Mobilizing the older patient with myeloma

Although hematopoietic progenitor/stem cells (HPC) have been used for autologous transplants for approximately 25 years, it is only recently that we have begun to finally understand the factors which play important roles in causing these cells to leave their marrow niches and circulate in the blood. Still less is understood about factors important in homing of these cells from the blood to the marrow, and their re-engraftment there. Nonetheless, a significant amount of clinical information exists on how to make these cells leave the marrow in order to facilitate their collection from the blood for use as a transplant graft. This review provides an overview of what is currently known about the factors influencing mobilization of HPC from the marrow into the blood. Further, it suggests how this knowledge may be used to individually optimize collection of HPC. It is particularly important to optimize collection in the older myeloma patient, where it has traditionally been difficult to collect adequate numbers of cells for the tandem transplant now thought to provide the best hope for long-term survival in this disease.