Mobilization guidelines – pro
Currently, mobilized cells are the preferable and major source of stem and progenitor cells harvested for autologous and allogeneic transplantations because of the higher yield of these cells, leading to faster engraftment and decreased procedural risks compared with harvested BM cells. mobilization with chemotherapy plus growth factor will generally yield more CD34+ cells than growth factor alone. However, mobilizing without a growth factor should be attemtped first. The following algorithm is proposed in a recent review 1.
Attempt first collection relatively early, i.e., with < 12 months prior therapy.
Attempt collection first with chemotherapy plus growth factor (except for patients over 70 with > 12 months prior therapy and platelets < 200 × 109/L, for whom growth factors alone may be tried first). The choice of growth factor (G-CSF versus GM-CSF) may depend on data under development regarding the importance of early immune reconstitution on time to progression and long-term disease-free survival. Pegylated filgrastim may replace standard G-CSF if studies show it to be equivalent or better than standard G-CSF.
If mobilization is inadequate and patient is in CR or near-CR: wait at least 3 weeks, then remobilize with combination growth factors. In the future, AMD3100 may be a possibility.
In general, studies demonstrate that CM will mobilize more stem cells than G-CSF alone but with a similar failure rate suggesting that CM works best in those patients already destined to mobilize well. There is no fool[roof method to predict those who mobilize well. Exceptions to this rule may exist, however; several recent studies have shown that CM improves obilization in traditionally difficult-to-mobilize patients, such as those with lymphoma.
1.Michele H. Cottler-Fox, Tsvee Lapidot, Isabelle Petit, Orit Kollet, John F. DiPersio, Dan Link and Steven Devine , Stem Cell Mobilization. ASH Education Book January 1, 2003 vol. 2003 no. 1 419-437
2. Sergio Giralt et al, Review Optimizing Autologous Stem Cell Mobilization Strategies to Improve Patient Outcomes: Consensus Guidelines and Recommendations. Biology of Blood and Marrow Transplantation, Volume 20, Issue 3, March 2014, Pages 295308
3. L. Bik To How I treat patients who mobilize hematopoietic stem cells poorly
October 27, 2011; Blood: 118 (17)