Enhancing CD34+ Cell Mobilization and Engraftment after Autologous Hematopoietic Stem Cell Transplantation via Adjustment of Granulocyte Colony-Stimulating Factor Dose and Period, a Single Center Experience

Background and Objective: Insufficient mobilization of hematopoietic stem cells and delayed engraftment are reported in autologous hematopoietic stem cell transplantation (AHSCT). The aim if this study was to identify and introduce predictive factors for mobilization and engraftment. Materials and Methods: The participants include AHSCT candidates. Pre-apheresis CD34+ cells and CD34+ count per kilogram (CD34+ CPK) in the apheresis products were assessed by flow cytometry. There were other parameters connected to platelet and neutrophil engraftment as well as mobilization by granulocyte-stimulating growth factor (G-CSF). Univariate, multivariate, and receiver operating characteristic (ROC) analyses were used in the statistical study. Results: The predictive value of CD34+ CPK for platelet engraftment was fair (AUC: 76.9%) with the cut-off of 3.5×106, while it was poor for neutrophil engraftment (AUC: 64.4%) with the cut-off of 3.4×106. The multiple-variate analysis demonstrated that age and CD34+ CPK were positively correlated with platelet engraftment (p-values less than 0.01 and 0.005, respectively), while CD34+ CPK and total dose of infused G-CSF (TDIG) were associated with neutrophil engraftment (p-values: 0.03). In high rates, the TDIG correlated negatively with CD34+ CPK, CD34+ cell counts in pre-apheresis peripheral blood samples, and total engraftment, indicating negative effects of high and long-term doses of G-CSF on mobilization and engraftment. Conclusion: The management of AHSCT will be more efficient by considering the age, CD34+ CPK, and TDIG. For enhanced engraftment, adjusting the G-CSF injection days for 4 days and total dose of G-CSF on 4000 micrograms are suggested.