Weighty choices: selecting optimal G-CSF doses for stem cell mobilization to optimize yield

Area of Science:

• Hematology
• Transplant Immunology
• Cellular Therapy

Background:

• Limited data exist on donor body mass index (BMI) impact on peripheral blood stem cell (PBSC) mobilization using granulocyte colony-stimulating factor (G-CSF).
• Obesity is associated with increased circulating progenitor cells and enhanced stem cell mobilization.

Purpose of the Study:

• To evaluate the impact of donor BMI on G-CSF-mobilized PBSC yield in healthy unrelated donors.
• To determine if lower G-CSF doses per kilogram are effective in donors with higher BMI.

Main Methods:

• Retrospective analysis of 20,884 PBSC donations from the Center for International Blood and Marrow Transplant Research database (2006-2016).
• Evaluation of donor BMI categories (normal, overweight, obese, severely obese) and G-CSF dosing.
• Assessment of pain and toxicities reported by donors.

Main Results:

• Obese and severely obese donors exhibited significantly higher PBSC collection yields compared to normal and overweight donors.
• Increased G-CSF dose correlated with higher stem cell yield in normal/overweight donors.
• Higher G-CSF doses beyond 780 μg/day (obese) or 900 μg/day (severely obese) did not increase yield.
• Obesity was associated with increased self-reported donation-related pain and toxicities.

Conclusions:

• Donor BMI significantly influences PBSC mobilization response to G-CSF.
• Obese and severely obese donors achieve higher yields, but higher G-CSF doses beyond a certain threshold are ineffective.
• Maximum effective G-CSF doses should be considered for obese donors to avoid unnecessary toxicity and pain.