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Kinetics of Peripheral Blood Stem Cell Mobilization Following G-CSF-Supported Chemotherapy

^a Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany;
^b Cytonet Heidelberg GmbH, Transplantation Laboratory, Heidelberg, Germany

Key Words. Mobilization kinetics • Peripheral blood stem cell collection • CD34⁺ • Poor mobilizer • Premobilization therapy

Stefan Fruehauf, M.D., Department of Internal Medicine V, University of Heidelberg, Hospitalstr. 3, 69115 Heidelberg, Germany. Telephone: 49-6221-562781; Fax: 49-6221-565722; e-mail: stefan_fruehauf{at}med.uni-heidelberg.de

It would be a clinical and economical advantage if the optimal time point of peripheral blood stem cell (PBSC) mobilization following G-CSF-supported chemotherapy (CT) was known in advance. Therefore, we retrospectively analyzed mobilization parameters in 113 adult tumor patients treated in our institution within 1 year. The start of apheresis was guided by CD34⁺ cell measurements in the PB and occurred on or after day 11 after start of mobilization CT in 97% of patients. The median peak (p)CD34⁺ cell count in PB uniformly occurred on day 14-15 (range: 6-32 days) after the start of CT, irrespective of the diagnosis (multiple myeloma n = 76, other histology n = 37), the type, but not the amount, of premobilization CT or radiotherapy (RT), the mobilization regimen, or the G-CSF dosage administered. Among more heavily pretreated patients (>six cycles of prior CT or RT), a higher proportion mobilized late (pCD34⁺ cell count later than day 20 in 12% and 13%, respectively, versus 2%-5% in the other groups). Therefore, we propose to start measuring CD34⁺ cells in the PB on day 11 after the start of mobilization therapy. The wide range of optimal mobilization time points argues for an individualized rather than a preset start of apheresis.

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