FACTORS THAT INFLUENCE COLLECTION AND ENGRAFTMENT OF AUTOLOGOUS PERIPHERAL-BLOOD STEM-CELLS

Purpose: To analyze factors that affect the collection of peripheral-b lood stem cells (PBSC) before transplant and the tempo of engraftment after transplant. Patients and Methods: A consecutive series of 243 pa tients with breast cancer (n = 87), malignant lymphoma (n = 90), multi ple myeloma (n = 32), or other malignancies (n = 34) had PBSC collecte d following stimulation with colony-stimulating factors (CSFs) or afte r chemotherapy followed by CSF. Infusion of PBSC was performed followi ng myeloablative chemotherapy with chemotherapy with or without total- body irradiation (TBI). Postinfusion CSFs were administered to 72 pati ents. An analysis of factors that influence CD34(+) cell yield was per formed by linear regression. Cox regression analysis was used to deter mine factors that affect the kinetics of granulocyte and platelet reco very following infusion of PBSC. Results: Mobilization with chemothera py followed by CSF, a diagnosis of breast cancer, absence of marrow di sease, no prior history of radiation therapy, and fewer cycles of conv entional-dose chemotherapy were associated with a higher average daily yield of CD34(+) cells. In the multivariate analysis, the CD34 conten t of infused cells and the use of a posttransplant CSF influenced neut rophil recovery after infusion of PBSC. CD34 content was also importan t for predicting platelet recovery. The use of postinfusion CSF was as sociated with ct significant delay in platelet recovery in patients wh o received less than 5.0 x 10(6) CD34(+) cells/kg, but there was no di scernable effect in patients who received greater than 5.0 x 10(6) CD3 4(+) cells/kg. Conclusion: Disease states and prior treatment influenc e the ability to mobilize PBSC. CD34 cell dose is an important predict or of engraftment kinetics after PBSC transplant, regardless of diseas e or mobilization technique. The use of postinfusion CSF improves neut rophil recovery, but at low CD34 doses con delay platelet recovery. (C ) 1995 by American Society of Clinical Oncology.