Abstract
Abstract 4387
Absolute peripheral blood (PB) pre-apheresis CD34+ count has been shown to predict the CD34+ yield/Kg in patients undergoing autologous stem cell mobilization and apheresis. Determining correlates of PB pre-apheresis CD34+ counts would facilitate identifying patients that may be at high risk of mobilization failure.
A total of 851 consecutive autologous apheresis procedures were performed at M.D. Anderson Cancer Center between January 2005 and December 2009. We randomly selected half (N=413) of this study population to serve as a study sample (described in table), and preserved the remaining for validation studies. In this study population, we observed that 96% of patients with PB pre-apheresis CD34+ counts of >40/μL collected >2×106 CD34+cells/Kg on the first day of apheresis. We sought to determine patient and disease characteristics that are associated with higher PB pre-apheresis CD34+ counts (>40/μL). These factors included patient age (quartiles), gender, weight (quartiles), diagnosis (Multiple Myeloma vs. Hodgkin's and Non-Hodgkin's Lymphoma), disease status at transplant (remission vs. active disease), number of prior chemotherapy regimens (< 2 vs. ≥2), blood count on day of collection: hemoglobin level (≤10 vs. >10 g/dL), WBC (<4 vs. ≥ 4 ×109/L), absolute neutrophil count [ANC] (< vs.≥ median), and platelet count (≤150 vs. <150 ×109/L); and number days (≤ vs. > median) from the beginning of mobilization to the first apheresis procedure.
On univariate analysis, shorter duration from beginning of mobilization therapy to first day of apheresis (odds ratio [OR] =4.7, p <0.001), and weight >95 Kg (OR=1.8, p=0.01), were significantly associated with a PB CD34+count >40/μL; whereas a diagnosis of Multiple Myeloma (OR=0.5, p=0.002), age >60 years (OR=0.6, p=0.009), pre-apheresis WBC <4 × 109/L (OR=0.5, p=0.004) and ANC (< median p=0.003) were significantly associated with PB CD34+ counts of ≤ 40/μL. These factors, with the exception of age, remained significant on multivariate analysis. Shorter duration of mobilization (OR=8.1, p<0.001) had the strongest association with PB CD34+ count >40/μL. A diagnosis of Multiple Myeloma was associated with lower PB CD34+ count in patients who had a shorter mobilization course (OR=0.3, p<0.001), but not in those who took longer to mobilize. Lower WBC and ANC counts were associated with lower PB CD34+ count, and this effect was more pronounced for patients who had both low WBC and ANC (OR=0.4, p=0.001) than for those who had low ANC but high WBC count (OR=0.5, p=0.025). Weight >95 Kg was still associated with higher PB CD34+ count, (OR=1.9, p 0.01). There was no association between PB CD34+ count and any of the remaining factors evaluated.
Our data suggest that patients who take longer to mobilize, have low WBC and [ANC] pre-apheresis might benefit from early intervention with novel mobilization strategies.
| . | N=413 . | (%) . | PB CD34+>40μ/L (%) . |
|---|---|---|---|
| Diagnosis | |||
| Multiple Myeloma | 232 | 56% | 33% |
| Non-Hogkin's Lymphoma | 132 | 32% | 46% |
| Hodgkin's Lymphoma | 49 | 12% | 55% |
| Gender | |||
| Female | 160 | 39% | 35% |
| Male | 253 | 61% | 43% |
| Duration of mobilization (days) | |||
| ≤ median | 261 | 68% | 50% |
| >median | 125 | 32% | 18% |
| Age, (years) | |||
| ≤ 50 | 124 | 30% | 51% |
| 51-60 | 132 | 32% | 40% |
| 61-70 | 122 | 30% | 34% |
| >70 | 35 | 8% | 23% |
| Weight, Kg (quartiles) | |||
| ≤ 70 | 104 | 25% | 32% |
| 71-85 | 113 | 27% | 39% |
| 86-95 | 82 | 20% | 38% |
| >95 | 114 | 28% | 50% |
| Disease status at mobilization | |||
| Active disease | 87 | 21% | 37% |
| No Active disease | 320 | 79% | 52% |
| Prior Chemotherapy regimens | |||
| >2 | 146 | 35% | 42% |
| ≤ 2 | 266 | 65% | 38% |
| Blood count pre- apheresis | |||
| Hemoglobin (g/dL) | |||
| ≤ 10 | 85 | 21% | 40% |
| >10 | 324 | 79% | 40% |
| WBC (x109/L) | |||
| <4 | 117 | 29% | 29% |
| ≥4 | 292 | 71% | 44% |
| ANC (x109/L) | |||
| < median | 251 | 61% | 34% |
| ≤ median | 158 | 39% | 49% |
| Platelets, (x109/L) | |||
| ≤ 150 | 75 | 18% | 33% |
| >150 | 334 | 82% | 42% |
| WBC (x109/L) / ANC (x109/L) | |||
| WBC >4 / ANC> median | 157 | 38% | 50% |
| WBC>4 / ANC ≤ median | 135 | 33% | 38% |
| WBC≤ 4 / ANC > median | 116 | 28% | 29% |
| . | N=413 . | (%) . | PB CD34+>40μ/L (%) . |
|---|---|---|---|
| Diagnosis | |||
| Multiple Myeloma | 232 | 56% | 33% |
| Non-Hogkin's Lymphoma | 132 | 32% | 46% |
| Hodgkin's Lymphoma | 49 | 12% | 55% |
| Gender | |||
| Female | 160 | 39% | 35% |
| Male | 253 | 61% | 43% |
| Duration of mobilization (days) | |||
| ≤ median | 261 | 68% | 50% |
| >median | 125 | 32% | 18% |
| Age, (years) | |||
| ≤ 50 | 124 | 30% | 51% |
| 51-60 | 132 | 32% | 40% |
| 61-70 | 122 | 30% | 34% |
| >70 | 35 | 8% | 23% |
| Weight, Kg (quartiles) | |||
| ≤ 70 | 104 | 25% | 32% |
| 71-85 | 113 | 27% | 39% |
| 86-95 | 82 | 20% | 38% |
| >95 | 114 | 28% | 50% |
| Disease status at mobilization | |||
| Active disease | 87 | 21% | 37% |
| No Active disease | 320 | 79% | 52% |
| Prior Chemotherapy regimens | |||
| >2 | 146 | 35% | 42% |
| ≤ 2 | 266 | 65% | 38% |
| Blood count pre- apheresis | |||
| Hemoglobin (g/dL) | |||
| ≤ 10 | 85 | 21% | 40% |
| >10 | 324 | 79% | 40% |
| WBC (x109/L) | |||
| <4 | 117 | 29% | 29% |
| ≥4 | 292 | 71% | 44% |
| ANC (x109/L) | |||
| < median | 251 | 61% | 34% |
| ≤ median | 158 | 39% | 49% |
| Platelets, (x109/L) | |||
| ≤ 150 | 75 | 18% | 33% |
| >150 | 334 | 82% | 42% |
| WBC (x109/L) / ANC (x109/L) | |||
| WBC >4 / ANC> median | 157 | 38% | 50% |
| WBC>4 / ANC ≤ median | 135 | 33% | 38% |
| WBC≤ 4 / ANC > median | 116 | 28% | 29% |
Totals may vary because of missing data.
Popat:Otsuka: Research Funding.
Author notes
Asterisk with author names denotes non-ASH members.
