Patients mobilizing large numbers of CD34+ cells ('super mobilizers') have improved survival in autologous stem cell transplantation for lymphoid malignancies

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 5; pp. 437 - 441
• Main Authors: BOLWELL, B. J, POHLMAN, B, SWEETENHAM, J. W, RYBICKI, L, SOBECKS, R, DEAN, R, CURTIS, J, ANDRESEN, S, KOO, A, MINEFF, V, KALAYCIO, M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-09-2007
• Subjects: Adolescent; Adult; Age Factors; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; CD34 antigen; Cell survival; Chemotherapy; Data Collection; Diagnosis; Etoposide; Health aspects; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - standards; Hematopoietic Stem Cells - cytology; Hodgkin's lymphoma; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocyte Count; Lymphoma; Lymphoma - therapy; Lymphomas; Medical sciences; Methods; Middle Aged; Patient outcomes; Physiological aspects; Prognosis; Retrospective Studies; Stem cell transplantation; Stem cells; Survival; Survival Rate; T cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Treatment Outcome; United States; Human; stem cells; stem cell transplant; Cell survival; Hematology; Stem cell; Hematopoietic cell; Malignant hemopathy; Lymphoid neoplasm; Lymphoma; Mobilization; Autograft; Lymphoproliferative syndrome; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705763

The cellular composition of an autologous graft may influence autologous stem cell transplantation (ASCT) outcome. Etoposide (VP) plus filgrastim (G) frequently mobilizes high numbers of CD34+ cells for autologous transplantation. We investigated whether patients collecting high numbers of CD34+ cells ('super mobilizers') have a better outcome than other patients. We reviewed 350 consecutive adult patients with NHL or Hodgkin's lymphoma receiving an ASCT from January 1994 to December 2005, mobilized with VP+G. Super mobilizers were defined as collecting a minimum of 8 x 10(6) CD34+ cells/kg. Two hundred and three patients were super mobilizers, while 147 collected between 2.0 and 7.95 CD34+ cells/kg. Super mobilizers were younger and more likely to have received two or fewer prior chemotherapy regimens (80 versus 63%, P<0.001). Median CD34+ cell dose for the super mobilizing group was 13.7 x 10(6) versus 4.4 x 10(6)/kg in the standard collecting group. The super mobilizer group had a superior overall survival (P=0.006). In multivariable analysis, favorable disease status and younger age at transplant, and super mobilization were associated with improved survival. We conclude that patients had an improved ASCT outcome if large numbers of CD34+ cells were mobilized and infused. The explanation for this observation is unknown.