Abstract

Abstract 2142

Poster Board II-119

High-dose chemotherapy in conjunction with autologous SCT is the preferred treatment of relapsed Hodgkin disease and non-Hodgkin lymphoma and newly diagnosed multiple myeloma. Failure to achieve optimal stem cell mobilization results in multiple subsequent attempts, which consumes large amounts of growth factors and potentially requires antibiotics and transfusions. We retrospectively reviewed the natural history of stem cell mobilization attempts at our institution from 2001 through 2007 to determine the frequency of suboptimal mobilization in patients with hematologic malignancy undergoing autologous transplant and analyzed the subsequent resource utilization in patients with initially failed attempts. Of 1,775 patients undergoing mobilization during the study period, stem cell collection (defined by the number of CD34+ cells/kg) was “ optimal” (≥5×106) in 53%, “low” (≥2 to 5×106) in 25%,“ poor” (<2×106) in 10%, and “failed” (<10 CD34+ cells/mL) in 12%. In the 47% of collections that were less than optimal, increased resource consumption included increased use of growth factors and antibiotics, subsequent chemotherapy mobilization, increased transfusional support, more apheresis procedures, and more frequent hospitalization. Other costs often omitted include the need for hospitalization, which was seen in 5% to 11% of the patients in our study. Parenteral antibiotics were needed when fever developed in 7% of patients with Hodgkin disease, 4% with non-Hodgkin lymphoma, and 24% with multiple myeloma who underwent mobilization using a chemotherapy pulse. When stem cell mobilization was not immediately optimal, subsequent attempts to mobilize failed completely in 3 of 42 patients (7%) with Hodgkin disease (3% of the original Hodgkin disease cohort), 56 of 157 (36%) with multiple myeloma (6% of the original myeloma cohort), and 50 of 328 (15%) with non-Hodgkin lymphoma (7% of the original non-Hodgkin lymphoma cohort). These usually unappreciated costs of stem cell mobilization failure highlight the need for more effective mobilization strategies.

Table 1.

Outcome of Collection Attempts

Collection Outcomeb Diseasea
 
Hodgkin Disease (n=93) Non-Hodgkin Lymphoma (n=685) Multiple Myeloma (n=997) 
Optimal (≥5×10640 (43) 199 (29) 699 (70) 
Low (≥2 to <5×10628 (30) 262 (38) 162 (16) 
Poor (<2×1068 (9) 119 (17) 48 (5) 
Failed 17 (18) 105 (15) 88 (9) 
Collection Outcomeb Diseasea
 
Hodgkin Disease (n=93) Non-Hodgkin Lymphoma (n=685) Multiple Myeloma (n=997) 
Optimal (≥5×10640 (43) 199 (29) 699 (70) 
Low (≥2 to <5×10628 (30) 262 (38) 162 (16) 
Poor (<2×1068 (9) 119 (17) 48 (5) 
Failed 17 (18) 105 (15) 88 (9) 
a

Values are No. of patients (%).

b

Outcome given as number of CD34+ cells/kg.

Table 2.

Prior Therapy in Suboptimal Mobilizations

No. of Regimensb Diseasea
 
Non-Hodgkin Lymphoma (n=486) Multiple Myeloma (n=298) 
Hodgkin Disease (n=53) 
2 (0.4) 
4 (8) 88 (18) 173 (58) 
30 (57) 200 (41) 80 (27) 
17 (32) 88 (18) 24 (8) 
≥4 2 (4) 108 (22) 21 (7) 
No. of Regimensb Diseasea
 
Non-Hodgkin Lymphoma (n=486) Multiple Myeloma (n=298) 
Hodgkin Disease (n=53) 
2 (0.4) 
4 (8) 88 (18) 173 (58) 
30 (57) 200 (41) 80 (27) 
17 (32) 88 (18) 24 (8) 
≥4 2 (4) 108 (22) 21 (7) 
a

Values are No. of mobilizations (%).

b

No. of primary chemotherapy regimens for the malignancy before attempting to collect stem cells.

Table 3.

Characteristics of Patients With Suboptimal Mobilization

Characteristic Diseasea
 
Hodgkin Disease (n=42) Non-Hodgkin Lymphoma (n=328) Multiple Myeloma (n=157) 
Male sex 21 (50) 218 (66) 100 (64) 
Age, y 40b (28-49) 59b (50-65) 63b (57-69) 
CD34+ cell yield, cells/kgc    
    Optimal (≥5×1060 (0) 0 (0) 0 (0) 
    Low (≥2 to <5×10625 (60) 187 (57) 100 (64) 
    Poor (<2×1065 (12) 80 (24) 19 (12) 
    Failed 12 (29) 61 (19) 38 (24) 
Prior radiotherapy 25 (60) 107 (33) 66 (42) 
No. of apheresis rounds 3 (0-4) 3 (2-4) 4b (2-6) 
No. of prior primary chemotherapy regimens 2 (2-3) 2 (2-3) 1b (1-2) 
Characteristic Diseasea
 
Hodgkin Disease (n=42) Non-Hodgkin Lymphoma (n=328) Multiple Myeloma (n=157) 
Male sex 21 (50) 218 (66) 100 (64) 
Age, y 40b (28-49) 59b (50-65) 63b (57-69) 
CD34+ cell yield, cells/kgc    
    Optimal (≥5×1060 (0) 0 (0) 0 (0) 
    Low (≥2 to <5×10625 (60) 187 (57) 100 (64) 
    Poor (<2×1065 (12) 80 (24) 19 (12) 
    Failed 12 (29) 61 (19) 38 (24) 
Prior radiotherapy 25 (60) 107 (33) 66 (42) 
No. of apheresis rounds 3 (0-4) 3 (2-4) 4b (2-6) 
No. of prior primary chemotherapy regimens 2 (2-3) 2 (2-3) 1b (1-2) 
a

Values are No. of patients (%) or median (interquartile range).

b

P<.001.

c

After first suboptimal mobilization attempt.

Disclosures:

Gertz:genzyme: Research Funding.

Author notes

*

Asterisk with author names denotes non-ASH members.