Management strategies for poor peripheral blood stem cell mobilization
1Institute for Transfusion Medicine, University Hospital Essen, Hufelandstrasse 55, Germany. rainer.moog@uni-due.de
Summary
Peripheral blood stem cells (PBSC) are preferred for hematopoietic rescue, but some patients struggle to mobilize enough. This review focuses on strategies for poor mobilizers, including growth factors and apheresis, to improve stem cell yields.
Area of Science:
- Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Peripheral blood stem cells (PBSC) largely replaced bone marrow (BM) for hematopoietic rescue after high-dose chemotherapy.
- Mobilization failure poses a risk to high-dose chemotherapy efficacy.
- CD34+ cell counts increase with chemotherapy and growth factor administration.
Purpose of the Study:
- To review PBSC mobilization strategies, with a focus on patients who mobilize poorly.
- To discuss factors influencing PBSC mobilization.
- To highlight emerging therapies for improving stem cell yields.
Main Methods:
- Review of existing literature on PBSC mobilization.
- Analysis of factors affecting mobilization, including patient characteristics and treatment regimens.
- Evaluation of mobilization strategies for poor mobilizers, such as growth factor combinations and large volume apheresis.
Main Results:
- Mobilization is influenced by age, gender, growth factor type/dose, diagnosis, chemotherapy, and prior radiation.
- Poor mobilizers are defined as those with <10 CD34+ cells/µL.
- Remobilization, high-dose G-CSF, G-CSF/GM-CSF combinations, and large volume apheresis show promise for improving CD34+ yields.
Conclusions:
- Effective strategies exist to improve PBSC mobilization in poor mobilizers.
- Novel agents like long-acting G-CSF and CXCR4 antagonists are under investigation.
- Large volume apheresis can increase CD34+ cell yield but may increase citrate reactions.
