Mobilization Strategies: HPC(A) Collections for Autologous Hematopoietic Cell Transplants
Autologous hematopoietic cell transplantation with peripheral blood progenitor cells is a potentially curative treatment option for a variety of hematological diseases. Common strategies for peripheral blood CD34+ cell mobilization include the use of hematopoietic growth factors alone or in combination with chemotherapy, resulting in a marked increase of CD34+ cells in the peripheral blood. However, a significant proportion of patients fail to mobilize adequately. To enhance CD34+ cell release from the bone marrow, plerixafor, a chemokine receptor type 4 (CXCR4) antagonist, can be given in addition to growth factors ± chemotherapy.
In this chapter, we aim to show the best approaches to mobilize CD34+ cells and possibilities of optimizing collection yields in patients who mobilize poorly. We list risk factors for poor mobilization and, based on this factors, suggest appropriate mobilization regimens. As the most robust predictive factor for poor CD34+ cell collection is the CD34+ cell count in the peripheral blood before initiation of apheresis, a defined threshold helps to identify patients at risk and allows preemptive intervention to immediate rescue mobilization in these patients.
In addition, we discuss minimal and optimal CD34+ cell collected dose for sustained engraftment and engraftment characteristics associated with lower-than-optimal cell dose.
KeywordsG-CSF Plerixafor Mobilization Collection Transplantation Progenitor cell CD34+ cell hematopoiesis
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