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Peripheral blood stem cell transplantation (PBSCT) is an effective treatment for hematological malignancies. Mobilization of peripheral blood progenitor cells performs in different ways among transplantation centers. Forceful mobilization schedules are comprised of growth factor alone, chemotherapy along with growth factor and also, a newly combination of novel agent such as plerixafor with any approach. With the appearance of numerous modifications in stem cell mobilization field over the past decade and advent of novel stem cell mobilization techniques, it seems to be necessary to review recent publications about stem cell mobilization strategies to respond above cited issues. Relevant literature was identified by a PubMed search (1996–2016) of English-language literature using the terms mobilization, Allogeneic Stem Cells Transplantation, Autologous Stem Cells Transplantation and technical aspects of apheresis. Although many institutions have established their own procedures to improve stem cell mobilization success rates accompanying cost-effectiveness considerations, an optimal stem cell mobilization regimen and methods have not been well-defined, yet. Practical guidelines are required to address critical clinical issues including proper growth factor, the most Impressive chemotherapy and its dosage and appropriate time for leukapheresis initiation. Hence, based on literature, we prepared practical guidelines in this review.
Hematopoietic Stem cells transplantation (HSCT) is become a curative option for patients who suffer from hematological malignancies. 1,2 The usage of both autologous and allogeneic HSCT for adults and pediatric has exceedingly increased, over the past several decades. Small amounts of hematopoietic stem cells (HSCs) are able to circulate in Peripheral blood (PB). 3 So, HSCs mobilization from bone marrow (BM) to PB and their collection can be crucial element of HSCT programs. 4,5 Despite the vast using of peripheral stem cells transplantation (PBSCT) as therapeutic strategy, it is difficult to achieve a consensus about its parameters. These parameters are type of growth factor and its optimal dosage, effectiveness type of chemotherapy and its dosage and how to predict poor mobilize patients and which time is best to initiate leukapheresis. 6 Nowadays, most transplantation institutions have adjusted own strategies according to their priorities and resource availabilities. Therefore, there are not any standard identical approaches. Hence, this paper aims to review current literature and guide lines on mobilization strategies to underscore the importance of mentioned problems.
Mobilization guidelines for autologous and allogeneic transplantation were obtained by the way of literature search. Extracted information about mobilization schedules, laboratory monitoring protocols and technical aspects of apheresis for adults and pediatrics are main foundations of presented guide lines in our review.
1- The recommended dose for sibling donors
2- The recommended dose for unrelated donors
1- Transplantation from sibling donors
2- Transplantation from unrelated donors
A summary of stem cells mobilization strategies and target cells dose for allogeneic stem cells transplantation is shown in Figure 1.
Mobilization Strategies for Autologous Transplantation in Adults
1A) G-CSF alone strategy utilization for Multiple Myeloma (MM) patients
Optimal harvest is possible when G-CSF is given 3 hours before apheresis versus administration was performed on the evening before apheresis. For acquire proper consequence, leukapheresis should be beginning on the fifth day.
1B) G-CSF alone and/or Plerixafor strategies utilization about None-Hodgkin Lymphoma (NHL)
G-CSF and chemotherapy dose elements
2A) Chemotherapy plus growth factor mobilization strategy in Multiple Myeloma patients: High-dose cyclophosphamide + G-CSF are probably the most commonly used chemo mobilization strategy. Some studies also suggest that etoposide-based mobilization approaches can be considered as alternative choice.
2B) Chemotherapy plus growth factor mobilization strategy in Lymphoma patients: Chemotherapy + G-CSF as part of disease specific induction and salvage regimens have always regarded the preferred method. Such approaches can eliminate to require additional chemo-mobilizations or steady-state mobilizations before auto-HSCT in these heavily treated patients. Further, it is more effective than cyclophosphamide-based chemo-mobilization.
A summary of stem cells mobilization strategy and target cells dose for autologous stem cells transplantation in adults is shown in Figure 2.
A summary of stem cells mobilization and apheresis strategies and target cells dose for autologous stem cells transplantation in pediatrics is shown in Figure 3.
1- Legitimate reasons to G-CSF alone strategy selection
2- Plerixafor plus G-CSF mobilization strategy:
3- Chemo mobilize strategy option
In chemo-mobilization strategy, the start of leukapheresis is commonly determined by threshold of CD34 cell counts. There is no consensus on optimal threshold; therefore, institutional practice or institutional local instructions have varied has varied from minimal CD34 counts of 5 to 20/µL.
Prediction of mobilization after chemotherapy
1-Proven poor mobilizes definition
2-Predicted poor mobilisers
Advanced disease (2 lines of chemotherapy).
3-Other criteria are comprised
Poor mobilization prediction in Multiple Myeloma patients
A summary of strategies for prediction of poor mobilize patients in autologous stem cells transplantation is shown in Figure 4.
1-Border Line Poor Mobilize
Relatively Poor Mobilize and Poor Mobilize
A summary of apheresis and mobilization strategies based on CD34 cell count prior to apheresis for poor mobilize patients in autologous stem cells transplantation is shown in Figure 5.
PBSC mobilization can be enhanced with a proper approach in allogeneic and autologous HSCT. In autologous HSCT, depended on the patient’s disease and treatment protocol the results of stem cell collection will be different. A low CD34+ cell count in PB before apheresis is a key predictor factor for poor PBSC collection. Hence, enumeration of CD34+ cell prior apheresis may appraisal the risk for poor PBSC collection and could permit suitable intervention to overcome of mobilization failure.
This manuscript was supported by Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Authors deny any conflict of interest related to this study.