Mobilization of hematopoietic progenitor cells for autologous blood stem cell transplantation: analysis of experience at Inha University Hospital

초록

At our hospital, we used G-CSF preceded by chemotherapy for HPC mobilization, including high dose cytarabine (3g/m sq over 2 hours BID every other day for 6 doses) for acute myeloid leukemia, cyclophosphamide (4g/m sq for 1 dose) for multiple myeloma, lymphoma, and breast cancer, and DHAP (dexamethasone 40mg for 4 consecutive days, cytarabin 2g/m sq over 2 hours BID for 1 day, cisplatin 100mg/m sq over 24 hours) for lymphoid malignancy. We started G-CSF at a fixed dose of 300ug SQ every day as soon as the leukocyte count began to rise after chemotherapy induced myelosuppression. Leukapheresis was commenced at the time when leukocyte count rose up to 1000/uL, and repeated for 2-4 consecutive days. Thirty five patient (male to female, 12:23; ages raging 4-60 with a median of 37; acute leukemia in 4, myeloma in 4, lymphoma in 14, breast cancer in 13) underwent a total of 174 courses (range per capita 2-16, median 4) of leukapheresis for HPC collection prior to autologous bood stem cell transplantation (ASCT) from January 1998 through December 2001. The CD34+ cell count collected in each series of leukapheresis ranged 0.23-79.3X10(6)/kg with a median of 5.6X10(6)/kg. The target amount of CD34+ cell could not be collected in one of 35, and her bone marrow was harvested before ASCT. All the patients achieved good engraftment after ASCT. The mean days +/- S.D. required for WBC count to be over 1,000/uL were 23.0+/-1.4 in cytarabin arm, 12.54+/-0.66 in DHAP arm, and 11.75+/-2.1 days in cyclophosphamide arm. Patient’s age, sex, underlying malignancy, mobilization protocol, and WBC count or the degree of exposure to chemotherapy before mobilization did not show any statistically significant correlation with the rapidity or the amount of mobilized HSC collection on Kruskal-Wallis test. Ages cut off below or above 35 showed marginally significant correlation with the amount of HPC collection.