[Rhonda]

Stem cell collection - how much is enough?

by Rhonda on Wed Aug 05, 2015 11:58 am

Good morning,

I started my stem cell harvest yesterday. The first day I collected 2.9 million. I was told my goal is 4 million. I have been told I only need 2 million for my transplant and 2 million if they don't graft. These numbers are so low compared to others.

Can someone tell me why? I am concerned, but believe I am am in a good facility with good doc­tors.

Thank you,
Rhonda

[reece93]

Re: Stem cell collection - how much is enough?

by reece93 on Wed Aug 05, 2015 1:53 pm

My husband has his transplant at MD Anderson on April 29, 2015. They collected 6 million over 2 days. They said that is enough for 2 transplants, but I see people write of their doctors using that many and more for 1 transplant. Pretty confusing, right?

[Rhonda]

Re: Stem cell collection - how much is enough?

by Rhonda on Wed Aug 05, 2015 2:07 pm

Hi Reece1993

It is very confusing, 2 million is so low. I read in a past post 2.4 million was considered a failed harvest now I only need 2 million. I wonder what the determining factor is.

I wish your husband the best.

Rhonda

[Rneb]

Re: Stem cell collection - how much is enough?

by Rneb on Wed Aug 05, 2015 3:44 pm

Mine was 4 Million + in just less than 3 hours...

They said it was enough for 2-3 transplants....and promptly kicked my butt out, while I was still chewing calcium tablets. Go figure.

They are on ice, and have been since March 2013.

I really wouldn't worry, if I was in your situation.

Good luck.

[Rhonda]

Re: Stem cell collection - how much is enough?

by Rhonda on Wed Aug 05, 2015 7:51 pm

Thanks Rneb

That is funny. I was actually chewing calcium tabs on my way out yesterday. My total collection for the two days was 4.2, so I met my goal. I am thankful for that.

Have a good evening and wishing you the best in the future.

Rhonda

[CabinGirl]

Re: Stem cell collection - how much is enough?

by CabinGirl on Thu Aug 06, 2015 8:09 pm

I collected over 15 million stem cells in 2 days of harvest. I've had one transplant, where I received about 5.2 million stem cells during transplant. I've got the rest frozen in case I need them in the future. I was told by my myeloma specialist they prefer a minimum of 3 million stem cells per transplant.

[JimNY]

Re: Stem cell collection - how much is enough?

by JimNY on Thu Aug 06, 2015 8:27 pm

Hi Rhonda,

There is an International Myeloma Working Group consensus statement related to the harvesting of stem cells for transplantation, and I think it will help answer your question. It says the following:

The current minimal threshold CD34 cell dose to be infused is agreed to be greater than or equal to 2 million CD34 cells/kg for a single transplant. However, the current optimal dose for ideal platelet recovery is considered to be 4-6 million CD34 cells/kg.

(Note that "CD34 cell dose" is what we usually call "stem cell dose.)

After the above statement, there is this "Conclusion/assessment":

The committee suggested that a minimum target of 4 million CD34+ cells/kg be collected and that if feasible an average of 8-10 million CD34+ cells/kg be collected. These targets would allow most patients with myeloma to undergo at least two autografts with an optimal CD34 dose during the course of their disease.

There is additional background information about the basis for the conclusion in the text preceding it. It's worth reading if you're really interested in the subject.

This consensus statement was published in 2009. I don't think there is a more recent one, because these sort of things don't get updated too often. But I did not check really, really carefully.

Here's the title and link to the article:

S Giralt et al, "International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100)", Leukemia, June 25, 2009 (full text of article)

[JimNY]

Re: Stem cell collection - how much is enough?

by JimNY on Thu Aug 06, 2015 8:37 pm

After a bit more checking, I found another reference that should be helpful. It's a consensus statement from a panel of experts, published in 2014.

It lists these recommendations, focusing mainly on what is needed for a single stem cell transplant, although it does address the case of multiple transplants in the final recommendation:

• The minimum recommended stem cell dose is 2 × 106 CD34+ cells/kg.
   
• The decision to accept a collection yield of 1-2 × 106 CD34+ cells/kg for aHSCT should be individualized to each patient's clinical parameters and cir­cum­stances; in some cases, the benefit of aHSCT may be sufficiently com­pel­ling to use doses in this range if absolutely necessary.
   
• Although minimum numbers are clear, the ideal target numbers are less clear. In general, higher target doses may result in faster engraftment times, but con­sideration should be given to the balance between targets and the number of apheresis sessions required to attain the target collection. The recom­mend­ed stem cell collection target is 3-5 × 106 CD34+ cells/kg, but in some cases it may be reasonable to accept a yield of 2.5 × 106 CD34+ cells/kg in a single apheresis session rather than prolong the mobilization by several days to reach a target of 5 × 106 CD34+ cells/kg.
   
• CD34+ cell doses of 5 × 106 cells/kg may lead to improved platelet recovery and less resource utilization compared with doses of ≤3 × 106 cells/kg, pro­vided that the higher target can be collected in a few apheresis sessions.
   
• Higher targets are necessary if multiple transplantations are planned. The col­lection target in this setting should be double the target used at the in­di­vid­u­al center for a single trans­plan­ta­tion, to allow optimal cell doses for each trans­plan­ta­tion.

Source:

S Giralt et al, "Optimizing Autologous Stem Cell Mobilization Strategies to Improve Patient Outcomes: Con­sensus Guidelines and Recommendations", Biology of Blood and Marrow Trans­plan­ta­tion, March 2014 (abstract; links to full-text PDF and full-text HTML can be found on the abstract page; full-text of article in either PDF or HTML is available at each link for no charge)

[Castaway]

Re: Stem cell collection - how much is enough?

by Castaway on Fri Aug 07, 2015 12:44 am

Rhonda,

I thought that I would have collected more on my first day of collection. I collected 3 million cells. I was told that they needed somewhere between 3 and 5 million. the second day I collected a little over 2 million.

During my inital high dose of chemo, then daily Neupogen injections, I really had no side effects. No bone pain, nothing. I was worrried that something wasn't going right after reading so many posts about bone pain and side effects. I guess that I should feel happy with what I collected, but I was so hoping that I would have collected enough for two transplants. Keeping enough frozen for that second one if needed.

Castaway

[JoAnn B]

Re: Stem cell collection - how much is enough?

by JoAnn B on Fri Aug 07, 2015 2:29 am

I collected 10 million cells in 6 hours. I was infused with 5 million that did not engraft. After 4 weeks, my white blood count was -0.04. I was given the other 5 million, which engrated within days. I have no cells in reserve for a second transplant. This was back in 2012, so maybe the amount of cells for transplant has changed. But if you have the same results as me (which is very rare), you also would not have any cells for a second transplant. I think this is something you should discuss with you doctor.