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Published on: March 14, 2011
Defining "poor mobilizer" in pediatric patients who need an autologous peripheral blood progenitor cell
Julián Sevilla1, María Guillén, Ana Castillo
1Servicio de Hemato-Oncología, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. jsevilla.hnjs@salud.madrid.org
Insights
Identifying poor mobilizers in pediatric hematopoietic progenitor cell (HPC) transplantation is crucial. Prior radiotherapy emerged as the primary factor linked to mobilization failure in children, particularly those with Ewing sarcoma.
Area of Science:
- Pediatric Hematology
- Oncology
- Cellular Therapy
Background:
- The definition and predictors of poor mobilizers in pediatric autologous peripheral blood hematopoietic progenitor cell (HPC) mobilization lack clarity.
- Existing research often focuses on collection success rather than the mobilization process itself.
Purpose of the Study:
- To analyze variables influencing CD34(+) cell count during HPC mobilization in pediatric patients.
- To identify predictors of poor mobilization in this population.
Main Methods:
- Retrospective analysis of pediatric patients undergoing autologous peripheral blood HPC mobilization.
- Evaluation of factors impacting CD34(+) cell counts post-mobilization.
Main Results:
- A CD34(+) cell count >10/μL was associated with successful mobilization in 92.2% of pediatric patients.
- Prior radiotherapy was identified as the main variable predicting poor mobilization.
- Patients with Ewing sarcoma who received radiotherapy and standard granulocyte colony-stimulating factor (G-CSF) mobilization were at high risk for failure.
Conclusions:
- Establishing a CD34(+) cell count threshold of >10/μL can help define successful mobilization in children.
- Radiotherapy is a significant risk factor for poor HPC mobilization in pediatric oncology patients.
- Consideration of high-dose G-CSF or novel agents is recommended for high-risk patients, such as those with Ewing sarcoma treated with radiotherapy, to prevent treatment delays.
Abstract:
The definition of poor mobilizers is not clear in pediatric patients undergoing autologous peripheral blood hematopoietic progenitor cell (HPC) mobilization. Most studies conducted in children define those variables related to the collection of HPC after leukapheresis, but the information regarding exclusively the mobilization process is scarce. In our experience, most children (92.2%) reach the target CD34(+) cell dose for autologous peripheral blood progenitor cell transplantation if CD34(+) cell count was higher than 10/μL. No differences were observed between those with >20 CD34(+) cells/μL and 11-20 CD34(+) cells/μL. In this study, we analyzed the variables that influence CD34(+) cell count; we found that prior use of radiotherapy was the main variable related to poor mobilization. Patients diagnosed with Ewing sarcoma, treated with radiotherapy and mobilized with standard doses of granulocyte colony-stimulating factor (G-CSF) were also at a high risk of mobilization failure. In these patients, we should consider mobilization with high dose G-CSF and be prepared with new mobilization agents to avoid delay on their course of chemotherapy.
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