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

J. Olivieri, I. Attolico, R. Nuccorini, S.P. Pascale, M. Chiarucci, M. Poiani, P. Corradini, L. Farina, G. Gaidano, L. Nassi, S. Sica, N. Piccirillo, P.E. Pioltelli, M. Martino, T. Moscato, M. Pini, F. Zallio, F. Ciceri, S. Marktel, A. MengarelliP. Musto, S. Capria, F. Merli, K. Codeluppi, G. Mele, F. Lanza, G. Specchia, D. Pastore, G. Milone, F. Saraceni, E. Di Nardo, P. Perseghin, A. 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. © 2017 The Author(s) 2017, under exclusive licence to Macmillan Publishers Limited, part of Springer Nature.
Original languageEnglish
Pages (from-to)461-473
Number of pages13
JournalBone Marrow Transplantation
Volume53
Issue number4
DOIs
Publication statusPublished - 2018

Keywords

  • carmustine
  • cyclophosphamide
  • cytarabine
  • filgrastim
  • fludarabine
  • granulocyte colony stimulating factor
  • lenalidomide
  • lenograstim
  • melphalan
  • pegfilgrastim
  • plerixafor, adult
  • age
  • area under the curve
  • Article
  • bone marrow biopsy
  • cancer radiotherapy
  • cytopenia
  • diagnostic test accuracy study
  • female
  • Hodgkin disease
  • human
  • lymphoma
  • major clinical study
  • male
  • medical decision making
  • middle aged
  • multiple cycle treatment
  • multiple myeloma
  • nonhodgkin lymphoma
  • observational study
  • prediction
  • predictive value
  • priority journal
  • receiver operating characteristic
  • remission
  • retrospective study
  • risk assessment
  • scoring system
  • sensitivity and specificity
  • stem cell mobilization
  • treatment failure

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