Successful autologous bone marrow rescue in patients who failed peripheralblood stem cell mobilization

We assessed autologous bone marrow (BM) harvest and hematologic recovery af ter high-dose chemotherapy (HDCT) in patients who failed to achieve periphe ral blood stem cell (PBSC) mobilization. One hundred and ninety-three patie nts with germ cell tumor, malignant lymphoma, sarcoma or medulloblastoma we re scheduled for HDCT. In 123 patients, PBSC were mobilized by disease-spec ific chemotherapy plus granulocyte colony-stimulating factor (G-CSF). In 11 0/123 patients (89%) with circulating CD34+ eel counts greater than or equa l to 10/mul, sufficient hematopoietic autografts were collected (group A). In 13/123 patients (11%) with peripheral CD34+ cell counts < 10/<mu>l, PBSC harvesting was not performed (group B). These latter patients were classif ied as "poor mobilizers" and underwent second-line BM harvest at a median o f 46 (range 10-99) days after mobilization failure. Seventy patients with f irst-line BM harvest (group C) acted as historical controls. Ten patients f rom group B proceeded to HDCT and nine were evaluable for hematopoietic rec onstitution. Recovery to neutrophils >0.5 x 10(9)/l was comparable with gro up C patients: 16 (range 9-34) days vs 13 (range 8-98) days. However, plate let (PLT) reconstitution >20 x 10(9)/l was significantly slower, with a med ian of 35 (range 13-50) days as compared with 19 (range 9-148) days (P=0.01 06) for control patients. Supportive care requirements, febrile days and le ngth of hospital stay were not significantly different between the two grou ps of patients. We conclude that patients who fail to mobilize PBSC should be evaluated for second-line BM harvest. This approach may preserve the the rapeutic option of HDCT for these patients.