Abstract 4058

Stratification models for prediction of the likelihood of success of peripheral blood stem cell collection via apheresis in patients are lacking. Peripheral blood (PB) CD34+ cells concentration ([CD34+]) pre-apheresis, and blood volume processed (BVP) have been shown to predict the CD34+ cell dose collected on the first day of apheresis (Pierelli et al Vox Sanguinis 2006, 91; 126). We sought to determine the predictive value of these factors, in addition to other mobilization and patient characteristics, in a total 851 consecutive autologous apheresis procedures performed at M.D. Anderson Cancer Center between 01/05–12/09. Patients and Methods: Baseline patient characteristics considered include age, gender, weight, diagnosis, complete blood counts on day of collection, and the absolute PB CD34+ counts within 24 hours of the first apheresis procedure. The study population was randomly divided into equal study (n=425) and validation (n=426) samples. Results: We report results of analyses performed on the study sample which included 241 Multiple Myeloma patients (pts), 135 Non-Hodgkin's Lymphoma pts, and 49 Hodgkin's pts. Logistic regression analysis was used to evaluate the association between CD34+ collected dose > 2 × 106/Kg (available for 401/425 pts) and BVP (L); BVP/Kg; pre-apheresis blood counts including [CD34+], Hemoglobin level (≤10 vs. >10 g/dL), WBC (<4 vs. >4 x109/L), absolute neutrophil count [ANC] (< vs.≥ median), and platelet count (≤150 vs. <150 x109/L); days to first apheresis procedure from start of mobilization regimen (< vs. ≥ median); patient's age (quartiles) and gender; and diagnosis. On univariate analysis, pre-apheresis [CD34+] count was the most significant predictor of CD34+ dose collected on the first day of apheresis (graph). Ninety-six percent of patients with [CD34+] >40/μL (n=158) collected >2 x106CD34+ cells/Kg, while only 8% of those with [CD34+] ≤ 10/μL (n=25) reached that target. The proportion of patients who collected >2 x106CD34+ cells/Kg increased from 15% to 67% with increasing [CD34+] counts ranging between11–40/μL (n=218). Additional significant predictors of higher CD34+ dose collected in this group of pts (n=218) included larger BVP/Kg (>0.2 L/Kg, n=50, p<0.001), shorter than the median duration from start of mobilization to the first apheresis procedure (n=122, p<0.001), and male gender (n=128, p 0.01). Low Hemoglobin (n=42, p 0.007), low WBC (n=69, p 0.02), low platelet count (n=41, p 0.02), age >60 yrs (n=90, p0.06), and NHL histology (n=56, p 0.02) were associated with collection of lower CD34+yield/Kg. There was no impact of patient's weight or ANC. Multivariate analyses are ongoing to evaluate the independent prognostic value of these predictors. The resulting model will be validated in an independent sample. Conclusion: Patients whose pre-apheresis absolute CD34+ counts are between 11–40/μL may be able to collect a higher CD34+ cell dose/Kg on the first day of stem cell collection if higher blood volume is processed, especially patients who took longer to mobilize.
Table:
ABS PRE APHERESIS CD34 between 11–40/μL (N=218)N>2 X106/Kg CD34 D1OR95% CIP value
Final pre-apheresis CD34+ count/μL      
    11–15 59 15% Ref.   
    16–25 88 31% 2.4 1.06–5.7 0.04 
    25–30 29 52% 5.9 2.1–16 0.001 
    31–40 42 67% 11 4.3–29 <0.001 
BVP, L, Day 1 quartiles      
    14 63 33% Ref.   
    >14–16 52 40% 1.3 0.6–2.9 0.4 
    >16–18 54 37% 1.2 0.5–2.5 0.7 
    >18 47 36% 1.1 0.5–2.5 0.8 
BVP, L/Kg, Day 1, quartiles      
    ≤ 0.2 166 31 Ref   
    >0.2 50 56 2.9 1.5–7.7 0.001 
      
*Days on GCSF <med      
    Yes 87 16% 5.5 2.8–10.8 <0.001 
    No 119 51%    
Combination days on G-CSF/BV      
    Fewer days G-CSF/High BVP 32 66% Ref.   
    Fewer days G-CSF/Low BVP 87 46% 0.4 0.2–1.03 0.06 
    More days on G-CSF/High BVP 15 33% 0.3 0.1–0.9 0.04 
    More days on G-CSF/Low BVP 71 13% 0.1 0.03–0.2 <0.001 
Age, years      
    ≤ 60 128 41% Ref.   
    >60 90 29% 0.6 0.3–1.02 0.06 
Labs Before starting mobilization      
Hgb g/dL, quartiles      
    ≤10 42 21% 0.4 0.2–0.8 0.007 
    >10 173 39% Ref.   
WBC x109/L, quartiles      
    <4 69 19% 0.2 0.05–0.7 0.02 
    ≥ 4 146 44% Ref.   
PLT x109/L, quartiles      
    ≤150 41 19% 0.4 0.2–0.8 0.02 
    >150 174 40% Ref   
WBC Day 1 apheresis      
    ≤median 104 24% 0.3 0.2–0.6 <0.001 
    >median 114 47%    
Diagnosis      
    Non-Hodgkin's lymphoma 56 23% 0.4 0.2–0.9 0.02 
    Hodgkin's 19 37% 0.8 0.3–2.2 0.7 
    Multiple Myeloma 143 41% Ref.   
Gender      
    Female 90 27% 0.5 0.3–0.9 0.01 
    Male 128 43% Ref.   
ABS PRE APHERESIS CD34 between 11–40/μL (N=218)N>2 X106/Kg CD34 D1OR95% CIP value
Final pre-apheresis CD34+ count/μL      
    11–15 59 15% Ref.   
    16–25 88 31% 2.4 1.06–5.7 0.04 
    25–30 29 52% 5.9 2.1–16 0.001 
    31–40 42 67% 11 4.3–29 <0.001 
BVP, L, Day 1 quartiles      
    14 63 33% Ref.   
    >14–16 52 40% 1.3 0.6–2.9 0.4 
    >16–18 54 37% 1.2 0.5–2.5 0.7 
    >18 47 36% 1.1 0.5–2.5 0.8 
BVP, L/Kg, Day 1, quartiles      
    ≤ 0.2 166 31 Ref   
    >0.2 50 56 2.9 1.5–7.7 0.001 
      
*Days on GCSF <med      
    Yes 87 16% 5.5 2.8–10.8 <0.001 
    No 119 51%    
Combination days on G-CSF/BV      
    Fewer days G-CSF/High BVP 32 66% Ref.   
    Fewer days G-CSF/Low BVP 87 46% 0.4 0.2–1.03 0.06 
    More days on G-CSF/High BVP 15 33% 0.3 0.1–0.9 0.04 
    More days on G-CSF/Low BVP 71 13% 0.1 0.03–0.2 <0.001 
Age, years      
    ≤ 60 128 41% Ref.   
    >60 90 29% 0.6 0.3–1.02 0.06 
Labs Before starting mobilization      
Hgb g/dL, quartiles      
    ≤10 42 21% 0.4 0.2–0.8 0.007 
    >10 173 39% Ref.   
WBC x109/L, quartiles      
    <4 69 19% 0.2 0.05–0.7 0.02 
    ≥ 4 146 44% Ref.   
PLT x109/L, quartiles      
    ≤150 41 19% 0.4 0.2–0.8 0.02 
    >150 174 40% Ref   
WBC Day 1 apheresis      
    ≤median 104 24% 0.3 0.2–0.6 <0.001 
    >median 114 47%    
Diagnosis      
    Non-Hodgkin's lymphoma 56 23% 0.4 0.2–0.9 0.02 
    Hodgkin's 19 37% 0.8 0.3–2.2 0.7 
    Multiple Myeloma 143 41% Ref.   
Gender      
    Female 90 27% 0.5 0.3–0.9 0.01 
    Male 128 43% Ref.   
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Disclosures:

No relevant conflicts of interest to declare.

Topics:
apheresis, hematopoietic stem cell mobilization, stem cells, granulocyte colony-stimulating factor, brachial plexus neuritis, cd34 antigens, hemoglobin, hodgkin's disease, lymphoma, non-hodgkin, multiple myeloma

Author notes

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Asterisk with author names denotes non-ASH members.

© 2011 by The American Society of Hematology
2011
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