부산대학교 도서관

Introduction Published guidelines recommend 6-7 days of G-CSF followed by peripheral blood progenitor cell (PBPC) collection on day 5. Given successful PBPC collection occurs in some autologous transplants by day 4, and concern that a subset of healthy allogeneic donors may be maximally mobilized before day 5, we performed a feasibility study evaluating day 4 allogeneic PBPC collection. Methods This single-center prospective study included adult patients with malignant diseases receiving first allogeneic stem cell transplant between 7/1/2013 – 6/30/2017. HLA-matched sibling donors received 10 μg/kg G-CSF subcutaneously prior to PBPC collection. Donors collected on day 4 of G-CSF if peripheral blood (PB) CD34+ counts were ≥0.04 × 106/ml, and on day 5 if <0.04 × 106/ml. Those with inadequate collected CD34+ cells/kg recipient weight underwent repeat collection. Transplant characteristics, PBPC product composition, and cost analysis of the collection procedure were compared to a historical cohort collected on day 5. Results 101 patients/donors were eligible for inclusion, with 75 in the historical cohort. Target collection was ≥4 × 106 CD34+ PBPC/kg recipient weight. Of the 101 donors on study, 50 (49.5%) had adequate collection on day 4, 26 (25.7%) collected on day 5, and 25 (24.8%) required two-day collections. Median day 4 PB CD34+ cell count was 0.06 (range 0.03-0.13) × 106/ml for donors collected on day 4, 0.03 (0.007-0.09) × 106/ml for day 5, and 0.019 (0.004-0.04) × 106/ml for two-day collections (p<0.001). Median collected (7.25 × 106/kg recipient weight) and infused (5.67 × 106/kg recipient weight) PBPC product CD34+ cell counts were significantly greater in day 4 products. In comparison, infused total nucleated (7.13 × 108/kg recipient weight), mononuclear (5.84 × 108/kg recipient weight), and CD3+ (2.14 × 108/kg recipient weight) cell counts were significantly lower in day 4 products. Compared to the historical cohort, donors with day 4 collection were significantly more likely to develop bone pain, require narcotics, and over-the-counter medications. There were no significant differences in time to neutrophil or platelet engraftment, or in the incidence of acute or chronic GVHD. Cost analysis revealed a 6.7% savings in direct costs per collection procedure for the day 4 collection method versus historical cohort. Conclusions Approximately 50% of healthy sibling donors can generate adequate PBPC collection when using a day 4 PB CD34+ threshold of ≥0.04 × 106/ml. While differences in PBPC product composition and donor symptoms were seen based on day of collection, we found no evidence of adverse post-HCT outcomes associated with day 4 PBPC collection. Day 4 may be the optimal day of stem cell collection for a population of healthy donors, without adverse effect on transplant outcomes, and with an anticipated cost savings. These findings merit further analysis in larger HCT cohorts. [ABSTRACT FROM AUTHOR]