Successful autologous bone marrow rescue in patients who failed peripheral blood stem cell mobilization

• Published in: Annals of hematology Vol. 79; no. 12; pp. 681 - 686
• Main Authors: RICK, O, BEYER, J, KINGREEN, D, KÜHL, J. S, ZINGSEM, J, HUHN, D, SIEGERT, W, SCHWELLA, N
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.12.2000; Springer Nature B.V
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Dose-Response Relationship, Drug; Female; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Mobilization; Hematopoietic Stem Cell Transplantation; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Tissue and Organ Harvesting; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Case study; Human; Mobilization; Autograft; Blood cell; Stem cell; Hematopoietic cell; Bone marrow; Graft; Therapeutic protocol; Failure; WHO
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s002770000215

We assessed autologous bone marrow (BM) harvest and hematologic recovery after high-dose chemotherapy (HDCT) in patients who failed to achieve peripheral blood stem cell (PBSC) mobilization. One hundred and ninety-three patients with germ cell tumor, malignant lymphoma, sarcoma or medulloblastoma were scheduled for HDCT. In 123 patients, PBSC were mobilized by disease-specific chemotherapy plus granulocyte colony-stimulating factor (G-CSF). In 110/ 123 patients (89%) with circulating CD34+ cell counts 2 > or = 10/microl, sufficient hematopoietic autografts were collected (group A). In 13/123 patients (11%) with peripheral CD34 + cell counts < 10/microl, PBSC harvesting was not performed (group B). These latter patients were classified as "poor mobilizers" and underwent second-line BM harvest at a median of 46 (range 10-99) days after mobilization failure. Seventy patients with first-line BM harvest (group C) acted as historical controls. Ten patients from group B proceeded to HDCT and nine were evaluable for hematopoietic reconstitution. Recovery to neutrophils >0.5 x 10(9)/l was comparable with group C patients: 16 (range 9-34) days vs 13 (range 8-98) days. However, platelet (PLT) reconstitution >20 x 10(9)/l was significantly slower, with a median of 35 (range 13-50) days as compared with 19 (range 9-148) days (P = 0.0106) for control patients. Supportive care requirements, febrile days and length of hospital stay were not significantly different between the two groups of patients. We conclude that patients who fail to mobilize PBSC should be evaluated for second-line BM harvest. This approach may preserve the therapeutic option of HDCT for these patients.