Can high volume leukapheresis substitute plerixafor to yield an optimal dose of CD34+ vells from poor mobilizers?

• Published in: Cytotherapy (Oxford, England) Vol. 21; no. 5; p. S61
• Main Authors: Lin, Y, Park, Y, Khanal, A, Patel, P, Campbell-Lee, S, Liu, L, Vidanovic, V, Sweiss, K, Peace, D, Rondelli, D, Mahmud, N
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2019
• Subjects: Advanced Basic Science; Other
• ISSN: 1465-3249; 1477-2566
• DOI: 10.1016/j.jcyt.2019.03.442

Background & AimBoth chemokine receptor CXCR4 antagonist plerixafor (P) as well as high volume (HV) leukapheresis have been shown to reduce mobilization failure rates. However, no direct comparisons of such collection methods currently exist. In this single center retrospective study, we compared the collection efficiency in adult patients diagnosed with multiple myeloma (MM) or non-Hodgkins Lymphoma (NHL) undergoing autologous stem cell transplantation (ASCT) comparing yields based on pre apheresis peripheral blood (PB) CD34+ cell number (<50 or >50 cells/µL, Fig 1).Methods, Results & ConclusionThe collection methods used included HV vs. regular volume (RV) with or without P. There was a total of 116 patients (78 MM & 38 NHL) in the study group with a total of 191 collections. RV without P was used for patients whose pre-apheresis CD34 count was >50/µL. RV (+P) or HV (+P) or HV without P groups were used to investigate whether HV can substitute RV (+P) for poor mobilizers (<50 CD34+ cells /µl). While the addition of P failed to augment CD34 collection efficiency (CD34/L), RV (+P) notably increased CD34 collection efficiency in comparison to HV without P but the difference was not statistically significant (20.14 ± 3.42 vs 14.29 ± 1.71 × 10 6/L CD34+ cells, p = 0.06). The CD34+ cell yields (CD34/kg) from a single collection when compared between groups with or without P displayed no significant difference (Table 1). However, when collection efficiency was compared based on basal CD34 number, both RV and HV groups yielded significantly greater CD34+ cells when P was added. HV yielded greater CD34+ cells/kg recipient body weight than RV with basal CD34 cells <50/µL while HV yielded significantly lower CD34+ cells than RV (+P) (Table 1). When the basal CD34+ cells was <50/µL mobilization failure rate was 68% for RV but HV displayed only 34% failure rate and becomes 0% if basal PB is above 50 CD34+ cells/µl (Table 1). Thus the majority of patients having <50 CD34+ cells/µL can be rescued without P by employing HV with comparable adverse effects to RV (+P). HV group experienced notably higher incidents of platelet transfusions while RV group required more electrolyte replacement. In summary, both RV (+P) and HV apheresis are capable of reducing the failure rates to reach the minimal CD34+ yields. Our data suggest that except the poorest mobilizers (<20 CD34/µL), HV apheresis can be a cost effective substitute to P to obtain an optimal CD34 graft without exerting any additional adverse effects.