Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: A single center experience

Attilio Olivieri, Massimo Offidani, Mauro Montanari, Luca Ciniero, Isabella Cantori, Laura Ombrosi, Cristiana M. Masia, Riccardo Centurioni, Stefania Mancini, Marino Brunori, Pietro Leoni

Research output: Contribution to journalArticle

Abstract

Background and Objective. While the minimum number of CD34+ cells required for complete and long lasting engraftment is quite well established, there is not general agreement about the optimal number of CD34+ per kg needed in order to obtain engraftment as rapidly as possible. In the present study we assess factors affecting hemopoietic recovery and the optimal peripheral blood progenitor cell (PBPC) number for rapid engraftment in patients treated with high-dose therapy. Design Methods. We enrolled 80 consecutive patients affected by hematologic and non-hematologic malignancies treated with a median of 10 chemotherapy courses (range 3-38). PBPC collection was performed after mobilization with high-dose chemotherapy and G-CSF 5 μg/kg/day. The circulating and harvested CD34+ cells were recognized in the cytofluorimetric CD45+/CD14- lymphocyte gate. After myeloablative therapy, PBPC infusion was followed by G-CSF 5 μg/kg/day from day +5 until WBC ≤ 5.0x109/L. Univariate and multivariate Cox analyses were performed to investigate factors affecting hemopoietic recovery. The Kaplan- Meier probabilities of hemopoietic reconstitution were compared by log-rank test to assess the optimal CD34+ cell number for rapid engraftment. Results. We performed a median of two apheresis (range 1-4) per patient and we infused a median of 6.1x106 CD34+ cells/kg (range 0.5-30.5). Absolute neutrophil count (ANC) > 0.5x109/L was reached after 11 days (range 8-15). The only factor affecting granulocyte recovery proved to be the CD34+ cell number, 5.0 to 7.8x105 CD34+ cells/kg allowed a significantly faster granulocyte recovery than <2.5x106 CD34+ cells/kg (p = 0.0312). Platelet transfusion independence (> 20x109/L) and 50x109/L platelets were reached after 12 (range 8-24) and 15 days (range 9-40), respectively. The CD34+ cell number was also the only factor affecting platelet recovery; the number of 5.0 to 7.8 CD34+ cells/kg allowed a significantly faster platelet recovery than the lower dose, whereas a higher number did not. No late graft failures were observed. Patients receiving 5.0 to 7.8x109 CD34+ cells/kg had a significantly shorter duration of neutropenia, fewer platelet transfusions and less time spent in hospital than those receiving lower number did, whereas patients transplanted with a higher number had no advantage. Interpretation and Conclusions. When G-CSF is employed both for PBPC mobilization and after PBPC transplantation, the CD34+ cell number is the only factor that affects hemopoietic recovery. Moreover, > 5.0x106 CD34+ cells/kg is the optimal number for obtaining rapid platelet recovery and reducing the costs of HDT but there is no advantage exceeding the threshold of 7.8x106 CD34+ cells/kg.

Original languageEnglish
Pages (from-to)329-337
Number of pages9
JournalHaematologica
Volume83
Issue number4
Publication statusPublished - Apr 1998

Keywords

  • G-CSF
  • Hemopoietic recovery
  • High-dose therapy
  • PBCP autotransplantation

ASJC Scopus subject areas

  • Hematology

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    Olivieri, A., Offidani, M., Montanari, M., Ciniero, L., Cantori, I., Ombrosi, L., Masia, C. M., Centurioni, R., Mancini, S., Brunori, M., & Leoni, P. (1998). Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: A single center experience. Haematologica, 83(4), 329-337.