Autologous transplantation in acute myeloid leukemia: peripheral blood stem cell harvest after mobilization in steady state by granulocyte colony-stimulating factor alone

In order to determine whether granulocyte colony-stimulating factor (G-CSF) alone initiated during steady state was able to mobilize peripheral blood stem cells (PBSC) in acute myeloid leukemia (AML) and to assess predictive factors for engraftment after autologous PBSC transplantation, we studied 4 9 successive adult AML patients for whom autologous transplantation was pla nned between July 1994 and November 1998. G-CSF was used as priming agent a nd was initiated at least 4 weeks after the last day of chemotherapy, while neutrophil count was >0.5x10(9)/1 and platelet count was >30x10(9)/1. A me dian of three aphereses was performed resulting in a median collection of 1 4.8x10(8) nucleated cells/kg containing 7.7x10(8) mononuclear cells/kg, 47. 1x10(4) CFU-GM/kg, and 3.8x10(6) CD34(+) cells/kg. A significant correlatio n was observed between nucleated cell, mononuclear cell, and CFU-GM yields, while no correlation was found with CD34+ cell yield. Recruitment was not significantly different in patients with CD34+ leukemic cells at the time o f initial diagnosis when compared to that of those presenting, with CD34(-) blastic cells. Thirty-three patients actually underwent transplantation. R easons for not autografting were inadequate stem cell harvest (ten patients ), early relapse (two patients), prolonged neutropenia (one patient), organ failure (two patients), or patient refusal (one patient). Median time to a chieve a neutrophil count greater than 0.5x10(9)/1 and platelet count >50x1 0(9)/1 untransfused was 13 and 36 days, respectively. A predictive factor f or a shorter period neutropenia and a shorter thrombopenia was a higher cou nt of harvested nucleated cells (p<0.01 and p=0.02, respectively). A higher count of harvested cells was also a predictive factor for less red cell an d platelet transfusions (p=0.03 and p=0.02, respectively). The number of CD 34(+) harvested PBSC was not predictive for engraftment. We conclude that P BSC mobilization with G-CSF alone initiated in steady state is a feasible, safe, and suitable procedure for harvesting cells in sight of autologous tr ansplantation in adult acute myeloid leukemia.