobilizers." Two patients at our institution received the drug as part of an additional mobilization strategy. Method: Medical records of patients who had stem cell mobilization were reviewed. Two patients who failed routine mobilization protocol received PTH as part of an additional mobilization regimen. Clinical outcomes, collection, and engraftment data were reviewed. Result: Patient 1 had a diagnosis of Hodgkin Lymphoma and failed to mobilize adequately on the first attempt using filgrastim and plerixafor with peripheral blood CD34 counts of 1, 4, and 3 resulting in cancellation of stem cell collection. For the second mobilization attempt, teriparatide was added to the regimen. Peripheral blood CD34 counts improved to 8, 6, and 2 resulting in three collections with a total of 2.23 x 106 CD34/kg for reinfusion. Engraftment data showed 14 days for neutrophils and 17 days for platelets. The patient is 6 months post-transplant with no major morbidities reported, currently in maintenance therapy, and has not recurred. Patient 2 had a diagnosis of multiple myeloma and failed to mobilize on filgrastim and plerixafor with peripheral blood CD34 counts of 2, 2, and 2 resulting in collections with a total of 0.6 x 106 CD34/kg for reinfusion. For the second mobilization attempt, peripheral blood CD34 counts of 2, 2, 2, and 0 resulting in collections with a total of 0.822 x 106 CD34/kg for reinfusion. For the third mobilization attempt, teriparatide was added to the regimen. Peripheral blood CD34 counts improved to 8 and 4 resulting in collections with a total of 1.8 x 106 CD34/kg for reinfusion. Patient expired one month after collection without reinfusion. Conclusion: Two patients who failed standard mobilization for stem cell collection at our institution received teriparatide as part of an additional stem cell mobilization regimen. Adequate doses of stem cell products for transplant were collected. One patient was reinfused and subsequently engrafted appropriately. Teriparatide can be used in the setting of poor mobilization. Disclosures No relevant conflicts of interest to declare.

Bortezomib Given in Sequence with Anthracycline and Thalidomide-Containing Regimens Does Not Adversely Affect Stem Cell Mobilization and Engraftment in Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 541-541
Author(s):  
Geoffrey L. Uy ◽  
Nicholas M. Fisher ◽  
Steven M. Devine ◽  
Hanna J. Khoury ◽  
Douglas R. Adkins ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Stem Cell Mobilization ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Cd34 Cells ◽  
Cell Mobilization ◽  
High Dose Melphalan

Abstract Bortezomib (VELCADE®) is a selective inhibitor of the 26S proteasome proven to be safe and effective in the treatment of relapsed or refractory multiple myeloma (MM). While high-dose chemotherapy with autologous hematopoietic stem cell transplant (AHSCT) remains the standard of care, there is considerable interest in incorporating bortezomib into the initial treatment of MM. However, the role of bortezomib in frontline therapy for MM will depend in part on its effects on subsequent stem cell mobilization and engraftment. We conducted a pilot study of bortezomib administered pretransplant followed by high-dose melphalan with AHSCT. Two cycles of bortezomib 1.3 mg/m2 were administered on days 1, 4, 8, and 11 of a 21-day treatment cycle. One week after the last dose of bortezomib, stem cell mobilization was initiated by administering filgrastim 10 mcg/kg/day subcutaneously on consecutive days until stem cell harvest was completed. Stem cell collection began on day 5 of filgrastim via large volume apheresis (20 L/day) performed daily until a minimum of 2.5 x 106 CD34+ cells/kg were collected. Patients were subsequently admitted to the hospital for high-dose melphalan 100 mg/m2/day x 2 days followed by reinfusion of peripheral blood stem cells 48 hours later. Sargramostim 250 mcg/m2/day subcutaneously was administered starting day +1 post-transplant and continued until the absolute neutrophil count (ANC) ≥ 1,500/mm3 for 2 consecutive days. To date, 23 of a planned 40 patients have been enrolled in this study with 19 patients having completed their initial therapy with bortezomib followed by AHSCT. Patient population consists of 16 male and 7 female patients with the median age at diagnosis of 58 years (range 38–68). Myeloma characteristics at diagnosis were as follows (number of patients): IgG (16), IgA (7) with stage II (9) or stage III (14) disease. Prior to receiving bortezomib, 11 patients were treated with VAD (vincristine, Adriamycin and dexamethasone) or DVd (Doxil, vincristine and dexamethasone), 5 patients with thalidomide and 5 patients with both. Two patients did not receive any prior chemotherapy. All patients successfully achieved the target of 2.5 x 106 CD34+ cells/kg in either one (15/19 patients) or two (4/19 patients) collections with the first apheresis product containing a mean of 5.79 x 106 CD34+ cells/kg. Analysis of peripheral blood by flow cytometry demonstrated no significant differences in lymphocyte subsets before and after treatment with bortezomib. Following AHSCT, all patients successfully engrafted with a median time to neutrophil engraftment (ANC ≥ 500/mm3) of 11 days (range 9–14 days). Platelet engraftment (time to platelet count ≥ 20,000/mm3 sustained for 7 days without transfusion) occurred at a median of 12 days (range 9–30 days). Eleven patients were evaluable for response at 100 days post-transplant. Compared to pre-bortezomib paraprotein levels, 3 patients achieved a CR or near CR, 7 maintained a PR while 1 patient developed PD. We conclude that pretransplant treatment with 2 cycles of bortezomib does not adversely affect stem cell yield or time to engraftment in patients with MM undergoing AHSCT. Updated results and detailed analysis will be available at the time of presentation.

Poor Hematopoietic Stem Cell Mobilizers in Multiple Myeloma:A Single Institution Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4237-4237
Author(s):  
Guillermo J. Ruiz-Delgado ◽  
Avril Lopez-Otero ◽  
Ana Hernandez-Arizpe ◽  
Aura Ramirez-Medina ◽  
Guillermo J. Ruiz-Arguelles
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Stem Cell Mobilization ◽  
High Dose ◽  
Single Institution ◽  
Hematopoietic Stem ◽  
Viable Cells ◽  
Cell Mobilization ◽  
Poor Mobilizers

Abstract Abstract 4237 High-dose chemotherapy rescued by autologous peripheral blood stem cell transplantation is considered standard of care for patients with multiple myeloma. Hematopoietic stem cell mobilization is accomplished by administration of hematopoietic growth factors combined or not with myelosuppressive chemotherapy. In a single institution, in a group of twenty eight myeloma patients deemed eligible for autologous transplant, stem cell mobilization was attempted using only filgrastim: Twenty six individuals were given 31 autografts employing one to four (median three) apheresis sessions, to obtain a target stem cell dose of 1 × 106 CD34 viable cells / Kg of the recipient. The median number of grafted cells was 7.56 × 106 CD34 viable cells / Kg of the recipient; the range being 0.92 to 14.8. By defining as poor mobilizers individuals in which a cell collection of less than 1 × 106 CD34 viable cells / Kg was obtained, a subset of eight poor mobilizers was identified; in two patients the autograft was aborted because of an extremely poor CD34 cell yield (less than 0.2 × 106 CD34 viable cells / Kg of the recipient) after four apheresis sessions. The long-term overall survival of the patients grafted with more than 1 × 106 CD34 viable cells / Kg was better (80% at 80 months) than those grafted with less than 1 × 106 CD34 viable cells / Kg (67% at 76 months). Methods to improve stem cell mobilization are needed and may result in obtaining better results when autografting multiple myeloma patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Factors affecting autologous peripheral blood hematopoietic stem cell collections by large-volume leukapheresis: a single center experience

2011 ◽  
Vol 9 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Araci Massami Sakashita ◽  
Andrea Tiemi Kondo ◽  
Andreza Alice Feitosa Ribeiro ◽  
Andrea Neri Folchini Cipolletta ◽  
Monica Vilela Colesanti ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cell Count ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Cell Yield ◽  
Hematopoietic Stem ◽  
Factors Affecting ◽  
Peripheral Blood Cd34 ◽  
Stem Cell Collection

Objective: To evaluate factors affecting peripheral blood hematopoietic stem cell yield in patients undergoing large-volume leukapheresis for autologous peripheral blood stem cell collection. Methods: Data from 304 consecutive autologous peripheral blood stem cell donors mobilized with hematopoietic growth factor (usually G-CSF), associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 × 106 CD34+ cells/kg of body weight. Pre-mobilization factors analyzed included patient's age, gender and diagnosis. Post mobilization parameters evaluated were pre-apheresis peripheral white blood cell count, immature circulating cell count, mononuclear cell count, peripheral blood CD34+ cell count, platelet count, and hemoglobin level. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches). Results: Pre-mobilization factors correlating to poor CD34 + cell yield in univariate analysis were acute myeloid leukemia (p = 0.017) and other hematological diseases (p = 0.023). Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001), granulocytes (p = 0.002), hemoglobin level (p = 0.016), and CD34+ cell concentration (p < 0.001) in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001) was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. Conclusion: In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.

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