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Derived hematological indices during peripheral blood stem cell mobilization in the plerixafor era: insightful
Mohandoss Murugesan1, Lakshmi P Niveditha2, Edakkadath Raghavan Sindhu3
1Transfusion Medicine, Malabar Cancer Centre (Postgraduate Institute of Oncology Sciences and Research), Thalassery, Kerala, India.
Introduction:
Derived hematological indices reflect immune activation, but their dynamics during the plerixafor era and their predictive value for stem cell yield remain unclear.
Objectives:
To assess changes in derived hematological inflammatory markers during peripheral blood stem cell mobilization in autologous patients and allogeneic donors, and to evaluate their correlation with CD34+ stem cell yield. These markers include ratios (neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte), and composite indices (systemic immune-inflammation and systemic inflammation response indices).
Methods:
A retrospective analysis was conducted of 127 autologous and 53 allogeneic mobilization events between January 2019 and March 2024. Blood counts and derived indices were analyzed before and after granulocyte colony-stimulating factor administration with and without plerixafor. CD34+ cell enumeration was performed after mobilization. Dynamic changes in inflammatory indices and their correlation with CD34+ counts were assessed.
Results:
After mobilization, there was a significant increase in the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index, and a decrease in the platelet-to-lymphocyte and lymphocyte-to-monocyte ratios in both groups. While allogeneic donors had higher CD34+ counts (median 110 cells/µL versus 48 cells/µL in autologous), no consistent correlation was found between dynamic inflammatory marker changes and CD34+ yield. Plerixafor use in autologous patients significantly influenced the platelet-to-lymphocyte ratio and systemic immune-inflammation index dynamics, highlighting its role in modulating the acute inflammatory response in the plerixafor era.
Conclusions:
Inflammatory markers change significantly during mobilization with granulocyte colony-stimulating factor, reflecting acute immune activation. However, the studied markers do not predict CD34+ yield and should not replace direct enumeration. Their role may be better suited to complement biological understanding rather than clinical decision-making.
