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Similar efficacy outcomes with peripheral blood stem cell versus bone marrow for autologous stem cell transplantation in acute myeloid leukemia: Long-term follow-up of the EORTC-GIMEMA randomized AML-10 trial
Baron, F., Efficace, F., Cannella, L., Stevens-Kroef, M., Amadori, S., de Witte, T., Lübbert, M., Venditti, A., Suciu, S.
American journal of hematology. 2024
Abstract
We report here the long-term follow-up of the only prospective randomized trial of autologous hematopoietic stem cell transplantation (auto-HSCT) with peripheral blood stem cells (APBSCT) versus auto-HSCT with bone marrow (ABMT) in acute myeloid leukemia (AML) patients in first remission (CR). We observed that among patients alive and still in CR 5 years after planned auto-HSCT, approximately 10% of the patients died in the following 10 years. This stresses the need for long-term close surveillance of AML patients after auto-HSCT. Further, long-term follow-up of the trial confirms that APBSCT was comparable to ABMT in term of disease-free-survival and overall survival.
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2.
Primed for change: The effect of a blood prime on peripheral blood stem cell collection and accuracy of a prediction tool in pediatric patients
Rahim, M. Q., Goebel, W. S., Delph, J., Soundar, E.
Journal of clinical apheresis. 2023
Abstract
Pediatric apheresis collection of peripheral blood stem cells for autologous transplantation often requires use of a blood prime. We evaluated the relationship between pre-apheresis blood CD34(+) counts and final CD34(+) yield with use of a blood prime. Forty patients underwent apheresis stem cell collection in a 5 year period in our hospital, of which 27 required blood priming of the apheresis machine. Despite the blood prime group having significantly higher pre-apheresis CD34(+) cell counts, this group processed a relatively higher volume of blood due to a higher dilutional effect and collected significantly less than predicted CD34(+) cell yield. Use of weight-specific collection efficiencies and dilution-adjusted pre-apheresis CD34(+) counts will help in accurately estimating the whole blood volume to process for PBSC collection and therefore increase efficiency and decrease the overall cost of collection.
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3.
Hematopoietic Progenitor Cell Counts of the Leukapheresis Product Determined Using Sysmex XN Analyzers Predict a Sufficient Number of CD34+ Stem Cells in a Peripheral Blood Stem Cell Harvest for Autologous Transplantation
Imoto, N., Kondo, Y., Uchida, K., Kurahashi, S.
Internal medicine (Tokyo, Japan). 2023
Abstract
Objective Several institutions outsource CD34(+) cell counting of leukapheresis products, limiting rapid measurements, as results are obtained the next day. This problem is compounded with plerixafor use, a stem cell-mobilizing drug that increases leukapheresis efficiency but requires administration the day before leukapheresis. Use of this drug for a second leukapheresis procedure before the first-day leukapheresis CD34(+) count results are confirmed causes unnecessary leukapheresis and expensive plerixafor administration. We investigated whether or not measuring hematopoietic progenitor cells in leukapheresis products (AP-HPCs) using a Sysmex XN-series analyzer could resolve this problem. Patients and methods We retrospectively compared the absolute AP-HPC value per body weight with the CD34(+) (AP-CD34(+)) count in 96 first-day leukapheresis product samples obtained between September 2013 and January 2021. Comparisons were also conducted according to regimen: granulocyte colony-stimulating factor (G-CSF) monotherapy, chemotherapy plus G-CSF, or plerixafor mobilization. Results AP-CD34(+) and AP-HPC counts correlated strongly (r(s) =0.846) overall and, in particular, under chemotherapy plus G-CSF (r(s) =0.92) but correlated mildly under G-CSF monotherapy (r(s) =0.655). AP-HPCs could not completely be dichotomized based on an AP-CD34(+) threshold of 2×10(6)/kg for any stimulation procedure. In most cases with AP-HPCs >6×10(6)/kg, the AP-CD34(+) count exceeded 2.0×10(6)/kg, but in 5.7% of these cases, the AP-CD34(+) count was <2.0×10(6)/kg. A cut-off of AP-HPCs >4.843×10(6)/kg yielded a sensitivity of 71% and specificity of 96% for predicting AP-CD34(+)≥2×10(6)/kg. Conclusion AP-HPCs can identify cases in which sufficient stem cells have been collected.
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4.
Prediction of success of CD34+ collection for autotransplantation in children
Corbel, A., Cousin, E., Le Tallec, A., Fausser, J. L., Pannetier, M., Garrot, E., Gandemer, V.
Bulletin du cancer. 2023
Abstract
INTRODUCTION Intensive chemotherapy with autologous stem cell transplantation is a therapeutic tool used in paediatric oncology. In adult patients, a peripheral blood CD34+ cell count superior to 20/μL enables an adequate collection of peripheral blood stem cells. There are no recommendations for children. This study aimed to determine whether the count of circulating CD34+ cells on the day before cytapheresis predicts successful collection in paediatric patients. METHODS We retrospectively studied all paediatric patients who underwent apheresis for stem cell autotransplantation in the CHU of Rennes between 2010 and 2019. Successful apheresis was defined as a collection superior to 3×10(6) CD34+/kg. "Success" and "failure" groups were compared. RESULTS In total, 122 apheresis procedures were performed in 105 patients. It was a successful procedure in 81% of patients and a failure in 19% of patients. A minimal cut-off of circulating CD34+ count superior to 13/μL on D-1 allowed us to predict a collection of at least 3×10(6) CD34+/kg (PPV 94,8%, NPV 51,4%). For children aged<6 years, the association with leucocyte increase during the 5 days before the procedure improved the prediction of success. DISCUSSION The peripheral blood CD34+ cell count is a predictive factor for successful collection in paediatric patients. The minimal cut-off that allows an adequate collection of peripheral blood stem cells is inferior to the minimal cut-off in adult patients. Nevertheless, this minimal number of circulating CD34+ cells is insufficient to predict the success or failure of apheresis in patients younger than 6 years of age.
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5.
The Impact of CD34(+) Cell Collection Yields for Autologous Transplant on Survival Outcomes in Multiple Myeloma
Lebel, E., Lajkosz, K., Masih-Khan, E., Reece, D., Trudel, S., Tiedemann, R., Prica, A., Kukreti, V., Chen, C.
Clinical lymphoma, myeloma & leukemia. 2023
Abstract
INTRODUCTION According to previous data, higher yields of stem-cells collected to support autologous transplantation may predict for improved outcomes. We aimed to assess the association between high stem-cells collection and survival outcomes in multiple myeloma (MM) MATERIALS AND METHODS We reviewed all patients who underwent autologous transplantation for MM at our center over a 10-year period, and initially used a predefined threshold of 8 × 10(6)/kg used in previous studies. RESULTS Six hundred twenty-one patients were analyzed. Higher mobilization did not correlate with favorable outcomes post-transplant. The most efficient mobilizers, collecting ≥8 × 10(6)/kg (n = 478) achieved a shorter median progression-free survival (PFS) of 24.1m versus 34.5m in patients collecting 4.5 to 8 × 10(6)/kg (n = 129). A small group (n = 14) collecting ≤4.5 × 10(6)/kg but minimum of 2 × 10(6)/kg to support autologous transplantation exhibited the worst outcomes (median PFS 11.4m). Further analysis of potential confounders identified greater use of bortezomib induction in the lower mobilizers, however, sensitivity analysis in patients receiving bortezomib revealed similar results- worst outcomes to the most efficient mobilizers. CONCLUSION Although bortezomib is not considered stem-cell toxic, it may be associated with lower stem cell collection yields. Bortezomib's efficacy at induction may partially explain the improved outcomes, however, other factors may be involved, and are discussed. We can conclude that with our large cohort and long follow-up, high stem-cell mobilization does not appear to predict for a long-term survival advantage.
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6.
Retrospective comparison of two different cell separators for autologous peripheral blood stem cell collection: Single center experience
Keklik, M.
Hematology, transfusion and cell therapy. 2023
Abstract
INTRODUCTION Autologous peripheral blood stem cell (PBSC) transplantation has become a standard treatment option for certain hematological malignancies. The collection of PBSCs for transplantation is a well-established process and the effectiveness can vary depending on the cell separator. We aimed to compare the effectivity of two devices, the Spectra Optia and the Amicus for autologous PBSC collection. We also evaluated the effect of the peripheral white blood cell (WBC) count on the CD34+ collection efficiency (CE2). METHODS We retrospectively evaluated 262 apheresis procedures performed in patients between 2015 and 2021 at the Apheresis Unit of our transplantation center. The PBSCs were collected by the Spectra Optia cell separator with continuous Mononuclear Collection (cMNC) (128 procedures) or the Amicus (MNC) (134 procedures). In addition to the apheresis parameters and product characteristics, we also evaluated the effect of the pre-apheresis peripheral WBC count on the CE2. RESULTS There was no significant difference in the CD34+ CE2 between the Spectra Optia and Amicus devices (median 65.06% and 68.24%, respectively, p = 0.070). In the Amicus group, the CE2 ratio was found to be statistically significantly higher in patients with a pre-apheresis peripheral WBC count of 15 × 10(9)/L (median 81.70%, 68.06%, 61.35% and 58.13%, respectively, p < 0.001). CONCLUSION While both devices collected autologous PBSC effectively and safely, the Amicus provided a higher rate of CE2 at low pre-apheresis WBC counts. To our knowledge, this is the first study to evaluate the CE2 in autologous PBSC collection devices based on pre-apheresis WBC counts.
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7.
Impact of residual tumor cells in the stem cell collection on multiple myeloma patients receiving autologous stem cell transplantation
Xu, J., Yan, W., Fan, H., Liu, J., Li, L., Du, C., Deng, S., Sui, W., Xu, Y., Qiu, L., et al
Annals of hematology. 2023
Abstract
Autologous stem cell transplantation (ASCT) is the standard therapy for patients with transplant-eligible multiple myeloma (TEMM). However, the ideal depth of response required before ASCT and the impact of residual tumor cells in the stem cell collection (SCC) on survival remains unclear. Here we collected data of 89 patients with TEMM undergoing ASCT and analyzed the minimal residual disease of SCC (cMRD) and bone marrow (BM) (mMRD) before transplantation. Before ASCT, 31.5% and 76.4% of patients achieved MRD negativity in BM and SCC, respectively. Tumor cells were less in SCC samples than that in BM samples. Neoplastic cells in SCC could be observed in patients with different responses after induction therapy, and there were no significant differences in the percentage and level of cMRD among these subgroups (P > 0.05). No correlation was found between the cMRD status and the response patients achieved after ASCT (P > 0.05). The median follow-up was 26.8 months. mMRD negativity before ASCT was associated with longer PFS (55.9 vs. 27.1 months; P = 0.009) but not OS (not reached vs. 58.9 months; P = 0.115). Patients with different cMRD statuses before ASCT experienced similar PFS (40.5 vs. 76.4 months for negativity vs. positivity; P = 0.685) and OS (not reached vs. 58.8 months for negativity vs. positivity; P = 0.889). These results suggested that detectable cMRD does not significantly predict the inferior post-ASCT response or shorter survival, and patients are eligible to undergo ASCT upon achieving partial response.
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8.
Prolonged Lenalidomide Induction Does Not Significantly Impair Stem Cell Collection in Multiple Myeloma Patients Mobilized With Cyclophosphamide or Plerixafor: A Report From The Covid Era
Rybinski, B., Rapoport, A. P., Badros, A. Z., Hardy, N., Kocoglu, M.
Clinical lymphoma, myeloma & leukemia. 2022
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Free full text
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Abstract
INTRODUCTION Induction therapy for multiple myeloma is traditionally capped at 6 cycles of lenalidomide due to concerns that longer treatment compromises the ability to collect sufficient stem cells for autologous stem cell transplantation (ASCT). However, during the COVID-19 pandemic, many of our patients received prolonged lenalidomide induction due to concerns about proceeding to ASCT. We investigated whether prolonged induction with lenalidomide affects the efficacy of stem cell collection among patients mobilized with cyclophosphamide and/or plerixafor. PATIENTS AND METHODS This single center, retrospective study included patients who were treated with lenalidomide induction regimens, received mobilization with cyclophosphamide or plerixafor, and underwent apheresis in preparation for ASCT. 94 patients were included, 40 of whom received prolonged induction with >6 cycles of lenalidomide containing regimen. RESULTS Patients who received prolonged induction were more likely to require >1 day of apheresis (38% vs. 15%; OR 3.45; P = .0154), and there was a significant correlation between the duration of lenalidomide treatment and the apheresis time required to collect sufficient cells for transplant (R(2) = 0.06423, P = .0148). However, there was no significant difference between patients who received prolonged induction and those who did not with respect to CD34(+) stem cell yields at completion of apheresis (9.99 vs. 10.46 cells/Kg, P = .5513) or on the first day of collection (8.29 vs. 9.59 cells/Kg, P = .1788). CONCLUSION Among patients treated with >6 cycles of lenalidomide, mobilization augmented with cyclophosphamide and/or plerixafor will likely facilitate sufficient stem cell harvest to permit ASCT.
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Impact of daratumumab based induction on stem cell collection parameters in Swedish myeloma patients
Lemonakis, K., Tatting, L., Lisak, M., Carlson, K., Crafoord, J., Blimark, C. H., Santamaria, A. I., Wichert, S., Lenhoff, S., Hansson, M.
Haematologica. 2022
Abstract
Not available.
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10.
Usefulness of hematopoietic progenitor cell monitoring to predict autologous peripheral blood stem cell harvest timing: A single-center retrospective study
Kasane, M., Kurosawa, S., Kojima, M., Iwashita, N., Kase, Y., Tsubokura, M., Nakabayashi, S., Ikeda, C., Kawamura, K., Matsushita, H., et al
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2021;:103150
Abstract
INTRODUCTION In autologous peripheral blood stem cell harvest (APBSCH), CD34-positive cells have been measured to assess the numbers of hematopoietic stem cells, but measurement requires specialized equipment. Recently, there was a report that peripheral blood hematopoietic progenitor cells (HPCs) are useful indicators of the presence of hematopoietic stem cells. We examined the usefulness of HPC monitoring to predict APBSCH timing. METHODS We retrospectively analyzed the relationship between HPC and collected CD34-positive cells in 84 consecutive patients who underwent APBSCH. RESULTS According to the receiver operating characteristics curve for the collection of =2 × 106 CD34-positive cells/kg, the HPC cut-off value on the day before collection was 21/µL, while that on the day of collection was 41/µL. No significant factors were found in the univariate analysis except for the HPC count on the day before collection (p < 0.001) and the day of collection (p < 0.001). According to the multivariate analysis, the HPC count on the day before collection (p < 0.001) and the day of collection (p < 0.001) were also factors that strongly influenced the quantity of CD34-positive cells collected. CONCLUSION Our results suggest that the HPC count on not only the day of collection but also the day before collection is a good indicator for appropriate APBSCH timing.