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

Autor: Richard T. Maziarz, Peggy Appel, R. Knight, Rogelyn P. Kwock, Gabrielle Meyers, Laura F. Newell, Bryon Allen, Susan Slater, Brad Cota, Rachel J. Cook, Kelsea M. Shoop, Carol Jacoby, Casondra Ottowa, S. Murray
Rok vydání: 2019
Předmět:
Adult
Male
0301 basic medicine
Cancer Research
medicine.medical_specialty
Adolescent
Platelet Engraftment
medicine.medical_treatment
Immunology
Population
Graft vs Host Disease
Antigens
CD34
Hematopoietic stem cell transplantation
Article
Young Adult
03 medical and health sciences
0302 clinical medicine
Internal medicine
Granulocyte Colony-Stimulating Factor
medicine
Humans
Transplantation
Homologous
Immunology and Allergy
Progenitor cell
Adverse effect
education
Prospective cohort study
Genetics (clinical)
Aged
Transplantation
education.field_of_study
business.industry
Siblings
Incidence (epidemiology)
Hematopoietic Stem Cell Transplantation
Cell Biology
Middle Aged
Hematopoietic Stem Cell Mobilization
Tissue Donors
Blood Cell Count
Granulocyte colony-stimulating factor
Treatment Outcome
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
Costs and Cost Analysis
Feasibility Studies
Female
business
Zdroj: Cytotherapy
ISSN: 1465-3249
DOI: 10.1016/j.jcyt.2019.04.001
Popis: Introduction Published guidelines recommend 6-7 days of G-CSF followed by peripheral blood progenitor cell (PBPC) collection on day 5. Given successful PBPC collection occurs in some autologous transplants by day 4, and concern that a subset of healthy allogeneic donors may be maximally mobilized before day 5, we performed a feasibility study evaluating day 4 allogeneic PBPC collection. Methods This single-center prospective study included adult patients with malignant diseases receiving first allogeneic stem cell transplant between 7/1/2013 – 6/30/2017. HLA-matched sibling donors received 10 μg/kg G-CSF subcutaneously prior to PBPC collection. Donors collected on day 4 of G-CSF if peripheral blood (PB) CD34+ counts were ≥0.04 × 106/ml, and on day 5 if Results 101 patients/donors were eligible for inclusion, with 75 in the historical cohort. Target collection was ≥4 × 106 CD34+ PBPC/kg recipient weight. Of the 101 donors on study, 50 (49.5%) had adequate collection on day 4, 26 (25.7%) collected on day 5, and 25 (24.8%) required two-day collections. Median day 4 PB CD34+ cell count was 0.06 (range 0.03-0.13) × 106/ml for donors collected on day 4, 0.03 (0.007-0.09) × 106/ml for day 5, and 0.019 (0.004-0.04) × 106/ml for two-day collections (p Median collected (7.25 × 106/kg recipient weight) and infused (5.67 × 106/kg recipient weight) PBPC product CD34+ cell counts were significantly greater in day 4 products. In comparison, infused total nucleated (7.13 × 108/kg recipient weight), mononuclear (5.84 × 108/kg recipient weight), and CD3+ (2.14 × 108/kg recipient weight) cell counts were significantly lower in day 4 products. Compared to the historical cohort, donors with day 4 collection were significantly more likely to develop bone pain, require narcotics, and over-the-counter medications. There were no significant differences in time to neutrophil or platelet engraftment, or in the incidence of acute or chronic GVHD. Cost analysis revealed a 6.7% savings in direct costs per collection procedure for the day 4 collection method versus historical cohort. Conclusions Approximately 50% of healthy sibling donors can generate adequate PBPC collection when using a day 4 PB CD34+ threshold of ≥0.04 × 106/ml. While differences in PBPC product composition and donor symptoms were seen based on day of collection, we found no evidence of adverse post-HCT outcomes associated with day 4 PBPC collection. Day 4 may be the optimal day of stem cell collection for a population of healthy donors, without adverse effect on transplant outcomes, and with an anticipated cost savings. These findings merit further analysis in larger HCT cohorts.
Databáze: OpenAIRE
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