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Gruppo Italian Trapianto di Midollo Osseo (GITMO) recently proposed a definition for proven “poor mobilizer” (PM) and criteria for predicted PM (pPM) based on G ± chemotherapy based mobilization strategy. Data from use of combination of G + P for mobilization (Mob) was not utilized in this proposal. We evaluate these criteria in our pts with lymphoma to identify specific prognostic factors.
Patients and Methods:
Data from 122 consecutive lymphoma pts, undergoing Stem Cell Mobilization (SCM) using G 10 µg/kg SC given at 6.00am on D 1-4 + P 0.24 mg/kg SC given once daily in an out-patient setting starting D 4, at our institution from 2009-2012, were collected. PM and pPM pts were identified based on the GITMO criteria. PM were defined as pts who collected < 2.0 x 10^6 CD34+ cells/kg in ≤ 3 apheresis. pPM pts were identified based on proposed criteria of 1 major or at least 2 minor criteria. Demographics, comorbidities, disease status and prior therapies were identified and collected.
Results:
122 pts with lymphoma (average age 52.45 yrs, range: 19-79 yrs) were identified and analyzed as a retrospective cohort. 70 (57%) pts were male and 52 (43%) pts female. 43 (35.2%) pts had ≥2 comorbidities. 88 (72%) pts had B-NHL, 11 (9%) T-NHL and 23 (19%) HD. Based on the GITMO definitions we identified 19 (15.6%) pts [avg age 57.84 yrs; range: 40-72 yrs] were proven PM and 51 (41.8%) pts [avg age 55.9 yrs; range: 27-79 yrs] predicted PM. 3 PM (15.8%) pts and 10 pPM (19.6%) pts had prior full courses of therapies that could adversely affect SCM. 3 PM pts and 19 pPM pts were > 65 yrs. 10 pPM (19.6%) pts had one major and 41 pPM (80.4%) pts had atleast 2 minor criteria favoring poor mobilization. In pPM pts the median total CD34+ cell yield was 4.46 x106 cells/kg in a median of 2 days (range: 1-4 days). 17 pPM (33.3%) pts achieved the minimumCD34+ cell yield of ≥ 2 x106 cells/kg within 1 pheresis day. Advanced disease, refractory disease, extensive BM involvement or cellularity <30% and age > 65 did impact the SCM or predict poor mobilization in either group. No specific predictors were identified in PM pts.
Conclusion:
We conclude that the use of Gruppo Italian Trapianto di Midollo Osseo (GITMO) criteria for prior identification of proven or predicted poor mobilizers although does help to identify potential poor mobilizers in patients with lymphoma, it does not predict the stem cell collection. However it does support the theory that this group of patients would benefit from use of alternative mobilization agents as Plerixafor.