CD 34 count in the Collect

[Liz]

What is the CD34 count in the total aulogous PBSC collects that is sufficient for an adult? For a Pediatric patient?

Thanks

Liz

[bmarotto]

We only do adults. Our hematologists ask for 5 million CD34+ per kg but usually settle for 3 million. Many of our patients are poor mobilizers. Plerixifor seems to help. I wish they gave it to all the patients.

[Liz]

Yes! a reply! Thank you bmarotto!

We use Neupogen, G-CSF, alone I shall ask our Oncologist about Mozobil, thanks.

We collect as you do 5 million per kg for adults. For Peds it is 6 million. The important thing is also to have back up bags.

The reason I ask is because the oncologists keep changing the number they want, its always more, more, more.

Appreciate your reply

Liz

[CM2]

For us the minimum acceptable dose is 2.5 x 10^6/ kg ideal weight for autos. MM patients they collect 5 million to have a second transplant in case of relapse. They always want more however - more like 5 or 6 per transplant if they can get it. Its a bit frustrating at times when the requested amount seems subject to various arbitrary decisions such as having 1 obese patient with complications engraft slowly - therefore all obese patients should get "more" for the next 6 months. Suddenly 10 years of data using ideal weight becomes irrelevant.

We have just started using Plerixafor/mozobil and its a big argument between hospital administration vs insurance who pays for it. You are talking a cost of approx $5000 per day (single use vial). Insurance wants to bundle it into the case rate and hospital wants to get paid for it separately since its not standard of care yet. We have only been using it on patients so far that would never have been able to mobilize enough for even a single transplant. It's also been a hassle logistically for dosing since the drug reps suggest it be given 10 hours before start of harvest, which either means the patient is on our same day unit with a nurse on OT at 10pm at night being observed while getting the drug - or our apheresis nurses would have to do something like start collection at 3 am. Not too reasonable.

[Liz]

Thank you for your repy CM2, this sounds familiar "subject to various arbitrary decisions" !

[applejw]

For single adult transplants, the MDs request 3 million CD34 per kg (ABW). Myeloma patients the endpoint is 6 million. Our docs have worked out an algorithm for the requested endpoint and circulating CD34 to determine when to start collections. It generally works well except for the infrequent poor mobilizer.

Peds generally want 3-5 million unless it's for a neuroblastoma patient - that usually means 10-15 million per kg. Most kids mobilize very well so the higher dose isn't a problem.

[Liz]

Thank you very much applejw. Do you have their algorithm?

Seriously, I would like to try it so that the collections stop falling on Sundays, Birthdays, holidays and even on marriages with no replacement operator

Thank you

Liz

[aking]

Liz,

We only collect adults and use actual body weight in determining how much to collect. We have a simple format we follow for collecting: 2 million CD34+/kg is minimum dose and goal is 5 for collection for each transplant. In cases where we collect for 2 transplants (mostly myeloma), the minimum we would want to collect is 4 and our goal is 10. We only use Plerixafor if we cannot mobilize a patient through usual methods (G-CSF only or G-CSF plus chemo). We had one special circumstance when we used it on a patient who had radiation to the pelvic area and was treated with many cycles of lenalidomide for myeloma (which has caused us to fail mobilization a few times when last treatment was done with close proximity to mobilization). We managed to get enough cells for two transplants with that one.

Ann