Peripheral Blood Progenitor Cell Mobilization for Autologous and Allogeneic Hematopoietic Cell Transplantation

Publication Date: May 8, 2014
Last Updated: March 14, 2022

Recommendations

Allogeneic Donors

What is the best myeloid growth factor and dose schedule for mobilization for adult patients?

Filgrastim (Neupogen, G-CSF) 10 mg/kg/day, as a single dose, or 5 mg/kg twice daily, with leukapheresis beginning on the fifth day. ( A )
564
Sargramostim (Leukine, GM-CSF). ( B )
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Lenograstim (Granocyte). ( B )
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Pegfilgrastim (Neulasta) 6-12 mg/d as a single dose. ( B )
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Plerixafor (Mozobil) 240 mg/kg as single agent. ( C )
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Is stem cell mobilization safe and effective for pediatric patients? What is the best myeloid growth factor and dose schedule for pediatric patients?

G-CSF 10 mg/kg/day either as a single daily dose, with leukapheresis beginning on the fifth day. ( C )
564

What are the target CD34+ doses for collection and infusion for adult patients?

For infusion:
  • Optimal: 4 x 106 CD34+ cells/kg
  • Maximum: 8 x 106 CD34+ cells/kg
For collection:
  • Minimum: 2 x 106 CD34+ cells/kg
( C )
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What are the target CD34+ cells doses for collection and infusion for pediatric patients?

For infusion:
  • Minimum: 2.4 x 106 CD34+ cells/kg
For collection:
  • Minimum: 2 x 106 CD34+ cells/kg
( C )
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What type of venous access is recommended?

For adult patients: Antecubital venous access is preferred. If peripheral access is not possible, central venous access may be placed by image guidance. ( C )
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For pediatric patients: Most small children require central venous catheter placement under general anesthesia. However, children aged between 7 and 12 years should still be assessed for possible use of peripheral vein access. ( C )
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Autologous Donors: Initial Mobilization Attempt

What is the optimal myeloid growth factor and dose schedule for initial mobilization for adult patients?

For growth factor only stem cell mobilization:
Filgrastim 10 mg/kg/day, as a single dose, with leukapheresis beginning on the fifth day. ( A )
564
Pegfilgrastim 12 mg, as a single dose, with leukapheresis beginning when the peripheral blood stem cell count is adequate (as defined below). ( C )
564
Plerixafor and filgrastim: filgrastim 10 mg/kg/day as a single dose with plerixafor 240 mg/kg in the afternoon or evening before beginning leukapheresis (on day 5). ( A )
564
For chemotherapy combined with growth factor for stem cell mobilization:
Filgrastim 5-10 mg/kg/day, as a single dose, beginning at least 24 h after completion of chemotherapy, and then leukapheresis beginning when the peripheral blood stem cell count or WBC count is adequate. ( A )
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Pegfilgrastim 6-12 mg/d as a single dose given at least 24 h after completion of chemotherapy and leukapheresis beginning when the peripheral blood stem cell count is adequate. ( A )
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What type of chemotherapy and dose is recommended for chemomobilization in adult patients?

Disease-specific chemotherapy (IEV, ESHAP, ICE). ( C )

IEV indicates ifosfamide, epirubicin, etoposide; ESHAP, etoposide, methylprednisolone, cytarabine, cisplatin; ICE, ifosfamide, carboplatin, etoposide

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Cyclophosphamide. ( C )
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Etoposide. ( C )
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What is the optimal myeloid growth factor and dose schedule for initial mobilization for pediatric patients?

For growth factor only stem cell mobilization:
Filgrastim 10 mg/kg/day, as a single dose, with leukapheresis beginning on the fifth day. ( C )
564
Plerixafor and filgrastim. ( C )
564
For chemotherapy combined with growth factor for stem cell mobilization:
Filgrastim 5-10 mg/kg/day as a single dose beginning at least 24 h after completion of chemotherapy, with leukapheresis initiated when peripheral blood stem cell count or WBC count adequate
or
Pegfilgrastim 100 mg/kg, as a single dose, at least 24 h after completion of chemotherapy with leukapheresis beginning when the peripheral blood stem cell count is adequate. ( C )
564

What type of chemotherapy and dose is recommended for chemomobilization in pediatric patients?

Disease specific chemotherapy. ( C )
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What are the target goals for collection from adult and pediatric patients?

Minimum: 2 x 106 CD34+ cells/kg
Optimal: 5 x 106 CD34+ cells/kg ( B )
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Higher number of cells has been associated with improved outcomes. ( C )
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When should you begin monitoring peripheral CD34+ counts?

For growth factors alone:
Beginning on the fourth day of G-CSF. ( C )
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For growth factors and chemotherapy:
Beginning generally 8-10 d after chemotherapy or WBC > 1000/mL. ( C )
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For growth factors and plerixafor:
The morning before and after plerixafor administration (days 4 and 5 of G-CSF therapy). ( C )
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When should you initiate leukapheresis?

For growth factors alone:
Beginning on day +4 or +5 after G-CSF initiation. ( C )
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For growth factors and plerixafor:
Leukapheresis should be initiated the following morning after plerixafor administration. ( A )
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For growth factors and chemotherapy:
Peripheral CD34+cell count > 20/mL or if peripheral CD34+ cell count not available, consider when WBC > 5.0 x 109/L and platelet count >75 x 109/L. ( C )
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Considerations for Special Populations, Comorbidities, and Other Topics

Patients at high risk of stem cell mobilization failure or for remobilization attempt

High-risk patients:
Upfront use or addition of plerixafor or chemotherapy mobilization during initial mobilization. ( C )
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Large-volume leukapheresis.

(C)
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For those who have failed initial mobilization attempt:
  • Plerixafor + growth factors
  • Chemotherapy + growth factors
(C)
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Pediatric patients with low weight

Patients below 15 kg are generally transfused to achieve hemoglobin >12 g/dL and platelet count > 40 x 109/L.

(C)
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Priming of the apheresis machine with either RBCs and/or albumin is important for patients who weigh <20 kg. ( C )
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Large volume leukapheresis (>3 times total blood volume) can be performed in patients with low birth weight. ( C )
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Obese patients

Single daily dosing G-CSF results in improved collection. ( C )
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Increased BMI does not impair ability to collect adequately dose of growth factor with plerixafor and G-CSF. ( C )
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Should dosing be according to ideal or actual body weight?

Not yet enough data to recommend one approach over the other. ( C )
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How to address thrombocytopenia?

For allogeneic stem cell donors:
Maximum of 2 d of collection and possible transfusion for postapheresis platelet count <75 x 109/L. ( C )
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For autologous stem cell transplant:
Transfuse for preapheresis platelet count below 30 x 109/L to prevent bleeding complications. ( C )
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Is there a threshold for leukocytosis for which growth factors should be held?

No recommendation, but general practice for many centers is to withhold G-CSF when WBC >100 x 109/L and to hold plerixafor when WBC >75 x 109/L. ( C )
564

Are G-CSF biosimilars recommended for use in PBPC mobilization?

Currently, there are insufficient data for recommending the use of G-CSF biosimilars for PBPC mobilization. ( C )
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Recommendation Grading

Overview

Title

Peripheral Blood Progenitor Cell Mobilization for Autologous and Allogeneic Hematopoietic Cell Transplantation

Authoring Organization

Publication Month/Year

May 8, 2014

Last Updated Month/Year

August 24, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Hospital, Operating and recovery room, Outpatient

Intended Users

Clinical researcher, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D019650 - Hematopoietic Stem Cell Mobilization

Keywords

Peripheral blood, Progenitor cell mobilization, Hematopoietic transplantation