Abstract 4387

Absolute peripheral blood (PB) pre-apheresis CD34+ count has been shown to predict the CD34+ yield/Kg in patients undergoing autologous stem cell mobilization and apheresis. Determining correlates of PB pre-apheresis CD34+ counts would facilitate identifying patients that may be at high risk of mobilization failure.

Methods.

A total of 851 consecutive autologous apheresis procedures were performed at M.D. Anderson Cancer Center between January 2005 and December 2009. We randomly selected half (N=413) of this study population to serve as a study sample (described in table), and preserved the remaining for validation studies. In this study population, we observed that 96% of patients with PB pre-apheresis CD34+ counts of >40/μL collected >2×106 CD34+cells/Kg on the first day of apheresis. We sought to determine patient and disease characteristics that are associated with higher PB pre-apheresis CD34+ counts (>40/μL). These factors included patient age (quartiles), gender, weight (quartiles), diagnosis (Multiple Myeloma vs. Hodgkin's and Non-Hodgkin's Lymphoma), disease status at transplant (remission vs. active disease), number of prior chemotherapy regimens (< 2 vs. ≥2), blood count on day of collection: hemoglobin level (≤10 vs. >10 g/dL), WBC (<4 vs. ≥ 4 ×109/L), absolute neutrophil count [ANC] (< vs.≥ median), and platelet count (≤150 vs. <150 ×109/L); and number days (≤ vs. > median) from the beginning of mobilization to the first apheresis procedure.

Results.

On univariate analysis, shorter duration from beginning of mobilization therapy to first day of apheresis (odds ratio [OR] =4.7, p <0.001), and weight >95 Kg (OR=1.8, p=0.01), were significantly associated with a PB CD34+count >40/μL; whereas a diagnosis of Multiple Myeloma (OR=0.5, p=0.002), age >60 years (OR=0.6, p=0.009), pre-apheresis WBC <4 × 109/L (OR=0.5, p=0.004) and ANC (< median p=0.003) were significantly associated with PB CD34+ counts of ≤ 40/μL. These factors, with the exception of age, remained significant on multivariate analysis. Shorter duration of mobilization (OR=8.1, p<0.001) had the strongest association with PB CD34+ count >40/μL. A diagnosis of Multiple Myeloma was associated with lower PB CD34+ count in patients who had a shorter mobilization course (OR=0.3, p<0.001), but not in those who took longer to mobilize. Lower WBC and ANC counts were associated with lower PB CD34+ count, and this effect was more pronounced for patients who had both low WBC and ANC (OR=0.4, p=0.001) than for those who had low ANC but high WBC count (OR=0.5, p=0.025). Weight >95 Kg was still associated with higher PB CD34+ count, (OR=1.9, p 0.01). There was no association between PB CD34+ count and any of the remaining factors evaluated.

Conclusion:

Our data suggest that patients who take longer to mobilize, have low WBC and [ANC] pre-apheresis might benefit from early intervention with novel mobilization strategies.

Table
N=413(%)PB CD34+>40μ/L (%)
Diagnosis    
Multiple Myeloma 232 56% 33% 
Non-Hogkin's Lymphoma 132 32% 46% 
Hodgkin's Lymphoma 49 12% 55% 
Gender    
Female 160 39% 35% 
Male 253 61% 43% 
Duration of mobilization (days)    
≤ median 261 68% 50% 
>median 125 32% 18% 
Age, (years)    
≤ 50 124 30% 51% 
51-60 132 32% 40% 
61-70 122 30% 34% 
>70 35 8% 23% 
Weight, Kg (quartiles)    
≤ 70 104 25% 32% 
71-85 113 27% 39% 
86-95 82 20% 38% 
>95 114 28% 50% 
Disease status at mobilization    
Active disease 87 21% 37% 
No Active disease 320 79% 52% 
Prior Chemotherapy regimens    
>2 146 35% 42% 
≤ 2 266 65% 38% 
Blood count pre- apheresis    
Hemoglobin (g/dL)    
≤ 10 85 21% 40% 
>10 324 79% 40% 
WBC (x109/L)    
<4 117 29% 29% 
≥4 292 71% 44% 
ANC (x109/L)    
< median 251 61% 34% 
≤ median 158 39% 49% 
Platelets, (x109/L)    
≤ 150 75 18% 33% 
>150 334 82% 42% 
WBC (x109/L) / ANC (x109/L)    
WBC >4 / ANC> median 157 38% 50% 
WBC>4 / ANC ≤ median 135 33% 38% 
WBC≤ 4 / ANC > median 116 28% 29% 
N=413(%)PB CD34+>40μ/L (%)
Diagnosis    
Multiple Myeloma 232 56% 33% 
Non-Hogkin's Lymphoma 132 32% 46% 
Hodgkin's Lymphoma 49 12% 55% 
Gender    
Female 160 39% 35% 
Male 253 61% 43% 
Duration of mobilization (days)    
≤ median 261 68% 50% 
>median 125 32% 18% 
Age, (years)    
≤ 50 124 30% 51% 
51-60 132 32% 40% 
61-70 122 30% 34% 
>70 35 8% 23% 
Weight, Kg (quartiles)    
≤ 70 104 25% 32% 
71-85 113 27% 39% 
86-95 82 20% 38% 
>95 114 28% 50% 
Disease status at mobilization    
Active disease 87 21% 37% 
No Active disease 320 79% 52% 
Prior Chemotherapy regimens    
>2 146 35% 42% 
≤ 2 266 65% 38% 
Blood count pre- apheresis    
Hemoglobin (g/dL)    
≤ 10 85 21% 40% 
>10 324 79% 40% 
WBC (x109/L)    
<4 117 29% 29% 
≥4 292 71% 44% 
ANC (x109/L)    
< median 251 61% 34% 
≤ median 158 39% 49% 
Platelets, (x109/L)    
≤ 150 75 18% 33% 
>150 334 82% 42% 
WBC (x109/L) / ANC (x109/L)    
WBC >4 / ANC> median 157 38% 50% 
WBC>4 / ANC ≤ median 135 33% 38% 
WBC≤ 4 / ANC > median 116 28% 29% 
View Large

Totals may vary because of missing data.

Disclosures:

Popat:Otsuka: Research Funding.

Topics:
apheresis, hematopoietic stem cell mobilization, multiple myeloma, chemotherapy regimen, hodgkin's disease, disease remission, hemoglobin, hemoglobin measurement, lymphoma, lymphoma, non-hodgkin

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2011 by The American Society of Hematology
2011
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