G-CSF Only Versus Chemotherapy and G-CSF Peripheral Blood Stem Cell Mobilization for Autologous Hematopoietic Stem Cell Transplant-Assessing a Change in Regime due to the COVID-19 Pandemic.

Wolf, JS.; Seymour, F.; Parrish, C.; Chandler, T.; Holt, M.; Griffin, J.; Karakantza, M.

G-CSF Only Versus Chemotherapy and G-CSF Peripheral Blood Stem Cell Mobilization for Autologous Hematopoietic Stem Cell Transplant-Assessing a Change in Regime due to the COVID-19 Pandemic.

All Authors

Wolf, JS.

Seymour, F.

Parrish, C.

Chandler, T.

Holt, M.

Griffin, J.

Karakantza, M.

LTHT Author

Seymour, Frances
Parrish, Christopher
Holt, Matthew
Karakantza, Marina

LTHT Department

Oncology
Haematology

Publication Date

2025

Item Type

Journal Article
Comparative Study

Abstract

Autologous stem cell transplant (ASCT) requires the collection of hematopoietic progenitor cells, commonly by apheresis (HPC-A). These CD34+ cells can be mobilized using Granulocyte Colony Stimulating Factor (G-CSF) only or chemomobilization plus G-CSF. Both methods may additionally include Plerixafor. The emergence of COVID-19 led to recommendations for preferential G-CSF only mobilization. To assess the impact of this recommendation on HPC-A harvesting, we analyzed data from the NHS Blood and Transplant Stem Cell Collection Registry for 1342 patients undergoing 2431 HPC-A procedures between 01/01/2019 and 31/12/2021. We compared G-CSF only, cyclophosphamide plus G-CSF (Cyclo-G) and G-CSF plus alternative chemotherapy (Chemo+G) mobilization. The outcomes collected were pre-apheresis CD34+ count, CD34+ yield per procedure, total CD34+ yield, number of apheresis procedures required to achieve the CD34+ target, mobilization failure, and Plerixafor use (+P). In multiple myeloma (MM), Cyclo-G (+/-P) mobilization produced significantly higher CD34+ yields than G-CSF only (7.44 vs. 4.75 x 106/kg; p < 0.0001). In Hodgkin lymphoma (HL) there was no statistically significant difference between regimes (CD34+ yield 4.53 x 106/kg with G-CSF only (+/-P), 5.52 x 106/kg with Cyclo-G (+/-P), 4.32 x 106/kg with Chemo+G (+/-P)). In Non-Hodgkin lymphoma (NHL), Chemo+G (+/-P) was the most successful regime (5.98 x 106/kg vs. 3.7 x 106/kg with G-CSF only (+/-P) vs. 3.69 x 106/kg with Cyclo-G (+/-P); p < 0.00001). On demand Plerixafor use resulted in > 95% successful mobilization in MM and NHL. CD34+ yields are higher using Cyclo-G and Chemo+G in NHL. In MM, G-CSF only resulted in yields sufficient for at least one transplant. In HL, our data show no evidence to support the use of Cyclo-G over G-CSF only.