Risk Factors and Outcomes of Stem Cell Mobilization Failure in Multiple Myeloma Patients

Te-Lin Hsu; Chun-Kuang Tsai; Chun-Yu Liu; Chiu-Mei Yeh; Fen-Lan Lin; Liang-Tsai Hsiao; Yao-Chung Liu; Hao-Yuan Wang; Po-Shen Ko; Ting-An Lin; Wen-Chun Chen; Po-Min Chen; Jin-Hwang Liu; Jyh-Pyng Gau; Chia-Jen Liu

doi:10.1159/000525565

Risk Factors and Outcomes of Stem Cell Mobilization Failure in Multiple Myeloma Patients

Transfus Med Hemother. 2022 Sep 5;50(1):39-50. doi: 10.1159/000525565. eCollection 2023 Feb.

Authors

Te-Lin Hsu¹, Chun-Kuang Tsai^{1

2}, Chun-Yu Liu^{2

3}, Chiu-Mei Yeh^{1

4}, Fen-Lan Lin³, Liang-Tsai Hsiao^{1

2}, Yao-Chung Liu^{1

2}, Hao-Yuan Wang^{1

2}, Po-Shen Ko^{1

2}, Ting-An Lin^{1

2}, Wen-Chun Chen^{1

2}, Po-Min Chen^{1

2}, Jin-Hwang Liu^{5

6

7}, Jyh-Pyng Gau^{1

2}, Chia-Jen Liu^{1

2

8}

Affiliations

¹ Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
³ Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
⁴ Institute of Public Health, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
⁵ Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
⁶ Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
⁷ Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei City, Taiwan.
⁸ Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.

Abstract

Introduction: Autologous hematopoietic stem cell transplantation (ASCT) is a well-established treatment for patients with multiple myeloma (MM), and adequate stem cell collection must be assured before ASCT. However, prediction of poor mobilizers (PMs) is still difficult despite several risk factors for mobilization failure having been identified.

Methods: We retrospectively analyzed MM patients at Taipei Veterans General Hospital in Taiwan who underwent stem cell collection between October 2006 and August 2020. A CD34⁺ cell collection of <1 × 10⁶ cells/kg was defined as a mobilization failure. The primary endpoint was mobilization failure. The secondary endpoint was overall survival (OS). Odds ratios (ORs) and 95% confidence intervals (CIs) for mobilization failure were calculated using a logistic regression model. The cumulative incidence of mortality was estimated using the Kaplan-Meier method.

Results: In the multivariate analysis, absolute monocyte count <500/µL (adjusted OR 10.75, 95% CI: 1.82-63.57, p = 0.009), platelet count <150,000/µL (adjusted OR 12.49, 95% CI: 2.65-58.89, p = 0.001) before mobilization, and time interval from diagnosis to stem cell harvest ≥180 days (adjusted OR 7.69, 95% CI: 1.61-36.87, p = 0.011) were risk factors for PMs. PM patients had poorer OS compared to patients with successful stem cell collection in the univariate analysis (log-rank test p = 0.027). The predicted probability of PMs was estimated by the multiple logistic regression model with a sensitivity of 84.6% and a specificity of 84.0%.

Conclusion: Absolute monocyte count <500/µL, platelet count <150,000/µL, and treatment duration more than 180 days before stem cell mobilization are risk factors for unsuccessful stem cell collection. Our prediction models have high sensitivity and specificity for mobilization failure prediction and allow for early interventions for possible PMs.

Keywords: Autologous hematopoietic stem cell transplantation; Multiple myeloma; Poor mobilizers; Stem cell mobilization; Thrombocytopenia.

Grants and funding

This study was supported by grants from Taipei Veterans General Hospital (V105E10-002-MY2-1, V105B-016, and V110C-195), the Ministry of Science and Technology (MOST 104-2314-B-075-085-MY2, MOST 105-2314-B-418-003-MY3, and MOST 109-2314-B-075-079-MY2), the Taiwan Clinical Oncology Research Foundation, the Szu-Yuan Research Foundation of Internal Medicine, the Yen Tjing Ling Medical Foundation, and the Chong Hin Loon Memorial Cancer and Biotherapy Research Center at National Yang Ming Chiao Tung University. The funding sources had no role in the study design or conduct, or in the decision to submit it for publication.