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Cytotherapy. 2019 May 10. pii: S1465-3249(19)30386-X. doi: 10.1016/j.jcyt.2019.04.001. [Epub ahead of print]

Feasibility and cost analysis of day 4 granulocyte colony-stimulating factor mobilized peripheral blood progenitor cell collection from HLA-matched sibling donors.

Author information

1
Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: newelll@ohsu.edu.
2
Hematopoietic Cell Processing Laboratory, Hospital and Clinics, Oregon Health & Science University, Portland Oregon, USA.
3
Knight Cancer Institute, Hematology and Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA.
4
Apheresis Unit, Hospital and Clinics, Oregon Health & Science University, Portland Oregon, USA.
5
Hospital and Clinics Financial Services, Oregon Health & Science University, Portland Oregon, USA.
6
Northwest Marrow Transplant Program, Oregon Health & Science University, Portland Oregon, USA.

Abstract

BACKGROUND:

Guidelines recommend treatment with 4-5 days of granulocyte colony-stimulating factor (G-CSF) for optimal donor peripheral blood progenitor cell (PBPC) mobilization followed by day 5 collection. Given that some autologous transplant recipients achieve adequate collection by day 4 and the possibility that some allogeneic donors may maximally mobilize PBPC before day 5, a feasibility study was performed evaluating day 4 allogeneic PBPC collection.

METHODS:

HLA-matched sibling donors underwent collection on day 4 of G-CSF for peripheral blood (PB) CD34+ counts ≥0.04 × 106/mL, otherwise they underwent collection on day 5. Those with inadequate collected CD34+ cells/kg recipient weight underwent repeat collection over 2 days. Transplant and PBPC characteristics and cost analysis were compared with a historical cohort collected on day 5 per our prior institutional algorithm.

RESULTS:

Of the 101 patient/donor pairs, 50 (49.5%) had adequate PBPC collection on day 4, with a median PB CD34+ cell count of 0.06 × 106/mL. Day 4 donors were more likely to develop bone pain and require analgesics. Median collected CD34+ count was significantly greater, whereas total nucleated, mononuclear and CD3+ cell counts were significantly lower, at time of transplant infusion for day 4 versus other collection cohorts. There were no significant differences in engraftment or graft-versus-host disease. Cost analysis revealed 6.7% direct cost savings for day 4 versus historical day 5 collection.

DISCUSSION:

Day 4 PB CD34+ threshold of ≥0.04 × 106/mL identified donors with high likelihood of adequate PBPC collection. Day 4 may be the optimal day of collection for healthy donors, without adverse effect on recipient transplant outcomes and with expected cost savings.

KEYWORDS:

hematopoietic progenitor cells; hematopoietic stem cell transplantation; peripheral blood stem cells; stem cell mobilization

PMID:
31085121
DOI:
10.1016/j.jcyt.2019.04.001

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