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Collection of peripheral blood stem cells. Dr Kacem Karima Department of clinical haematology -HAO CMH - 26/05/2012. High-dose chemotherapy with peripheral blood stem cell support: best option for a high risk group of patients - PowerPoint PPT Presentation
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Collection of peripheral blood stem cells
Dr Kacem KarimaDepartment of clinical
haematology -HAOCMH - 26/05/2012
• High-dose chemotherapy with peripheral blood stem cell support: best option for a high risk group of patients
• Mobilized peripheral blood stem cells (PBSC): main source for autologous SCT.
• Successful engraftment relies on CD34+progenitor cell dose.
• Critical step: effective PBSC mobilization but 15-30% of patients fail to mobilize.
Aims of this study:Analysis of mobilized patients profiles.
Review of our strategies for collection of PBSC.
Establish the influence of certain factors on the outcome of PBSC mobilization
Retrospective analysis
Patients with lymphoma (HL , NHL)
January 2005 - December 2011
Haematology department of Aziza OthmanaHospital
RESULTS
H/F 53/41 (sex ratio :1.29)
Median Age 33 (14 – 61)
HL 44
NHL 50
Stage III/IV
Initial BM involvement
74 (78%)
15 (16%)
Nb of patients : 94Nb of mobilizations : 104Criterion for adequate mobilization: at least 2.0 x 106 CD34+ cells/kg of patient.Leukapheresis: Nb CD34+(PB)≥ 20/mm3
Refractory Relapsed Total
CHL 29 15 44
Responsive Relapse or refractory Disease
NHL 44 06 50
Treatment characteristics
Previous RT 6
Median nb of regimens of CT 2 ( 1 – 4 )
Median nb of previous CT courses 5 (2 – 12 )
93 patients: mobilized with a combination of chemotherapy and growth factors (G-CSF)
- 5γ/kg/day 28 pts 30% - 5 puis 10γ/kg/day 62pts 66.6% - 10 γ/kg/day 3 pts 3.2%
One patient with G-CSF only.
Median delay/CTMedian delay /G-CSF
15 days(10-28)9 days (4-22)
Nb median leukapheresis 1.45 (1 – 3)
Nb median collected CD34+ 6 106/kg (1.37- 30.6 106/kg)
% failure 5.3 %
Nb CD34 106/kg p
Age (years) 0.05
> 50 4.96±2.24
< 50 8.54±6.34
Gender 0.34
M 8.59±6.58
F 7.34±5.33
BOM 0.25
Involved 6.2±4.6
Normal 8.34±6.25
RC at mobilization 0.28
Yes 8.91±7.5
No 7.4±4.91
Nb of cycles of CT 0.09
< 6 7.29 ± 5.35
> 6 9.6 ± 7.18
Hb (g/dl) 0.83
< 11 7.86 ± 6.2
> 11 8.15 ± 6.06
• Correlation between dose G-CSF and Nb CD34 collected
Dose (γ/kg/d) p
5 5.81±3.22 0.015
5 then 10 9.1±6.66
• 1st PBSC COLLECTIONLENOGRASTIM FILGRASTIM p
Median nb of CD34+ Cells mobilized
8.86 106/kg 7.74 106/kg 0.2
• Proven poor mobilizer (GITMO)Peak CD34+ circulating cell count < 20/μl with
less than 2 106 harvested CD34+ cells/kg
• Predicted poor mobilizer (GITMO): at least one major criterion or two minor criteria:Major criteria:- Failed previous mobilisation- Prior extensive therapy- Previous therapy: fluda, melphalanMinor criteria- At least 2 prior cytotoxic lines- Refractory disease- Extensive BM involvement at mobilisation- Age > 65 years- BM cellularity < 30% at mobilisation
• Failures: 5 in study period 5 between January and May 2012 /13 pts
Predictive factors of failure
Myelofibrosis 1pt
Refractory Disease 3 pts
Prior lines of CT ≥ 2 3 pts
Nb cycles ≥ 6 3 pts
Previous RT 2 pts
CONCLUSION:
- Peripheral CD34 count is a useful predictor for both harvest timing and successful collection of PBSC.
- Identify poor mobilizers patients
- G-CSF et Plerixafor : suitable combination for failure collection