Evaluation of a New Program for PBSC Collection with Fresenius COM.TEC Blood Cell Separator.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5265-5265
Author(s):  
Claudia Del Fante ◽  
Cesare Perotti ◽  
Gianluca Viarengo ◽  
Paola Bergamaschi ◽  
Andrea Marchesi ◽  
...  
Keyword(s):  
Cell Count ◽  
Peripheral Blood ◽  
Collection Efficiency ◽  
Cell Content ◽  
The Real ◽  
Cell Separator ◽  
Cd34 Cells ◽  
The Mean ◽  
The Difference ◽  
Wbc Count

Abstract Introduction: At moment PBSC collections can be performed using semiautomated or automated cell separator devices. The collection with semiautomated methods implies an augmented working load for the dedicated personnel and is strongly influenced by the operator. On the contrary, the automated methods offer the advantages of a diminuished working load for the dedicated personnel and an high standardization of the collection procedure. Herein we report our experience on 60 PBSC collections employing the new automated COM.TEC Fresenius autoMNC program that provides the possibility to predict the total number of CD34+ cells collected basing on the CD34+ cell count (x μL) pre-leukapheresis (LKF) collection in peripheral blood. Materials and Methods: 39 patients affected with various onchohematological diseases and10 healty donors were mobilized with chemotherapy + G-CSF or G-CSF alone, respectively, and subsequently underwent LKF collection for auto or allotransplant. According to our internal protocol 60 LKF collections were performed starting with a CD34+ cell count in peripheral blood at least of 20/μL. Net weight of the final LKF product and its CD34+ cell content were evaluated at the end of each PBSC collection procedure and then compared to the expected data calculated by the cell separator device. Moreover a post collection peripheral blood Plt count was evaluated for each patient/donor. Results: The mean starting WBC count was 25.86x103/μL (range: 4–82.3), Plt count was 151.38x103/μL (20–395), CD34+ cells was 96.63/μL (20–332). The mean WBC and CD34+ cells in the LKF collection were 224.78x103/μL (20.71–425.3) and 565.45x106 (59.3–1609.3), respectively. The mean volume of the LKF collection was 237.28 ml (120–503). The mean estimated CD34+ cell content was 498.37x106 while the real mean CD34+ LKF cell content was 623.32x106. The mean CD34+ cell collection efficiency was 91% (66–126). Finally, the mean post procedure Plt count in patient/donor was 77.91x103/μL (12–164). Conclusions: The automatized PBSC collection with the new program COM.TEC Fresenius autoMNC demonstrated a very high CD34+ cell collection efficiency. Moreover the possibility to predict the CD34+ cell yield permits an optimal management of the LKF collection, reducing the number of procedures per patient/donor. The difference observed between the mean estimated CD34+ cells and the real CD34+ cell content may be due to the intra-procedure stem cell mobilization phenomenon. Finally, this new automatized collection system demonstrated to limit the collection related thrombocytopenia either in patient or in donor.

Can We Predict the Number of Circulating CD34+ Cells From the Complete Blood Cell Count Before and After Plerixafor in Patients With Lymphoproliferative Disorders?

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S18-S19
Author(s):  
Mahtab Fakhari ◽  
Luciano J Costa ◽  
Lawrence A Williams ◽  
Marisa B Marques
Keyword(s):  
Stem Cell ◽  
Cell Count ◽  
Complete Blood Count ◽  
Cell Transplant ◽  
Cxcr4 Antagonist ◽  
Target Number ◽  
Cd34 Cells ◽  
The Difference ◽  
Cell Mobilization ◽  
Wbc Count

Abstract Stem cell transplant is a common treatment for hematopoietic neoplasms. We use a standardized stem cell mobilization regimen consisting of the following: day 1, 6 mg of pegfilgrastim (pegylated formulation of granulocyte-colony stimulating factor); day 3, 24 mg of plerixafor (reversible CXCR4 antagonist) followed by peripheral blood stem cell collection (PBSC) on day 4 after collecting a sample to measure the circulating CD34+ cells by flow cytometry. Since the latter results are not available as quickly as a STAT complete blood count (CBC), we hypothesized that the difference in CBC parameters from DAY 3 TO DAY 4 could be useful to predict the final collection yield. To test our theory, we carried out the following process from September 2018 to February 2019: day 3, CBC with differential before plerixafor; day 4, CBC with differential and sample for CD34+ cells before starting PBSC. We collected the following data from the electronic medical records: gender, age, and CBC parameters preplerixafor (evening of day 3) and morning of day 4 (preapheresis) plus circulating CD34+ count. We used a paired Student t test to compare the results of each patient. Fifty-seven adults (35 males, 22 females) with a median age of 64 ± 13 years were included; 76% had the diagnosis of multiple myeloma. On day 3 (preplerixafor), the median hematocrit was 36 ± 8%, the WBC count was 29 ± 13 × 103/µL, and the platelet count was 189 ± 64 × 103/µL. On the next morning (day 4), the hematocrit and platelet counts were not significantly different at 36 ± 4% and 182 ± 60 × 103/µL, respectively (P > .05). However, the median WBC count was significantly higher with a median of 43 ± 16 × 103/µL (P = 2.5 × 10–20). In both CBCs with differential, neutrophils comprised the majority at 82% and 74% pre- and postplerixafor, respectively (P = .01), lymphocytes went from 7% to 8% (P > .05), and monocytes increased from 6% to 6.5% (P = .02). The median CD34+ count preapheresis was 40 ± 47 cells/µL. We did not find any strong correlation between day 3 and day 4 CBC parameters and the CD34+ count, with only a very weak trend for higher CD34+ cells with increasing day 4 WBC count (R2 = 0.225). We conclude that the precollection CD34+ cell count is the best way to predict the PBSC yield and must be performed in order to ensure the target number of CD34+ cells is met for a successful engraftment.

scholarly journals The influence of kihap on the impact of Dolio-chagui kicks in taekwondo

2014 ◽  
Vol 20 (1) ◽  
pp. 54-57
Author(s):  
Rodrigo Dias Martins ◽  
Debora Cantergi ◽  
Jefferson Fagundes Loss
Keyword(s):  
Martial Arts ◽  
Random Order ◽  
T Test ◽  
Real Effect ◽  
The Real ◽  
The Mean ◽  
The Difference ◽  
The Impact

The kihapis a technique used in several oriental martial arts. It is a yell used by practitioners with the ex pectation of enhancing the force of a hit. However, the real effect of using the kihapis unknown. Therefore, this study aims to compare the peak of acceleration of the Dolio-chaguikick in taekwondo performed with and without the use of kihap. Twenty two experienced taekwondo practitioners performed 30 kicks each against a punching bag, alternating in random order with and without kihap, while the acceleration of the punching bag was measured. A t-test was used to compare the difference between the mean acceleration in both conditions. Higher values were found with the use of kihap(7.8 ± 2.8 g) than without the use of kihap(7.1 ± 2.4 g), p< 0.01, r= 0.57. The results indicate that kihapenhances the impact of the kick.

scholarly journals Allogeneic blood stem cell transplantation: peripheralization and yield of donor-derived primitive hematopoietic progenitor cells (CD34+ Thy- 1dim) and lymphoid subsets, and possible predictors of engraftment and graft-versus-host disease

Blood ◽  
1995 ◽  
Vol 86 (7) ◽  
pp. 2842-2848 ◽  
Author(s):  
M Korbling ◽  
YO Huh ◽  
A Durett ◽  
N Mirza ◽  
P Miller ◽  
...  
Keyword(s):  
Body Weight ◽  
Progenitor Cells ◽  
Peripheral Blood ◽  
Allogeneic Transplantation ◽  
Hematopoietic Progenitor Cells ◽  
Donor Blood ◽  
Hematopoietic Progenitor ◽  
Cd34 Cells ◽  
The Mean ◽  
Single Bone

Abstract Apheresis-derived hematopoietic progenitor cells have recently been used for allogeneic transplantation. Forty-one normal donors were studied to assess the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) (12 micrograms/kg/d) on the peripheralization of hematopoietic progenitor cells and lymphoid subsets. The white blood cell, polymorphonuclear cell (PMNC), and lymphocyte concentrations at the peak of rhG-CSF effect in the donor's peripheral blood (PB) exceeded baseline by 6.4-, 8.0-, and 2.2-fold, respectively. Corresponding concentrations of PB CD34+ cells and primitive subsets such as CD34+ Thy-1dim, and CD34+ Thy-1dim CD38- cells increased by 16.3-fold, 24.2-fold, and 23.2-fold, respectively in eight normal donors. The percentage of CD34+ Thy-1dim and CD34+ Thy- 1dim CD38- cells among CD34+ cells increased as well, suggesting an additional peripheralization effect of rhG-CSF on primitive CD34+ subsets. The preapheresis PB CD34+ and CD34+ Thy-1dim cell concentrations were predictive of their corresponding apheresis yield per liter of donor blood processed PB lymphoid subsets were not significantly affected by rhG-CSF treatment. The mean apheresis-derived yield of CD34+, CD34+ Thy-1dim, and CD34+ Thy-1dim CD38- cells per kilogram of recipient body weight and per liter of donor blood processed was 48.9 x 10(4) (n = 41), 27.2 x 10(4) (n = 10), and 1.9 x 10(4) (n = 10), respectively. As compared with 43 single bone marrow (BM) harvest, the CD34+ cell yield of peripheral blood progenitor cell allografts of 41 normal donors exceeded that of BM allografts by 3.7- fold and that of lymphoid subsets by 16.1-fold (CD3+), 13.3-fold (CD4+), 27.4-fold (CD8+), 11.0-fold (CD19+), and 19.4-fold (CD56+CD3-). All PBPC allografts were cryopreserved before transplantation. The mean recovery of CD34+ cells after freezing, thawing, and washing out dimethylsulfoxide was 86.6% (n = 31) and the recovery of lymphoid subsets was 115.5% (CD3+), 121.4% (CD4+), 105.6% (CD8+), 118.1% (CD19+), and 102.4% (CD56+CD3-). All donors were related to patients: 39 sibling-to-sibling, 1 parent-to-child, and 1 child-to-parent transplant. Thirty-eight transplants were HLA fully identical, two transplants differed in one and two antigens. Engraftment occurred in 38 recipients; two patients died too early to be evaluated, and one patient did not engraft. The lowest CD34+ cell dose transplanted and resulting in complete and sustained engraftment was 2.5 x 10(6)/kg of recipient body weight.(ABSTRACT TRUNCATED AT 400 WORDS)

Optimizing donor selection in order to establish a cord blood banking facility: maternal and obstetric factors impact

Open Medicine ◽  
2007 ◽  
Vol 2 (2) ◽  
pp. 180-189 ◽  
Author(s):  
Mihaela Chivu ◽  
Serban Nastasia ◽  
Camelia Sultana ◽  
Coralia Bleotu ◽  
Irina Alexiu ◽  
...  
Keyword(s):  
Cord Blood ◽  
Blood Volume ◽  
Donor Selection ◽  
Gestation Length ◽  
Gestational Length ◽  
Cell Content ◽  
Cd34 Cells ◽  
Newborn Weight ◽  
The Mean ◽  
Obstetric Factors

AbstractIn this study, we analyzed the obstetric factors affecting total nucleated cells (TNC) content of cord blood units to establish the criteria for umbilical cord blood (UCB) donor selection in our geographic area.UCB was collected from normal uncomplicated pregnancies. In every case, following data were recorded: (1) gestation length; (2) type of delivery (cesarean or vaginal); and (3) newborn characteristics: weight and sex. For each sample, TNC content, percentage and number of CD34+ cells, and viability were analyzed.The results showed that TNC content increases with cord blood volume, gestational length and newborn weight. The mean blood volume and the mean TNC per unit were 42.37 ± 13.5 ml and 55.49 ± 19.4 × 107, respectively. Stepwise regression analysis revealed a positive and significant correlation (r= 0.89) between these two variables. Meanwhile the CD34+ cell content remains unchanged in deliveries at 32–40 weeks of gestation. The mean CD34+ percentage obtained was 0.37 ± 0.06, and the total number of CD34+ cells was 4.827 ± 0.8204 × 104 / mL UCB.Concluding, the maternal and obstetric factors have a significant impact on UCB cell quantity and quality. The main criteria for UCB collection and storage resulted to be: a gestational age higher than 36–40 weeks and newborn weight > 3200g; gestation number ≤ 2 and placental weight > 700g can be added to the standard criteria to improve the bank efficiency. Our results have also become helpful in evaluating stored UCB units to establish the adequacy for clinical transplant utilization.

When to harvest peripheral-blood stem cells after mobilization therapy: prediction of CD34-positive cell yield by preceding day CD34-positive concentration in peripheral blood.

1996 ◽  
Vol 14 (3) ◽  
pp. 970-973 ◽  
Author(s):  
C Elliott ◽  
D M Samson ◽  
S Armitage ◽  
M P Lyttelton ◽  
D McGuigan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Peripheral Blood ◽  
Cell Number ◽  
Cell Yield ◽  
Peripheral Blood Stem Cells ◽  
Cd34 Cells ◽  
Blood Stem Cells ◽  
Cell Mobilization ◽  
Wbc Count ◽  
Therapy Prediction

PURPOSE To evaluate whether the CD34+ yield from a single peripheral-blood stem-cell (PBSC) harvest could be predicted by measurement of the patient's circulating WBC and CD34+ cell concentrations on the day before harvest. PATIENTS AND METHODS Thirty-nine patients with hematologic or nonhematologic malignancy underwent 41 stem-cell mobilization episodes with cytotoxic chemotherapy and/or granulocyte colony-stimulating factor (G-CSF), and a total of 63 leukapheresis procedures were performed. Peripheral-blood samples were analyzed for WBC and CD34+ cell concentration both on the day before and the day of leukapheresis. RESULTS The median WBC and CD34+ concentrations on the day preceding leukapheresis were 10.0 x 10(9)/L (range, 0.4 to 44.4) and 24.9 x 10(6)/L (range, 0.1 to 349.4), respectively. On the day of harvest, the corresponding figures were 15.1 x 10(9)/L (range, 1.5 to 52.6) and 29.3 x 10(6)/L (range, 0.1 to 543.1), respectively. The median CD34+ cell number collected in a single leukapheresis was 2.6 x 10(6)/kg body weight (range, 0.1 to 26.1). Both the preceding day (r = .84, P < .001) and harvest day (r = .95, P < .001) CD34+ circulating concentrations correlated significantly with the number of CD34+ cells per kilogram collected at leukapheresis. The correlation between CD34+ cells per kilogram collected and harvest day WBC count was also significant (r = .43, P <.001), but with the preceding day WBC count was nonsignificant. CONCLUSION The number of CD34+ cells harvested in a single leukapheresis can be predicted by measurement of the preceding day peripheral-blood circulating CD34+ concentration, and on the basis of these data a table of probable CD34+ cell yield has been constructed. This correlation may facilitate the efficient organization of leukapheresis procedures.

scholarly journals An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy

Blood ◽  
1995 ◽  
Vol 86 (10) ◽  
pp. 3961-3969 ◽  
Author(s):  
CH Weaver ◽  
B Hazelton ◽  
R Birch ◽  
P Palmer ◽  
C Allen ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Progenitor Cell ◽  
Cox Regression ◽  
Peripheral Blood Progenitor Cell ◽  
High Dose ◽  
Reference Laboratory ◽  
Cell Content ◽  
Platelet Recovery ◽  
Cd34 Cells ◽  
Kinetics Of

The CD34 antigen is expressed by committed and uncommitted hematopoietic progenitor cells and is increasingly used to assess stem cell content of peripheral blood progenitor cell (PBPC) collections. Quantitative CD34 expression in PBPC collections has been suggested to correlate with engraftment kinetics of PBPCs infused after myeloablative therapy. We analyzed the engraftment kinetics as a function of CD34 content in 692 patients treated with high-dose chemotherapy (HDC). Patients had PBPCs collected after cyclophosphamide based mobilization chemotherapy with or without recombinant human granulocyte colony-stimulating factor (rhG-CSF) until > or = 2.5 x 10(6) CD34+ cells/kg were harvested. Measurement of the CD34 content of PBPC collections was performed daily by a central reference laboratory using a single technique of CD34 analysis. Forty-five patients required a second mobilization procedure to achieve > or = 2.5 x 10(6) CD34+ cells/kg and 15 patients with less than 2.5 x 10(6) CD34+ cells/kg available for infusion received HDC. A median of 9.94 x 10(6) CD34+ cells/kg (range, 0.5 to 112.6 x 10(6) CD34+ cells/kg) contained in the PBPC collections was subsequently infused into patients after the administration of HDC. Engraftment was rapid with patients requiring a median of 9 days (range, 5 to 38 days) to achieve a neutrophil count of 0.5 x 10(9)/L and a median of 9 days (range, 4 to 53+ days) to achieve a platelet count of > or = 20 x 10(9)/L. A clear dose-response relationship was evident between the number of CD34+ cells per kilogram infused between the number of CD34+ cells per kilogram infused and neutrophil and platelet engraftment kinetics. Factors potentially influencing the engraftment kinetics of neutrophil and platelet recovery were examined using a Cox regression model. The single most powerful mediator of both platelet (P = .0001) and neutrophil (P = .0001) recovery was the CD34 content of the PBPC product. Administration of a post-PBPC infusion myeloid growth factor was also highly correlated with neutrophil recovery (P = .0001). Patients receiving high-dose cyclophosphamide, thiotepa, and carboplatin had more rapid platelet recovery than patients receiving other regimens (P = .006), and patients requiring 2 mobilization procedures versus 1 mobilization procedure to achieve > or = 2.5 x 10(6) CD34+ cells/kg experienced slower platelet recovery (P = .005). Although a minimal threshold CD34 dose could not be defined, > or = 5.0 x 10(6) CD34+ cells/kg appears to be optimal for ensuring rapid neutrophil and platelet recovery.

Predictive factors for peripheral-blood progenitor-cell collections using a single large-volume leukapheresis after cyclophosphamide and granulocyte-macrophage colony-stimulating factor mobilization.

1995 ◽  
Vol 13 (3) ◽  
pp. 705-714 ◽  
Author(s):  
J L Passos-Coelho ◽  
H G Braine ◽  
J M Davis ◽  
A M Huelskamp ◽  
K G Schepers ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Large Volume ◽  
Peripheral Blood ◽  
High Dose ◽  
Colony Stimulating Factor ◽  
Cell Content ◽  
Cd34 Cells ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Stimulating Factor

PURPOSE (1) To study the ability of mobilized peripheral-blood progenitor cells (PBPC) collected in a single large-volume leukapheresis performed on a predetermined date to accelerate engraftment after high-dose cyclophosphamide and thiotepa; (2) to establish the minimum dose of PBPC associated with early engraftment; and (3) to identify parameters predictive of collection of large numbers of PBPC. PATIENTS AND METHODS Twenty-three patients with breast cancer received cyclophosphamide (4 g/m2) and granulocyte-macrophage colony-stimulating factor ([GM-CSF] 5 micrograms/kg/d x 15 days) for PBPC mobilization. A single leukapheresis was performed 15 days after cyclophosphamide administration. Then, patients received high-dose cyclophosphamide and thiotepa followed by reinfusion of PBPC and 4-hydroperoxycyclophosphamide (4HC)-purged bone marrow. PBPC concentration was measured in serial peripheral-blood samples and in the leukapheresis product. Correlation analysis between PBPC dose and engraftment and between leukapheresis yield and patient characteristics was attempted. RESULTS A single leukapheresis processed a median 36 L (range, 24 to 46) blood and collected 5 x 10(6) CD34+ cells/kg (< 0.3 to 24) and 6.2 x 10(5) colony-forming units granulocyte-macrophage (CFU-GM)/kg (< 0.001 to 29). All sixteen patients (70%) reinfused with > or = 2.9 x 10(6) CD34+ cells/kg reached a level of greater than 1,000 leukocytes/microL by day 13 and greater than 50,000 platelets/microL by day 15. All of these patients had a percentage of peripheral-blood CD34+ cells > or = 0.5%, and all but one, a level of greater than 100,000 platelets/microL, on the day of leukapheresis. The bone marrow CD34+ cell percentage at study entry predicted the number of CD34+ cells collected after PBPC mobilization (R2 = .42, P = .002). All patients with > or = 2.5% bone marrow CD34+ cells experienced early engraftment. CONCLUSION Reinfusion of PBPC collected in a single leukapheresis accelerates engraftment in the majority of patients. Pretreatment bone marrow CD34+ cell content determines PBPC mobilization capacity and may help select hematopoietic rescue strategies.

Kinetics of CD34+ Cells in the Peripheral Blood of Patients with Primary Myelofibrosis Undergoing Splenectomy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3725-3725
Author(s):  
Rita Campanelli ◽  
Margherita Massa ◽  
Elisa Bonetti ◽  
Gianluca Viarengo ◽  
Vittorio Rosti ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Healthy Subjects ◽  
Primary Myelofibrosis ◽  
Extramedullary Hematopoiesis ◽  
Spleen Cells ◽  
Membrane Expression ◽  
Median Percentage ◽  
Spleen Tissue ◽  
Cd34 Cells ◽  
The Mean

Abstract We have previously shown that primary myelofibrosis (PMF) is characterized by an increased number of circulating CD34+ cells and that the membrane expression of CXCR4 on these cells is significantly lower than in healthy subjects in terms both of percentage and of mean fluorescence intensity (MFI). The advanced phase of PMF is characterized by the accumulation in various organs of myeloid progenitor and precursor cells in a process known as extramedullary hematopoiesis. The accumulation and growth of these cells in the spleen lead to the pathologic enlargement of the organ and, in a limited number of cases, splenectomy is required. We have investigated the kinetic of circulating CD34+ and CD34+CXCR4+ cells in patients with PMF before and after splenectomy. We have also compared the percentages of CD34+ and CD34+CXCR4+ cells found in the peripheral blood (PB) with those found in cells derived from spleen tissue samples, obtained soon after splenectomy. Five milliliter of PB in EDTA was obtained from 8 patients with PMF and from 2 healthy subjects (CTRLs), who underwent splenectomy because of traumatic injury of the organ, before (T0) and at different time points (24 hours, 72 hours, and 14 days) after splenectomy. In 6/8 patients and in the 2 CTRLs, spleen samples were obtained immediately after the removal of the organ. After extensive rinsing, each spleen sample was minced to obtain a single cell suspension. For cytofluorimetric analysis, PB and spleen cells were stained with FITC-conjugated anti-CD34 and PE-conjugated anti-CXCR4 monoclonal antibodies. The membrane expression of CXCR4 was evaluated as percentage of CD34+ cells expressing the antigen and as CXCR4 MFI of CD34+ cells. Results are expressed as median (range) or mean where appropriate. The median percentage of circulating CD34+ cells in patients with PMF gradually decreased after splenectomy [24h: 5.5 (0.6–20.1); 72h: 3.1 (0.9–8.5); 14d: 1.6 (0.5–6.7)] with respect to T0 [3.7 (0.2–17.1)]. Vice versa, the percentage of circulating CD34+ cells expressing the CXCR4 antigen increased after the intervention [(24h: 27.3 (12.0–59.6); 72h: 51.4 (24.7–87.7); 14d: 49.0 (34.0–59.7)] with respect to T0 [23.3 (6.2–27.3)]. CXCR4 MFI similarly increased (not shown). In 3/13 patients, assessed 4 months after splenectomy a further decrease of the percentage of circulating CD34+ cells [0.65 (023–1.95)] and a stable percentage of CD34+ cells expressing CXCR4 [44.0 (29.4– 56.0)] were observed. The mean percentage of circulating CD34+ cells in the 2 CTRLs showed an irregular tendency after splenectomy (24h: 0.39; 72h: 0.6; 14d: 0) with respect to T0 (0.7) whereas the mean percentage of circulating CD34+ cells expressing CXCR4 did not change after the intervention (24h: 72.5; 72h: 76.3; 14d: 88) with respect to T0 (82.5). CXCR4 MFI was stable too (not shown). In the spleen of the 6 PMF patients in whom a spleen tissue sample was obtained, the median percentage of CD34+ cells [6.1(2.4–17.5)] was higher (p<0.05) than in their PB at T0 [1.4 (0.2–7.0)]; on the contrary, the percentage of CD34+ spleen cells expressing CXCR4+ was decreased [10.4 (3.9–20)] with respect to that found at T0 in PB cells [22.6 (21.6–25.1)]. The spleen samples of PMF patients showed a percentage of CD34+ cells higher (p<0.05) than that of CTRLs [0.8 (0.5–1.2)], while both the percentage and the MFI of CD34+CXCR4+ cells were comparable (not shown). Taken together, these data support the hypothesis that most of the circulating CD34+ cells of patients with PMF before splenectomy derives from the spleen. The removal of this organ is associated with a decrease of the percentage of circulating CD34+ cells, with an increased expression of CXCR4 on these cells, which is still evident a few months after the intervention. These observations also suggest that, in addition to the spleen, other organs in which extramedullary hematopoiesis takes place can release into the PB different amounts of CD34+CXCR4+ cells.

Use of Plerixafor to Overcome Stem Cell Mobilization Failure: Long Term Follow up of Patients Proceeding to Transplant Using Plerixafor Mobilized Stem Cells

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4390-4390 ◽  
Author(s):  
Abhinav Deol ◽  
Judith Abrams ◽  
Ashiq Masood ◽  
Zaid Al-Kadhimi ◽  
Muneer H. Abidi ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Side Effects ◽  
Cell Count ◽  
Peripheral Blood ◽  
Cd 34 ◽  
Cd34 Cells ◽  
Significant Difference

Abstract Abstract 4390 Background: Plerixafor is a CXCR 4 antagonist which is now approved for use for stem cell (SC) mobilization with granulocyte colony stimulating factor (GCSF) in patients with non Hodgkin lymphoma (NHL) or multiple myeloma (MM). Prior to the approval of plerixafor, we enrolled 49 patients in a compassionate use protocol at our institution to mobilize SC for patients who previously failed at least one mobilization attempt. Methods: Patients received 0.24 mg/kg of plerixafor subcutaneously 9 –11 hrs prior to apheresis in addition to twice daily GCSF. Results: Median age of the patients was 64 years (range, 23–74 years). NHL was the most common diagnosis in 27 (55%) patients, followed by MM with 17(35%) patients and HD with 5 (10%) patients. Thirty nine patients (80%) had been treated with more than 2 chemotherapeutic regimens prior to the first attempt at stem cell collection. Thirty seven patients (76%) failed one previous mobilization attempt, while 12 (24%) had failed 2 or more previous attempts. Using the combination of Plerixafor and GCSF we collected ≥ 2.5 × 106 CD34+ cells/Kg in 33 patients (67%). The median days for pheresis were 1 day with a range of 1 to 3 days. The median SC dose collected was 4 × 106 CD34+ cells/Kg, with a range 2.5 – 14.3. The median CD-34+ peripheral blood count on the 1st day of their collection with plerixafor was 22.4/uL. In contrast the median peripheral blood CD-34+ cell count in these patients on the day of their first collection which failed was 6.2 /uL. The median increase using G-CSF and plerixafor was 14.9 CD-34+ cells/uL. We collected ≥ 2.5 × 106 CD34+ cells/Kg on 4/5 (80%) patients with HD, 13/17 (76%) patients with MM and 16/27 (59%) patients with NHL. Sixteen patients (33%) collected < 2.5 × 106 CD34+ cells/Kg. The median cell dose collected in these patients was 1.4 × 106 CD34+ cells/Kg with a range, 0.4–2.2. The median number of days of pheresis was 2 days (range, 1–4 days). In these16 patients the median CD-34+ count on the day of their previous failed collection was11.2/uL. Their CD-34+ cell count on their first day of collection after the use of G-CSF and plerixafor was 8.3/ul. Figure 1 shows the change in peripheral CD34 counts with the prior mobilization attempt and after plerixafor mobilization, for 38 patients in whom data was available. The most common side effects attributed to plerixafor were diarrhea, fatigue, thrombocytopenia and bone pain; observed in 12%, 8%, 8% and 6% patients, respectively. Forty three of the 49 patients proceeded to an autologus peripheral blood SC transplant, 34 patients received ≥ 2.5 × 106 CD34+ cells/Kg. Thirty two of these patients used the plerixafor collection as the only source of SC. Two patients had their plerixafor mobilized SC combined with a previous suboptimal SC collection. Nine patients received < 2.5 × 106 CD34 + cells/Kg; 4 patients received plerixafor mobilized SC alone, 5 patients received plerixafor mobilized SC combined with their previously mobilized SC. The preparative regimens used were R- BEAM (20 patients), Melphalan (16 patients), BEAM (6 patients) and Etoposide+TBI (1 patient). All patients received GCSF from day +6 till WBC engraftment. The median days of WBC and platelet engraftment were day +11 (range, 9–13 days) and day +16 (range, 11–77 days), respectively. There was no significant difference in days to engraftment between the patients who collected greater or less than 2.5 × 106 CD34 + cells/Kg. With a median follow up 13.7 months, long term engraftment data is available on 27 patients. The median white cell count, hemoglobin and platelet count 1 year after transplant was 4.7 × 109/L, 12.2 g/dL and 109 ×109/L, respectively. There was no significant difference in counts at the 1 year mark between patients who collected more or less than 2.5 × 106 CD34 + cells/Kg. To date 15 patients have evidence of disease progression. Two patients have developed MDS/AML post transplant. Conclusion: Overall, plerixafor leads to mobilization of sufficient stem cells in a vast majority of patients who have failed previous mobilization attempts and allows more patients to proceed to an autologous SC transplant. Plerixafor is well tolerated with minimal side effects, acceptable time to engraftment and acceptable peripheral blood counts at 1 yr after the transplant. Our analysis suggests that failure to increase peripheral CD34 count after plerixafor when compared to previous attempts may predict unsuccessful mobilization. Disclosures: Lum: Transtarget Inc: Equity Ownership, Founder of Transtarget.

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