The Correlation between G-CSF Dosage and the Number of Collected CD34+ Cells in Pediatric Patients Undergoing Peripheral Blood Stem Cell Mobilization

Ji Sook Lee; Hyun Joo Jung; Jun Eun Park

doi:10.5045/kjh.2006.41.4.243

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Lee, Jung, and Park: The Correlation between G-CSF Dosage and the Number of Collected CD34+ Cells in Pediatric Patients Undergoing Peripheral Blood Stem Cell Mobilization

Original Article

Korean J Hematol 2006;41(4):243-249.

Published online: 19 January 2006

DOI: https://doi.org/10.5045/kjh.2006.41.4.243

The Correlation between G-CSF Dosage and the Number of Collected CD34+ Cells in Pediatric Patients Undergoing Peripheral Blood Stem Cell Mobilization

Ji Sook Lee, M.D., Hyun Joo Jung, M.D., Jun Eun Park, M.D.

Department of Pediatric Hematology-Oncology, School of Medicine, Ajou University, Suwon, Korea

Correspondence to：Jun Eun Park, M.D. Department of Pediatric Hematology-Oncology, School of Medicine, Ajou University San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea Tel: +82-31-219-5160, Fax: +82-31-219-5169 E-mail: pedpje@ajou.ac.kr

Received 21 August 2006 Revised 10 October 2006 Accepted 10 October 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

In high risk malignancies of pediatric patients, many investigators have explored the use of stronger myeloablative regimens with autologous peripheral blood stem cell rescue such as the Tandem protocol. As the collection of peripheral blood stem cells in children have many risks, it is important to achieve the maximum number of CD34+ cells per leukapheresis. We analyzed the use of different doses of granulocyte-colony stimulating factor during a mobilization for an increased number of CD34+ cells.

Methods:

A retrospective chart review was performed for 31 patients undergoing autologous peripheral blood stem cell mobilization. All patients had received specific chemotherapies. At the nadir, each patient was injected with 5μg/kg/day G-CSF. When the level of white blood cells reached more than 1,000/μL, patients were divided according to the different dose of G-CSF that was given per day: Group I, 5μg/kg, Group II, 10μg/kg, Group III, 15μg/kg. After 2～3 days, leukapheresis was performed, and then the number of CD34+ cells and other cells were counted.

Results:

In group III, the number of collected CD34+ cells was 19.86±14.45×10⁶/kg and significantly higher than in the other two groups. Also, group III had significantly higher numbers of total nucleated cell, mononucleated cells, white blood cells, though the absolute neutrophil count compared with the other groups. There were no serious adverse effects associated with the higher G-CSF doses employed.

Conclusion:

At nadir, a pediatric patient received 5μg/kg G-CSF daily until the WBC count reached more than 1,000/μL. If the patient is injected with 15μg/kg/day of G-CSF, we can achieve a more sufficient CD34+ cell yield with one leukapheresis, safely.

Keywords: Peripheral blood stem cell transplantation, Mobilization, G-CSF, CD34+ cell

REFERENCES

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Table 1.

The characteristics of each patients injected with different dose of G-CSF∗

	Group 1 (n=10)	Group 2 (n=6)	Group 3 (n=15)	P-value
Injected dosage of G-CSF from D0^†	5μg/kg/day	10μg/kg/day	15μg/kg/day
Age (yrs)	7.08±4.81	6.15±4.59	4.64±2.32	0.280
Sex (M：F)	5：5	3：3	6：9	0.855
Diagnosis
Acute myeloid leukemia	2	3	0
Neuroblastoma	7	2	9
CNS tumor^‡	0	1	5
Ewing sarcoma	1	0	0
Rhabdomyosarcoma	0	0	1
Days to inject a differentdosage of G-CSF (days)	2.10±1.45	2.33±1.21	2.00±0.85	0.833

^∗ Granulocyte colony stimulating factor;

^† The day which total white blood cell (WBC) count reached more than 1,000/μL;

^‡ Central nervous system tumor.

Table 2.

The comparison of median cell yields between the groups

	Group I	Group II	Group III
CD34+ (×10⁶/kg)	6.33±5.09	5.42±3.05	19.86±14.45
TNC (×10⁸/kg)	4.10±2.01	4.20±2.35	10.50±4.85
MNC (×10⁸/kg)	2.51±1.31	2.62±1.31	7.34±4.09
WBC (/μL)∗	4,454.55±3,154.48	10,347.14±17,282.54	34,425.38±19,017.55
ANC (/μL)^†	2,244.45±1,785.10	8,785.29±16,443.70	29,412.31±18,215.21

^∗ White blood cell in peripheral blood on the harvest day;

^† Absolute neutrophil count in peripheral blood on the harvest day. Abbreviations: TNC, total nucleated cell; MNC, mononuclear cell.

Table 3.

The test of significancy (P-value) of median cell yields between the groups

Variables	Compared groups	P-value
CD34+	I：II	0.986
	III：I	0.016∗
	III：II	0.032∗
TNC	I：II	0.983
	III：I	0.000∗
	III：II	0.032∗
MNC	I：II	1.000
	III：I	0.001∗
	III：II	0.003∗
WBC	I：II	0.764
	III：I	0.000∗
	III：II	0.018∗
ANC	I：II	0.709
	III：I	0.001∗
	III：II	0.034∗

^∗ P-value＜0.05.

Abbreviations: TNC, total nucleated cell; MNC, mononuclear cell; WBC, white blood cell; ANC, absolute neutrophil count.

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