Autologous haematopoietic stem-cell transplantation (HSCT) is the standard treatment for a number of haematological malignancies. Achieving sufficient haematopoietic stem cell mobilisation is a prerequisite, but exactly how to define and achieve this goal remains a subject of debate. Key questions include which pharmacological agents to use, timing of treatments and mobilisation, and, in particular, target numbers of stem cells. Clinicians from Europe, North America and Asia compared their experiences and discussed these issues at a satellite workshop during the 3rd International Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM 2015). This review discusses the challenges of optimising leukapheresis in the context of these discussions. Although several studies suggest that the cell dose influences transplant outcomes in HSCT, other studies have not reached this conclusion. Recent data indicate that the graft composition also plays a role. More prospective study data are needed for a fuller understanding of engraftment outcomes using different mobilisation protocols.
Autologous haematopoietic stem-cell transplantation, leukapheresis, stem cell mobilisation
Patrick Wuchter is an Advisory Board member and has received honoraria from Sanofi-Aventis. He is an Advisory Board member and has received travel grants from Hexal AG. Kai Hubel is an Advisory Board member and received honoraria from Sanofi-Aventis, Roche, Gilead, Teva, Hexal, Celgene and Amgen.
Medical writing assistance was provided by Katrina Mountfort at Touch Medical Media, supported by Sanofi-Genzyme.
This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit.
June 23, 2016 Accepted
August 25, 2016
Patrick Wuchter, Institute of Transfusion Medicine and Immunology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Friedrich-Ebert- Str. 107, D- 68167 Mannheim, Germany. E: Patrick.Wuchter@medma.uni-heidelberg.de; Kai Hübel, Clinic I of Internal Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany. E: firstname.lastname@example.org
This review article was developed following a satellite workshop presented at the 3rd International Congress on Controversies in Stem Cell Transplantation and Cellular Therapies, which was organised by Sanofi- Genzyme. The publication of this article was supported by Sanofi-Genzyme, who were given the opportunity to review the article for scientific accuracy before submission. Any resulting changes were made at the author’s discretion.
Autologous haematopoietic stem-cell transplantation (HSCT) is widely employed in haematological malignancies including multiple myeloma (MM),1 Hodgkin and non-Hodgkin lymphoma (HL and NHL)2–5 and acute myeloid leukaemia (AML).6,7 High-dose chemotherapy is an effective treatment strategy in numerous malignant conditions, however, it requires the subsequent use of autologous HSCT in order to restore bone marrow function, mostly using HSCs from the patient’s peripheral blood.8 Rates of autologous HSCT have increased steadily during the past 2 decades.9–12 In 2014, more than 40,000 HSCT (57% autologous) were performed in Europe.13 The main indications for HSCT were leukaemias (33%; 4% autologous); lymphoid neoplasias (57%; 89% autologous); solid tumours; (4%; 97% autologous) and non-malignant disorders; (6%; 12% autologous).13 Recent trends in transplant activity include increased use of allogeneic HSCT for AML in first complete remission, myeloproliferative neoplasm (MPN) and aplastic anaemia with decreasing use in chronic lymphocytic leukaemia (CLL); and increased autologous HSCT for plasma cell disorders.13 The ability to improve patient outcomes with autologous HSCT is directly dependent, however, on successful mobilisation and collection of stem cells.
Various advances in HSCT over the past decade, including new stem cell mobilisation techniques, have led to the need to reassess strategies to optimise outcomes. In October 2015, clinicians from Europe, North America and Asia compared their experiences and discussed these issues at a Sanofi-sponsored satellite workshop at the 3rd International Congress on Controversies in Stem Cell Transplantation and Cellular Therapies (COSTEM 2015). This review aims to discuss the challenges of finding the optimal mobilisation strategy in the context of these discussions.
Key stages of haematopoietic stem-cell transplantation The HSCT process can be summarised as follows: administration of mobilisation agents, mobilisation, collection by leukapheresis, preparation of product for storage, cryopreservation, administration of high-dose chemotherapy, stem cell transplantation, and engraftment and recovery.14 HSCs usually circulate in small numbers in peripheral blood, therefore, their mobilisation from bone marrow into peripheral blood following treatment with chemotherapy and/or cytokines is an essential part of HSCT, and is one of the major challenges of the process.15
Progenitor stem cells express the cell surface marker antigen CD34, which is used in clinical practice to determine the extent and efficiency of peripheral blood stem cell collection.16
The number of peripheral blood CD34+
cells is used to monitor the timing of leukapheresis for autologous transplantation.17
Before collection, the number of CD34+
cells should ideally exceed 10-20/μl in peripheral blood.18
In terms of transplantation, a number of Phase II studies have established a correlation between CD34+ dose and outcome in terms of progressionfree survival (PFS) and overall survival (OS).19 Most clinical centres regard 2.5–4 x 106 CD34+ cells/kg body weight as an adequate cell number for autologous HSCT and 2.0 x 106 CD34+ cells/kg as the absolute minimum; this is based on a substantial body of clinical data.18,20–24 However, a minority of experts recommend increasing this threshold. Some studies suggest that doses exceeding 5 x 106 cells/kg are necessary for optimal engraftment23,25 and to reduce febrile complications and antibiotic use after transplantation.26 A 2000 literature review concluded that a of ≥8 x 106 CD34+ cells/kg is optimal, and correlated cell dose to platelet recovery,25 but this has been disputed. In addition, high levels of circulating CD34+ cells have been associated with better outcomes in MM27 and NHL.28 The reported improvement in outcomes may be due to decreases in non-relapse mortality from improved haematologic reconstitution and lower rates of infection.
Conversely, some studies have concluded that high cell doses are not correlated with improved outcomes. A study of patients with MM and NHL found that cell dose did not affect OS at one year.29 A cohort study (n=80) demonstrated that high dose CD34+ cells were not associated with lower blood component consumption after HSCT.30 In a retrospective study, patients (n=350) who mobilised high numbers of CD34+ cells (so-called supermobilisers) had improved outcomes in autologous HSCT for NHL and HL (see Figure 1).31 However, a similar study design (n=39) of patients with MM or Waldenström macroglobulinemia (WM) found no correlation between survival and number of mobilised CD34+ cells.32
In summary, there are insufficient data to conclude that high cell numbers are necessary in autologous HSCT. The optimum dose has not been comprehensively evaluated in prospective studies, most of which are registry-based and retrospective.
1. Child JA, Morgan GJ, Davies FE, et al., High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma, N Engl J Med, 2003;348:1875–83.
2. Oliansky DM, Czuczman M, Fisher RI, et al., The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of diffuse large B cell lymphoma: update of the 2001 evidence-based review, Biol Blood Marrow Transplant, 2011;17:20–47 e30.
3. Oliansky DM, Gordon LI, King J, et al., The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of follicular lymphoma: an evidence-based review, Biol Blood Marrow Transplant, 2010;16:443–68.
4. Lazarus HM, Rowlings PA, Zhang MJ, et al., Autotransplants for Hodgkin's disease in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry, J Clin Oncol, 1999;17:534–45.
5. Fedele R, Martino M, Recchia AG, et al., Clinical options in relapsed or refractory hodgkin lymphoma: an updated review, J Immunol Res, 2015;2015:968212.
6. Copelan EA, Hematopoietic stem-cell transplantation, N Engl J Med, 2006;354:1813–26.
7. Linker CA, Autologous stem cell transplantation for acute myeloid leukemia, Bone Marrow Transplant, 2003;31:731–8.
8. Gratwohl A, Baldomero H, Schmid O, et al., Change in stem cell source for hematopoietic stem cell transplantation (HSCT) in Europe: a report of the EBMT activity survey 2003, Bone Marrow Transplant, 2005;36:575–90.
9. Rios-Tamayo R, Sanchez MJ, Puerta JM, et al., Trends in survival of multiple myeloma: a thirty-year population-based study in a single institution, Cancer Epidemiol, 2015;39:693–9.
10. Auner HW, Szydlo R, Hoek J, et al., Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years, Bone Marrow Transplant, 2015;50:209–15.
11. Costa LJ, Zhang MJ, Zhong X, et al., Trends in utilization and outcomes of autologous transplantation as early therapy for multiple myeloma, Biol Blood Marrow Transplant, 2013;19:1615–24.
12. Gooley TA, Chien JW, Pergam SA, et al., Reduced mortality after allogeneic hematopoietic-cell transplantation, N Engl J Med, 2010;363:2091–101.
13. Passweg JR, Baldomero H, Bader P, et al., Hematopoietic stem cell transplantation in Europe 2014: more than 40 000 transplants annually, Bone Marrow Transplant, 2016; 51:786-92..
14. Giralt S, Bishop MR, Principles and overview of allogeneic hematopoietic stem cell transplantation, Cancer Treat Res, 2009;144:1–21.
15. Schmitz N, Linch DC, Dreger P, et al., Randomised trial of filgrastim-mobilised peripheral blood progenitor cell transplantation versus autologous bone-marrow transplantation in lymphoma patients, Lancet, 1996;347:353–7.
16. Civin CI, Banquerigo ML, Strauss LC, et al., Antigenic analysis of hematopoiesis. VI. Flow cytometric characterization of My-10- positive progenitor cells in normal human bone marrow, Exp Hematol, 1987;15:10–7.
17. To LB, Dyson PG, Juttner CA, Cell-dose effect in circulating stem-cell autografting, Lancet, 1986;2:404–5.
18. Duong HK, Savani BN, Copelan E, et al., Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation, Biol Blood Marrow Transplant, 2014;20:1262–73.
19. Jantunen E, Fruehauf S, Importance of blood graft characteristics in auto-SCT: implications for optimizing mobilization regimens, Bone Marrow Transplant, 2011;46:627–35.
20. Perez-Simon JA, Martin A, Caballero D, et al., Clinical significance of CD34+ cell dose in long-term engraftment following autologous peripheral blood stem cell transplantation, Bone Marrow Transplant, 1999;24:1279–83.
21. Weaver CH, Hazelton B, Birch R, et al., An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy, Blood, 1995;86:3961–9.
22. Oran B, Malek K, Sanchorawala V, et al., Predictive factors for hematopoietic engraftment after autologous peripheral blood stem cell transplantation for AL amyloidosis, Bone Marrow Transplant, 2005;35:567–75.
23. Giralt S, Costa L, Schriber J, et al., Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations, Biol Blood Marrow Transplant, 2014;20:295–308.
24. Pusic I, Jiang SY, Landua S, et al., Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation, Biol Blood Marrow Transplant, 2008;14:1045–56.
25. Siena S, Schiavo R, Pedrazzoli P, et al., Therapeutic relevance of CD34 cell dose in blood cell transplantation for cancer therapy, J Clin Oncol, 2000;18:1360–77.
26. Scheid C, Draube A, Reiser M, et al., Using at least 5x10(6)/ kg CD34+ cells for autologous stem cell transplantation significantly reduces febrile complications and use of antibiotics after transplantation, Bone Marrow Transplant, 1999;23:1177–81.
27. Raschle J, Ratschiller D, Mans S, et al., High levels of circulating CD34+ cells at autologous stem cell collection are associated with favourable prognosis in multiple myeloma, Br J Cancer, 2011;105:970–4.
28. Yoon DH, Sohn BS, Jang G, et al., Higher infused CD34+ hematopoietic stem cell dose correlates with earlier lymphocyte recovery and better clinical outcome after autologous stem cell transplantation in non-Hodgkin's lymphoma, Transfusion, 2009;49:1890–900.
29. Stiff PJ, Micallef I, Nademanee AP, et al., Transplanted CD34(+) cell dose is associated with long-term platelet count recovery following autologous peripheral blood stem cell transplant in patients with non-Hodgkin lymphoma or multiple myeloma, Biol Blood Marrow Transplant, 2011;17:1146–53.
30. Lefrere F, Delarue R, Somme D, et al., High-dose CD34+ cells are not clinically relevant in reducing cytopenia and blood component consumption following myeloablative therapy and peripheral blood progenitor cell transplantation as compared with standard dose, Transfusion, 2002;42:443–50.
31. Bolwell BJ, Pohlman B, Rybicki L, et al., Patients mobilizing large numbers of CD34+ cells ('super mobilizers') have improved survival in autologous stem cell transplantation for lymphoid malignancies, Bone Marrow Transplant, 2007;40:437–41.
32. Kakihana K, Ohashi K, Akiyama H, et al., Correlation between survival and number of mobilized CD34+ cells in patients with multiple myeloma or Waldenstrom macroglobulinemia, Pathol Oncol Res, 2010;16:583–7.
33. Wuchter P, Ran D, Bruckner T, et al., Poor mobilization of hematopoietic stem cells-definitions, incidence, risk factors, and impact on outcome of autologous transplantation, Biol Blood Marrow Transplant, 2010;16:490–9.
34. Anderlini P, Przepiorka D, Seong C, et al., Factors affecting mobilization of CD34+ cells in normal donors treated with filgrastim, Transfusion, 1997;37:507–12.
35. Hsu JW, Wingard JR, Logan BR, et al., Race and ethnicity influences collection of granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells from unrelated donors, a Center for International Blood and Marrow Transplant Research analysis, Biol Blood Marrow Transplant, 2015;21:165–71.
36. Mohty M, Hubel K, Kroger N, et al., Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation, Bone Marrow Transplant, 2014;49:865–72.
37. Hosing C, Saliba RM, Ahlawat S, et al., Poor hematopoietic stem cell mobilizers: a single institution study of incidence and risk factors in patients with recurrent or relapsed lymphoma, Am J Hematol, 2009;84:335–7.
38. Basak GW, Jaksic O, Koristek Z, et al., Identification of prognostic factors for plerixafor-based hematopoietic stem cell mobilization, Am J Hematol, 2011;86:550–3.
39. Kumar S, Dispenzieri A, Lacy MQ, et al., Impact of lenalidomide therapy on stem cell mobilization and engraftment postperipheral blood stem cell transplantation in patients with newly diagnosed myeloma, Leukemia, 2007;21:2035–42.
40. Tournilhac O, Cazin B, Lepretre S, et al., Impact of frontline fludarabine and cyclophosphamide combined treatment on peripheral blood stem cell mobilization in B-cell chronic lymphocytic leukemia, Blood, 2004;103:363–5.
41. Nervi B, Link DC, DiPersio JF, Cytokines and hematopoietic stem cell mobilization, J Cell Biochem, 2006;99:690–705.
42. Tomblyn M, Burns LJ, Blazar B, et al., Difficult stem cell mobilization despite adequate CD34+ cell dose predicts shortened progression free and overall survival after autologous HSCT for lymphoma, Bone Marrow Transplant, 2007;40:111–8.
43. Farina L, Guidetti A, Spina F, et al., Plerixafor 'on demand': results of a strategy based on peripheral blood CD34+ cells in lymphoma patients at first or subsequent mobilization with chemotherapy+G-CSF, Bone Marrow Transplant, 2014;49:453–5.
44. EMA, Summary of Product Characteristics: Mozobil. Available at: www.ema.europa.eu/docs/en_GB/document_library/ EPAR_-_All_Authorised_presentations/human/001030/ WC500030688.pdf (accessed date xx).
45. Shaughnessy P, Islas-Ohlmayer M, Murphy J, et al., Cost and clinical analysis of autologous hematopoietic stem cell mobilization with G-CSF and plerixafor compared to G-CSF and cyclophosphamide, Biol Blood Marrow Transplant, 2011;17:729–36.
46. Porrata LF, Inwards DJ, Ansell SM, et al., Infused autograft lymphocyte to monocyte ratio and survival in diffuse large B cell lymphoma, Biol Blood Marrow Transplant, 2014;20:1804–12.
47. Alegre A, Tomas JF, Martinez-Chamorro C, et al., Comparison of peripheral blood progenitor cell mobilization in patients with multiple myeloma: high-dose cyclophosphamide plus GM-CSF vs G-CSF alone, Bone Marrow Transplant, 1997;20:211–7.
48. Tuchman SA, Bacon WA, Huang LW, et al., Cyclophosphamidebased hematopoietic stem cell mobilization before autologous stem cell transplantation in newly diagnosed multiple myeloma, J Clin Apher, 2015;30:176–82.
49. Meldgaard Knudsen L, Jensen L, Gaarsdal E, et al., A comparative study of sequential priming and mobilisation of progenitor cells with rhG-CSF alone and high-dose cyclophosphamide plus rhG-CSF, Bone Marrow Transplant, 2000;26:717–22.
50. Zhou P, Zhang Y, Martinez C, et al., Melphalan-mobilized blood stem cell components contain minimal clonotypic myeloma cell contamination, Blood, 2003;102:477–9.
51. Chao NJ, Grima, D.T., Carrum, G. et al. , Chemo-mobilization provides superior mobilization and collection in autologous stem cell transplants but with less predictability and at a higher cost, Blood, 2011;118:4048.
52. Devine SM, Flomenberg N, Vesole DH, et al., Rapid mobilization of CD34+ cells following administration of the CXCR4 antagonist AMD3100 to patients with multiple myeloma and non-Hodgkin's lymphoma, J Clin Oncol, 2004;22:1095–102.
53. Cashen A, Lopez S, Gao F, et al., A phase II study of plerixafor (AMD3100) plus G-CSF for autologous hematopoietic progenitor cell mobilization in patients with Hodgkin lymphoma, Biol Blood Marrow Transplant, 2008;14:1253–61.
54. Calandra G, McCarty J, McGuirk J, et al., AMD3100 plus G-CSF can successfully mobilize CD34+ cells from non-Hodgkin's lymphoma, Hodgkin's disease and multiple myeloma patients previously failing mobilization with chemotherapy and/or cytokine treatment: compassionate use data, Bone Marrow Transplant, 2008;41:331–8.
55. Costa LJ, Miller AN, Alexander ET, et al., Growth factor and patient-adapted use of plerixafor is superior to CY and growth factor for autologous hematopoietic stem cells mobilization, Bone Marrow Transplant, 2011;46:523–8.
56. DiPersio JF, Micallef IN, Stiff PJ, et al., Phase III prospective randomized double-blind placebo-controlled trial of plerixafor plus granulocyte colony-stimulating factor compared with placebo plus granulocyte colony-stimulating factor for autologous stem-cell mobilization and transplantation for patients with non-Hodgkin's lymphoma, J Clin Oncol, 2009;27:4767–73.
57. Micallef IN, Stiff PJ, DiPersio JF, et al., Successful stem cell remobilization using plerixafor (mozobil) plus granulocyte colonystimulating factor in patients with non-hodgkin lymphoma: results from the plerixafor NHL phase 3 study rescue protocol,Biol Blood Marrow Transplant, 2009;15:1578–86.
58. Cheng J, Schmitt M, Wuchter P, et al., Plerixafor is effective given either preemptively or as a rescue strategy in poor stem cell mobilizing patients with multiple myeloma, Transfusion, 2015;55:275–83.
59. Hundemer M, Engelhardt M, Bruckner T, et al., Rescue stem cell mobilization with plerixafor economizes leukapheresis in patients with multiple myeloma, J Clin Apher, 2014;29:299–304.
60. Farina L, Spina F, Guidetti A, et al., Peripheral blood CD34+ cell monitoring after cyclophosphamide and granulocyte-colonystimulating factor: an algorithm for the pre-emptive use of plerixafor, Leuk Lymphoma, 2014;55:331–6.
61. Rosenbaum ER, Nakagawa, M., Pesek, G. et al, A 15-hour dosing-collection interval for plerixafor is at least as effective as the standard 10-hour interval [51st ASH Annual Meeting Abstract] Blood, 2009;114:2152.
62. Lefrere F, Mauge L, Rea D, et al., A specific time course for mobilization of peripheral blood CD34+ cells after plerixafor injection in very poor mobilizer patients: impact on the timing of the apheresis procedure, Transfusion, 2013;53:564–9.
63. Lisenko K, Pavel P, Bruckner T, et al., Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection, J Clin Apher, 2016;. doi: 10.1002/jca.21463.
64. Rosenbaum ER, O'Connell B, Cottler-Fox M, Validation of a formula for predicting daily CD34(+) cell collection by leukapheresis, Cytotherapy, 2012;14:461–6.
65. Porrata LF, Inwards DJ, Ansell SM, et al., Early lymphocyte recovery predicts superior survival after autologous stem cell transplantation in non-Hodgkin lymphoma: a prospective study, Biol Blood Marrow Transplant, 2008;14:807–16.
66. Porrata LF, Litzow MR, Inwards DJ, et al., Infused peripheral blood autograft absolute lymphocyte count correlates with day 15 absolute lymphocyte count and clinical outcome after autologous peripheral hematopoietic stem cell transplantation in non-Hodgkin's lymphoma, Bone Marrow Transplant, 2004;33:291–8.
67. Gordan LN, Sugrue MW, Lynch JW, et al., Correlation of early lymphocyte recovery and progression-free survival after autologous stem-cell transplant in patients with Hodgkin's and non-Hodgkin's Lymphoma, Bone Marrow Transplant, 2003;31:1009–13.
68. Nieto Y, Shpall EJ, McNiece IK, et al., Prognostic analysis of early lymphocyte recovery in patients with advanced breast cancer receiving high-dose chemotherapy with an autologous hematopoietic progenitor cell transplant, Clin Cancer Res, 2004;10:5076–86.
69. Kim H, Sohn HJ, Kim SE, et al., Lymphocyte recovery as a positive predictor of prolonged survival after autologous peripheral blood stem cell transplantation in T-cell non- Hodgkin's lymphoma, Bone Marrow Transplant, 2004;34:43–9.
70. Boulassel MR, Herr AL, de BEMD, et al., Early lymphocyte recovery following autologous peripheral stem cell transplantation is associated with better survival in younger patients with lymphoproliferative disorders, Hematology, 2006;11:165–70.
71. Joao C, Porrata LF, Inwards DJ, et al., Early lymphocyte recovery after autologous stem cell transplantation predicts superior survival in mantle-cell lymphoma, Bone Marrow Transplant, 2006;37:865–71.
72. Gorin NC, Labopin M, Boiron JM, et al., Results of genoidentical hemopoietic stem cell transplantation with reduced intensity conditioning for acute myelocytic leukemia: higher doses of stem cells infused benefit patients receiving transplants in second remission or beyond--the Acute Leukemia Working Party of the European Cooperative Group for Blood and Marrow Transplantation, J Clin Oncol, 2006;24:3959–66.
73. Saraceni F, Shem-Tov N, Olivieri A, et al., Mobilized peripheral blood grafts include more than hematopoietic stem cells: the immunological perspective, Bone Marrow Transplant, 2015;50:886–91.
74. Taubert I, Saffrich R, Zepeda-Moreno A, et al., Characterization of hematopoietic stem cell subsets from patients with multiple myeloma after mobilization with plerixafor, Cytotherapy, 2011;13:459–66.
75. Fruehauf S, Veldwijk MR, Seeger T, et al., A combination of granulocyte-colony-stimulating factor (G-CSF) and plerixafor mobilizes more primitive peripheral blood progenitor cells than G-CSF alone: results of a European phase II study, Cytotherapy, 2009;11:992–1001.
76. Varmavuo V, Mantymaa P, Silvennoinen R, et al., CD34+ cell subclasses and lymphocyte subsets in blood grafts collected after various mobilization methods in myeloma patients, Transfusion, 2013;53:1024–32.
77. Valtola J, Varmavuo V, Ropponen A, et al., Blood graft cellular composition and posttransplant recovery in non-Hodgkin's lymphoma patients mobilized with or without plerixafor: a prospective comparison, Transfusion, 2015;55:2358–68.
78. Zubair AC, Kao G, Daley H, et al., CD34(+) CD38(-) and CD34(+) HLA-DR(-) cells in BM stem cell grafts correlate with short-term engraftment but have no influence on long-term hematopoietic reconstitution after autologous transplantation, Cytotherapy, 2006;8:399–407.
79. Jiang L, Malik S, Litzow M, et al., Hematopoietic stem cells from poor and good mobilizers are qualitatively equivalent, Transfusion, 2012;52:542–8.
80. Porrata LF, Gastineau DA, Padley D, et al., Re-infused autologous graft natural killer cells correlates with absolute lymphocyte count recovery after autologous stem cell transplantation, Leuk Lymphoma, 2003;44:997–1000.
81. Dean R, Masci P, Pohlman B, et al., Dendritic cells in autologous hematopoietic stem cell transplantation for diffuse large B-cell lymphoma: graft content and post transplant recovery predict survival, Bone Marrow Transplant, 2005;36:1049–52.
82. Atta EH, de Azevedo AM, Maiolino A, et al., High CD8+ lymphocyte dose in the autograft predicts early absolute lymphocyte count recovery after peripheral hematopoietic stem cell transplantation, Am J Hematol, 2009;84:21–8.
83. Shaughnessy P, Chao N, Shapiro J, et al., Pharmacoeconomics of hematopoietic stem cell mobilization: an overview of current evidence and gaps in the literature, Biol Blood Marrow Transplant, 2013;19:1301–9.
Autologous haematopoietic stem-cell transplantation, leukapheresis, stem cell mobilisation