Favorable treatment outcome in non-Hodgkin's lymphoma patients with "poor"mobilization of peripheral blood progenitor cells

Our purpose was to evaluate the outcome and costs of high-dose chemotherapy and autologous peripheral blood progenitor cell (PBPC) transplantation in patients with the inability to mobilize sufficient numbers of PBPCs to allo w rapid engraftment after PBPC transplantation. We treated 172 consecutive non-Hodgkin's lymphoma (NHL) patients with cyclophosphamide and granulocyte colony-stimulating factor followed by apheresis to collect PBPCs. The cell s were separated on a Percoll gradient and purged with monoclonal antibodie s and complement. The patients were categorized as "good" mobilizers if a c ollection of greater than or equal to2 x 10(6) CD34(+) cells/kg was obtaine d (n = 138, 80%) or "poor" mobilizers if <2 x 10(6) CD34(+) cells/kg were o btained (n = 34, 20%). With a median follow-up of 3.5 years, there is no st atistically significant difference in actuarial event-free survival, overal l survival, or relapse for good mobilizers compared with poor mobilizers. H owever, there was a trend toward increasing nonrelapse, transplantation-rel ated mortality of 11.8% for poor mobilizers versus 3.6% for good mobilizers (P = .08) and early death from all causes including relapse within 120 day s (poor 20.6% versus good 8.7%, P = .06). The total cost for bone marrow tr ansplantation-related care was significantly higher, at $140,264 for poor m obilizers versus $80,833 for good mobilizers (P = .0001). The population of patients with NHL who mobilize PBPCs poorly into the circulation have a hi gher cost for posttransplant support. However, there is no significant diff erence in relapse, event-free survival, or overall survival for such patien ts compared with those who mobilize PBPCs easily.