Predicting failure of hematopoietic stem cell mobilization before it starts: the predicted poor mobilizer (pPM) score

Jacopo Olivieri, Immacolata Attolico, Roberta Nuccorini, Sara Pasquina Pascale, Martina Chiarucci, Monica Poiani, Paolo Corradini, Lucia Farina, Gianluca Gaidano, Luca Nassi, Simona Sica, Nicola Piccirillo, Pietro Enrico Pioltelli, Massimo Martino, Tiziana Moscato, Massimo Pini, Francesco Zallio, Fabio Ciceri, Sarah Marktel, Andrea MengarelliPellegrino Musto, Saveria Capria, Francesco Merli, Katia Codeluppi, Giuseppe Mele, Francesco Lanza, Giorgina Specchia, Domenico Pastore, Giuseppe Milone, Francesco Saraceni, Elvira Di Nardo, Paolo Perseghin, Attilio Olivieri

Research output: Contribution to journalArticlepeer-review

Abstract

Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure.

Original languageEnglish
JournalBone Marrow Transplantation
DOIs
Publication statusE-pub ahead of print - Jan 12 2018

Keywords

  • Journal Article

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