CD34+ cell mobilization for allogeneic progenitor cell transplantation: efficacy of a short course of G-CSF

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2001-02, Vol.41 (2), p.190-195
• Main Authors: De Fabritiis, Paolo, Iori, Anna Paola, Mengarelli, Andrea, Gozzer, Maria, Ferrazza, Giancarlo, De Propris, Maria Stefania, Romano, Atelda, Arcese, William
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; ALL = acute lymphoid leukemia; AML = acute myeloid leukemia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens, CD34 - blood; AP = accelerated phase; BC = blastic crisis; Biological and medical sciences; Blood Donors; Blood Specimen Collection; Bone marrow, stem cells transplantation. Graft versus host reaction; Bu = busulphan; BW = body weight; CML = chronic myeloid leukemia; CP = chronic phase; CR = complete remission; Cy = cyclophosphamide; Erythrocyte Transfusion; Female; gly-G-CSF = glycosylated G-CSF; Graft vs Host Disease - etiology; Granulocyte Colony-Stimulating Factor - administration & dosage; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Mobilization; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cells - immunology; Humans; Leukapheresis; Male; Medical sciences; MF = myelofibrosis; Middle Aged; MM = multiple myeloma; PB = peripheral blood; PBS-NaN3 = PBS containing 0.1-percent sodium azide; Platelet Transfusion; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1046/j.1537-2995.2001.41020190.x

BACKGROUND: G–CSF‐mobilized PBPCs are considered the richest source of HPCs for both autologous and allogeneic transplantation, but, despite their wide use, the best dose and schedule for G–CSF administration have not been definitively established. STUDY DESIGN AND METHODS: With a target of collecting from the peripheral blood ≥4 × 106 CD34+ cells per kg of body weight of the recipient, the short‐course administration of glycosylated G–CSF (gly‐G–CSF) in 30 healthy donors for an allogeneic transplantation was investigated. Gly‐G–CSF was given subcutaneously at a dose of 10 μg per kg per day in two divided doses over 3 days and was followed by a leukapheresis (on the 4th day) 12 hours after the last dose. RESULTS: A median of 53.5 circulating CD34+ cells per μL (range, 19‐190) was found in the 30 donors on the day of first leukapheresis, which allowed a median CD34+ cell collection of 6.0 × 106 per kg of body weight of the donor and 6.5 × 106 per kg of body weight of the recipient. In 25 (83%) of 30 donors, a single procedure was sufficient to collect the target CD34+ cells, while in the other 5, two leukapheresis procedures were required. Hematologic reconstitution was observed in all patients at a median of 14 days (range, 10‐23) for neutrophils and 14.5 days (range, 11‐46) for platelets. With a median infusion of 3.9 × 108 CD3+ T‐lymphocytes per kg of body weight of the recipient (range, 1.3‐7.8), acute and chronic GVHD occurred in 13 (43%) of 30 and 15 (60%) of 25 evaluable patients, respectively. After a median follow‐up of 337 days from transplant, 22 (73%) of 30 patients are alive in complete remission. CONCLUSION: A schedule consisting of 3‐day administration of gly‐G–CSF followed by a single leukapheresis can be proposed and widely accepted by healthy donors, as 84 percent of them reach the target in the estimated time with a reduced drug exposure. The cost of the procedure is reduced, in terms of both the growth factor administration and the number of leukapheresis procedures. The search for the optimum methods of donor management may improve the acceptability of this procedure and increase the number of allogeneic transplantations from PBPCs.