Timing of G-CSF Injection for Effective Autologous Stem Cell Collection

Granulocyte colony-stimulating factor (G-CSF) has been given approximately 12 hours before leukapheresis in the patients who are planned to do autologous stem cell collection. The objective of this study was to identify better timing of G-CSF administration which improves the efficacy of autologous stem cell collection. A total of 262 patients (157 male and 105 female patients, ages from 15 to 66 years with median of 49 years) who underwent autologous stem cell collection from January 2000 to March 2008 were included. The patients were diagnosed with Hodgkin’s lymphoma (N=19), non-Hodgkin’s lymphoma (N=131) and multiple myeloma (N=112). Peripheral blood stem cells were mobilized with lenograstim (Choongwae Pharma Corp., Seoul, Korea) following chemotherapy, such as cyclophosphamide (N=141), ESHAP (Etoposide, methylprednisolone, Ara-C and cisplatin, N=73) with (N=14) or without rituximab (N=59) and other chemotherapy regimens (N=48). Before November 2004, patients received lenograstim injection at a dose of 10 μg/kg subcutaneously at 8:00 PM and underwent peripheral stem cell collection on next day (N=129). After then patients received lenograstim injection at 6:00 AM and underwent peripheral stem cell collection at the same day (N=133). Injection of lenograstim at 6 AM was superior to injection of lenograstim at 8 PM with greater numbers of total collected CD34+ cells/kg in shorter duration of leukapheresis procedures (13.29 × 10⁶ versus 8.51 × 10⁶ CD34+ cells/kg; p=0.001, 2 versus 3 leukapheresis procedures; p=0.035). The median number of CD34+ cells/kg collected at first leukapheresis was also greater in 6 AM group (3.94 × 10⁶ versus 2.47 × 10⁶ CD34+ cells/kg; p=0.001). Stem cell collection efficacy defined as ratio of total collected CD34+ cells per days of leukpaheresis were 5.34 and 2.96, respectively. It was significantly better in the group of patients received lenograstim injection at 6 AM (p=0.001). The median number of patients who achieved a total collected CD34+ cells > 5 × 10⁶/kg was also greater in 6 AM group (113 versus 96; p=0.002). The present study shows that injection of lenograstim at 6 AM improves the efficacy of stem cell collection with greater number of collected CD34+ cells/kg in shorter duration of leukapheresis procedures compared to that of 8 PM group.