scholarly journals Spontaneous Autologous Graft-versus-Host Disease in Plasma Cell Myeloma Autograft Recipients: Flow Cytometric Analysis of Hematopoietic Progenitor Cell Grafts

2011 ◽  
Vol 17 (7) ◽  
pp. 970-978 ◽  
Author(s):  
Hillard M. Lazarus ◽  
Scott R. Sommers ◽  
Lisa M. Arfons ◽  
Pingfu Fu ◽  
S.A. Ataergin ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Graft Versus Host Disease ◽  
Progenitor Cell ◽  
Flow Cytometric Analysis ◽  
Hematopoietic Progenitor Cell ◽  
Plasma Cell Myeloma ◽  
Hematopoietic Progenitor ◽  
Graft Versus Host ◽  
Autologous Graft ◽  
Flow Cytometric

Utility Of An Algorithm For Use Of Plerixafor In Filgrastim-based Hematopoietic Progenitor Cell Mobilization In Patients With Plasma Cell Myeloma Treated With Carfilzomib-Lenalidomide-Dexamethasone.

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 906-906
Author(s):  
Susan F. Leitman ◽  
Nishant Tageja ◽  
Neha Korde ◽  
Yu Ying Yau ◽  
Sheila Phang ◽  
...  
Keyword(s):  
Cell Count ◽  
Plasma Cell ◽  
Hematopoietic Progenitor Cell ◽  
Plasma Cell Myeloma ◽  
Hematopoietic Progenitor ◽  
Evening Dose ◽  
Single Procedure ◽  
Regression Formula ◽  
Cd34 Cells ◽  
Cell Mobilization

Abstract Mobilization of hematopoietic progenitor cells (HPC) for subsequent autologous transplantation is difficult in patients with plasma cell myeloma (PCM) due to poor marrow reserve. Targeted HPC yields are generally not achieved in a single apheresis procedure without use of plerixafor as a supplement to standard filgrastim. Strategies to limit use of plerixafor, due to its expense, to cases of poor CD34 mobilization have been developed, but their applicability in patients receiving the novel induction regimen carfilzomib-lenalidomide-dexamethasone (CRD) (Blood 2012;120:1801) has not been described. We prospectively studied the CD34 cell mobilization responses of PCM patients following CRD induction, using a CD34 cell predictive algorithm to determine when plerixafor should be added to the mobilization regimen. Thirty patients, including 23 with PCM and 7 with smoldering PCM, mean age 55 (range 40-72), 47% male, received 4 to 7 cycles of CRD (median, 5 cycles), with the last dose of lenalidomide given at least one week prior to mobilization. Filgrastim 10-16 mcg/kg/day was given as a single evening dose for 5 days, with circulating CD34 count assessed 12 hours after the 4th dose. The pre-apheresis CD34 count after the 5th dose of filgrastim was predicted to be 10% greater than that after the 4th dose; this prediction was validated with an actual pre-apheresis CD34 count obtained the following day. Prior mobilization data derived from healthy HPC apheresis donors was used to generate a regression formula, y=0.45x+0.86, where x=the pre-apheresis circulating CD34 count after the 5th dose of filgrastim, and y=the expected yield of the apheresis procedure, expressed as millions of CD34 cells harvested per liter processed. Targeted yield was ≥ 4 x 106 CD34 cells/kg, with minimum acceptable yield ≥ 2 x 106 CD34 cells/kg. Plerixafor 240 mcg/kg was given with the 5th dose of filgrastim, 8-10 hours prior to apheresis, if the regression equation predicted a CD34 cell yield of < 4 x 106 CD34 cells/kg in a single procedure with a maximum of 30 liters processed. The actual volume processed was based on the stat blood CD34 count drawn immediately prior to apheresis. Procedures were performed on the Cobe Spectra device; continuous intravenous calcium was used to mitigate citrate toxicity. Central lines were required in 67% of subjects. Mean CD34 cell count in the entire group after the 4th dose of filgrastim was 29/uL (range 2-88/uL). Using the regression formula as a guide, 17/30 (57%) of patients received plerixafor. CD34 counts increased 4.2-fold in patients receiving plerixafor, from 15 ± 9/uL (m ± SD) on the day prior to apheresis to 53 ± 30/uL immediately pre-apheresis; CD34 counts did not change in patients who received filgrastim alone (from 48 ± 17/uL to 45 ± 19/uL). Guided by the stat pre-apheresis CD34 count, the volume processed in the first apheresis procedure was the same, 23 ± 7 (range 12-30) liters, with or without plerixafor. CD34 cells were collected with 72 ± 14% efficiency. First-procedure CD34 cell yields were 6.4 ± 2.5 x 106/kg (range 2.5-10.1) with supplemental plerixafor vs 5.8 ± 2.5 x 106/kg (range 1.1-9.3) with filgrastim alone. Only 2/30 patients underwent a second procedure; neither received plerixafor prior to the first procedure, and both received it prior to the second. In one patient, criteria for plerixafor administration were met, but the drug was inadvertently not given prior to the first procedure; in the second patient, an unexpectedly low pre-apheresis CD34 count was traced to inadequate self-administration of the 5th dose of filgrastim. All 30 patients achieved the minimum CD34 collection goal of ≥ 2 x 106 cells/kg and 29/30 did this in one procedure. The higher targeted collection goal of ≥ 4 x 106 CD34 cells/kg was achieved in a single procedure by 76% of patients in both the plerixafor group and the filgrastim-alone group. There was a trend for higher cumulative lenalidomide and carfilzomib doses to be associated with lower CD34 mobilization responses to filgrastim. Induction treatment with CRD does not appear to impair HPC mobilization response to filgrastim in patients with PCM, compared to older regimens. An algorithm that uses the CD34 cell count after 4 doses of filgrastim to predict the following day’s pre-apheresis CD34 count and thus determine whether plerixafor supplementation is needed, was useful in identifying the 40% of CRD-treated myeloma patients who do not need plerixafor. Disclosures: No relevant conflicts of interest to declare.

Limited Utility of Flow Cytometry Immunophenotyping for Assessment of Plasma Cells in Hematopoietic Progenitor Cell Apheresis Product From Patients With Multiple Myeloma

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S6-S7
Author(s):  
Yao Cheng ◽  
Shiyong Li
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Cell Population ◽  
Plasma Cell ◽  
Progenitor Cell ◽  
Plasma Cells ◽  
Total Sample ◽  
Hematopoietic Progenitor Cell ◽  
Hematopoietic Progenitor

Abstract Aim Flow cytometric immunophenotyping (FCI) is routinely performed in our laboratory to assess the clonality of plasma cells in hematopoietic progenitor cell apheresis (HPC-A) products as part of the quality control for multiple myeloma patients undergoing autologous stem cell transplantation. The purpose of this project is to investigate whether FCI is indicated for HPC-A when FCI is also performed on a bone marrow biopsy sample obtained before or after HPC-A collection. Materials and Methods The FCI results of HPC-A samples were retrieved from the laboratory database and analyzed. Relevant FCI results of the corresponding bone marrow biopsy samples were also retrieved and analyzed. All FCI was performed using BD FACSCalibur/FACSCanto with a four-color antibody panel, and the listmode data were analyzed by BD FACSDiva. Results FCI was performed on a total of 1,621 HPC-A samples in our laboratory from 02/01/2012 to 02/02/2018. A total of 58 HPC-A samples were positive for a monoclonal plasma cell population (3.8% of the total sample). Among those positive samples, 55 had bone marrow biopsy done before or after HPC-A collection: 38 within a month, 8 between 1 and 2 months, and 9 between 3 and 6 months. Fifty-four of 55 bone marrow samples were positive for a monoclonal plasma cell population by FCI. Conclusion The utility of FCI in the quality assessment of HPC-A products from patients with multiple myeloma is a very limited when FCI is performed on a bone marrow biopsy obtained within 6 months of HPC-A collection.

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