Collection of peripheral blood stem cells Dr Kacem Karima Department of clinical haematology -HAO CMH - 26/05/2012

High-dose chemotherapy with peripheral blood stem cell support: best option for a high risk group of patients Mobilized peripheral blood stem cells (PBSC): main source for autologous SCT. Successful engraftment relies on CD34+progenitor cell dose. Critical step: effective PBSC mobilization but % of patients fail to mobilize.

Aims of this study: Analysis of mobilized patients profiles. Review of our strategies for collection of PBSC. Establish the influence of certain factors on the outcome of PBSC mobilization

Retrospective analysis Patients with lymphoma (HL, NHL) January December 2011 Haematology department of Aziza Othmana Hospital

RESULTS

H/F53/41 (sex ratio :1.29) Median Age33 (14 – 61) HL44 NHL50 Stage III/IV Initial BM involvement 74(78%) 15 (16%) Nb of patients : 94 Nb of mobilizations : 104 Criterion for adequate mobilization: at least 2.0 x 10 6 CD34+ cells/kg of patient. Leukapheresis: Nb CD34+(PB)≥ 20/mm 3

RefractoryRelapsedTotal CHL Responsive Relapse or refractory Disease NHL440650

Treatment characteristics Previous RT6 Median nb of regimens of CT2 ( 1 – 4 ) Median nb of previous CT courses5 (2 – 12 )

93 patients: mobilized with a combination of chemotherapy and growth factors (G-CSF) - 5γ/kg/day 28 pts 30% - 5 puis 10γ/kg/day 62pts 66.6% - 10 γ/kg/day 3 pts 3.2% One patient with G-CSF only.

Median delay/CT Median delay /G-CSF 15 days(10-28) 9 days (4-22) Nb median leukapheresis1.45 (1 – 3) Nb median collected CD /kg ( /kg) % failure5.3 %

Nb CD /kgp Age (years)0.05 > ±2.24 < ±6.34 Gender0.34 M8.59±6.58 F7.34±5.33 BOM0.25 Involved6.2±4.6 Normal8.34±6.25 RC at mobilization0.28 Yes8.91±7.5 No7.4±4.91 Nb of cycles of CT0.09 < ± 5.35 > 69.6 ± 7.18 Hb (g/dl)0.83 < ± 6.2 > ± 6.06

Correlation between dose G-CSF and Nb CD34 collected Dose (γ/kg/d)p 55.81± then 109.1±6.66

1st PBSC COLLECTION LENOGRASTIMFILGRASTIMp Median nb of CD34+ Cells mobilized /kg /kg0.2

Proven poor mobilizer (GITMO) Peak CD34+ circulating cell count < 20/μl with less than harvested CD34+ cells/kg

Predicted poor mobilizer (GITMO): at least one major criterion or two minor criteria: Major criteria: -Failed previous mobilisation -Prior extensive therapy -Previous therapy: fluda, melphalan Minor criteria -At least 2 prior cytotoxic lines -Refractory disease -Extensive BM involvement at mobilisation -Age > 65 years -BM cellularity < 30% at mobilisation

Failures: 5 in study period 5 between January and May 2012 /13 pts Predictive factors of failure Myelofibrosis1pt Refractory Disease3 pts Prior lines of CT ≥ 23 pts Nb cycles ≥ 63 pts Previous RT2 pts

CONCLUSION: -Peripheral CD34 count is a useful predictor for both harvest timing and successful collection of PBSC. -Identify poor mobilizers patients -G-CSF et Plerixafor : suitable combination for failure collection