2017•Pediatric Hematology/Oncology and ImmunopathologyOpen access
Results of mobilization, apheresis and autoreinfusion of hematopoietic stem cells in children with neuroblastoma: role of monitoring the count of CD34+ cells in peripheral blood
Elena Kurnikova, И. Б. Кумукова, И. В. Гуз, R.D. Chismatullina, Т. V. Shamanskaya, Maria Fadeeva, Svetlana Glushkova, В. В. Бриллиантова, S.R. Varfolomeyeva, Pavel Trakhtman
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Abstract
Myeloablative chemotherapy with autologous hematopoietic stem cells transplantation, can improve the results of long-term survival in patients with high-risk neuroblastoma. This treatment requires a sufficient number of autologous peripheral blood stem cells. Methods: 118 apheresis procedures was completed for 116 children with high-risk neuroblastoma, the median age was 2 years and 10 months (range, 6 months to 13 years), median body weight of 13 kg (range, 5.8 to 47 kg). Mobilization with G-CSF at a dose of 10 mg/kg was initiated at the time of incipient recovery of hematopoiesis after the last cycle of chemotherapy, monitoring of CD34+ cells in peripheral blood were started on 3rd day from the beginning of mobilization. Apheresis was performed the following day after reaching the number of CD34+ cells 15 cells/μl after 4 consequent days of mobilization. Results: Modification of mobilization, based on CD34+ cells monitoring data, allowed us to reach the median number of CD34+ cells of 105,27 cells/μl (range, 14.8–714.8) at the day of apheresis. The median number of collected CD34+/kg was 14,43×106/kg b.w. (range, 2.68–74). Was revealed a significant correlation between the dose of CD34+/kg b.w in the apheresis product and the level of CD34+ cells in peripheral blood at the day of apheresis (R=0.762; р0.0001) and decrease of the results of mobilizing results and apheresis efficiency if mobilization was initiated later than after the 3rd course of chemotherapy. Conclusion: By monitoring the number of circulating CD34+ cells in peripheral blood and modification of mobilization tactic, the task to collect an adequate dose of CD34+ cells for autoSCT with one apheresis procedure was feasible. In 88 (75.86%) of the 116 patients we were able to collect 10×106/kg CD34+ cells and more, and 100% of patients collected 2.5×106/kg CD34+ cells with 1 apheresis.