Mobilisation failure in patients diagnosed as multipl myeloma and lymphoma, and factors affecting failure

Objective: Autologous stem cell transplantation is an important treatment modality which is widely used in hematological malignancies. It is necessary to collect stem cells for using autologous stem cell transplantation which shows survival benefit in many hematological diseases. Bone marrow and peripheral blood are used as stem cell sources. Because of many advantages, peripheral blood is used as the stem cell source in almost all of the autologous stem cell transplantation in late period. Under normal conditions CD34+ cell levels are low in peripheral blood. By mobilisation processes the CD34+ cell levels are increased and become suitable for apheresis. Mobilisation failure causes a delay in the stem cell transplantation. Furthermore mobilisation failure causes new attempts for collecting stem cells which result in additional costs and risks. It is important to predict mobilisation failure for using new mobilisation options in early stages which will protect patients from additional attempts and decrease the treatment costs. In this study we aimed to collect data which can help to predict mobilisation failure by analysing the mobilisation failure in Hodgkin, non-Hodgkin lymphoma and multiple myeloma patients who were assessed for autologous stem cell transplantation and mobilisation attempt was performed, followed in Dokuz Eylül University School of Medicine Hematology Department.Materials and Methods: 164 patients who were diagnosed with Hodgkin, non-Hodgkin lymphoma and multiple myeloma and were assessed for autologous stem cell transplantation and undergone mobilisation, followed in Dokuz Eylül University School of Medicine Hematology Department between 01.01.201 and 31.12.2011, and 188 mobilisation attempts of these patients were included. Demographical features and clinical data are obtained from hospital data base system and patient files.Results: Out of 164 patients, 86 (52,4%) were diagnosed as multipl myeloma, 78 (47,6%) were diagnosed as lymphoma, 59,1% (97 patients) were male, 40,1% (67 patients) were female. In 24 patients (20,5%) out of 164 patients mobilisation failure was seen. In patients diagnosed as multipl myeloma mobilisation failure rate was %9,3, in patients diagnosed as lymphoma mobilisation failure rate was 20,5%. In 40 (%21,3) mobilisation attempts of 188 mobilisation attempts mobilisation failure was observed. In 91 attempts of multipl myeloma patients 9,9% (9 attempts) mobilisation failure was seen. In 97 attempts of lymphoma patients 32% (31 attempts) mobilisation failure was seen. Diagnosis (lymphoma, p: <0,0001), increased chemotherapy cyclus number (p: <0,0001), low blood CD34+ cell levels on the first day of apheresis (p: <0,0001), low maximum blood CD34+ cell levels (p: <0,0001), low first apheresis yield (p:<0,0001), disease status at the time of mobilisation were found to be correlated with mobilisation failure (p: <0,0001). Age; gender; type of G-CSF; prior radiotherapy; time from diagnosis to mobilisation; time from last chemotherapy to mobilisation; bone marrow involvement; bone marrow fibrosis; the white blood cell, neutrophil, lymphocyte, monocyte counts on the first day of apheresis; hemoglobin an platelet levels on the firs day of apheresis were not corraleted with mobilisation failure. No stastistically significant difference was found between G-CSF alone and chemomobilisation when compared with mobilisation failure. In addition, in patients whom engraftment was achieved multiple day versus single day reinfusion and effects of multiple day reinfusion on engraftment was assessed. In patients with multiple day reinfusion it is found that neutrophil engraftment was significantly delayed (11 days versus 13 days, p: <0,05), and also for platelet engraftment a delay was observed (13 days versus 16 days) but this delay was not statistically significant (p:0,052)Discussion: In this retrospective study, in which patient number is partially low, mobilisation failure was observed in 14.6% of general patient population. In patients diagnosed as multipl myeloma mobilisation failure rate was 9,3% and in patients diagnosed as lymphoma mobilsation failure rate was 21.3%. Diagnosis, chemotherapy cyclus number, blood CD34+ cell levels on the first day of apheresis, first apheresis yield, disease status at the time of mobilisation were found to be correlated with mobilisation failure, and these findings are similar to literature. In addition it is found that multiple day reinfusion causes a delay on engraftment. As a result more comprehensive studies are needed especially to asses the effects of multiple day reinfusion on engraftment.Key words: Mobilisation failure, MM, HL, NHL, engraftment