Predictors of poor haematopoietic stem cell mobilisation in patients with haematological malignancies at a South African centre

Justin du Toit*, Marco Goeijenbier, Cecile du Toit, Pieter de Witt, Hannes Koornhof, Jenna Oosthuizen, Vernon Johan Louw, Matthew Seftel, Estelle Verburgh

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Autologous stem cell transplant (ASCT) is an established consolidation strategy in the treatment of haematological malignancies, however poor mobilisation (PM) can contribute to patient morbidity and high resource utilisation. Identifying the incidence, risk factors for PM and engraftment outcomes are important goals in our resource limited setting. Methods: We retrospectively analyzed patients with haematological malignancies that consecutively underwent ASCT at Groote Schuur hospital, Cape Town, South Africa from January 2013 to January 2019. Results: 146 patients – majority with multiple myeloma (MM)(41,8%), F:M= 1:2, underwent leukapheresis with median age of 32 years (range, 9 – 66 years). PM occurred in 25/146 (17%), mobilisation failure (MF) in 3/146 (2%) and super mobilisation (SMs) in 99/146 (68%), respectively. Risk factors for PM were: diagnosis of acute leukaemia (RR = 25, 95% CI 3.4 – 183, p = 0.002) and Hodgkin lymphoma (RR = 19, 95% CI 2.6 – 142, p = 0.004); low white cell count (WCC) at harvest (WCC < 9 × 109/L (RR=4.3, 95% CI 2.3 – 8.3, p < 0.0001) and two vs one line of prior therapy (RR = 3.1, 95% CI 1.45 – 6.7, p = 0.0037). Median days to neutrophil and platelet engraftment were 14 days (95% CI 14–15 days) and 16 days (95% CI 15–16 days) respectively. Conclusion: PM occurred in 17% of a contemporary South African ASCT cohort, albeit with a low MF rate (2%). There was surprisingly high rate (68%) of SMs, possibly reflective of superfluous mobilisation strategy in MM patients. We identified predictive factors for PM that will lead to enhanced cost-effective use of plerixafor.

Original languageEnglish
Article number103419
JournalTransfusion and Apheresis Science
Volume61
Issue number4
Early online date2 Mar 2022
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
Wits Donald Gordon Medical Centre funded the statistical analysis. Dr Petra Gaylard contributed to the statistical analyses.

Publisher Copyright:
© 2022 Elsevier Ltd

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