Second Attempts at Mobilization of Peripheral Blood Stem Cells in Patients with Initial Low CD34+ Cell Yields

The purpose of this study was to determine the effectiveness of second mobilization strategies in patients who yielded <2.5 x 10⁶ CD34+ PBSC/kg after initial mobilization. Repeat mobilization attempts were made with chemotherapy and G-CSF (n = 61) or G-CSF alone (n = 58) in patients who failed initial mobilization with chemotherapy and G-CSF (n = 92) or G-CSF alone (n = 27). A median of 0.27 X 10⁶ CD34+ cells/kg per apheresis was collected after the second mobilization, compared with 0.16 with initial harvests (p = 0.0001). Forty-eight percent achieved a target CD34+ cell dose ≥2.5 X 10⁶/kg when harvests from the first and second mobilizations were combined. Fifteen of 17 patients (88%) with ≥1.5 X 10⁶ CD34+ cells/kg harvested after first mobilization had ≥2.5 X 10⁶ CD34+ cells/kg collected when first and second harvests were combined, as compared with 42 of 102 (41%) achieving <1.5 X 10⁶ CD34+ cells/kg with first PBSC harvests (p = 0.0001). Second mobilizations with chemotherapy and G-CSF or G-CSF alone resulted in similar CD34+ cell yields. Toxicities of second mobilizations were comparable with those of first mobilizations. Seventy-nine patients (66%) received high-dose chemotherapy with PBSC support, with recovery of neutrophils and platelets in a median of 11 and 15 days, respectively. Transplant-related mortality was 4%, and event-free survival at 2 years was 0.34. It was concluded that second mobilization attempts in patients who fail to achieve ≥2.5 X 10⁶ CD34+ cells/kg on initial mobilization were successful in 48% of patients. G-CSF alone was as effective as chemotherapy plus G-CSF in mobilizing CD34+ cells and was associated with less morbidity.