Haematopoietic Stem Cell Mobilisation Regimens and Graft Composition in Autologous Transplantation

Abstract

Background: Autologous transplantation needs a graft collected by apheresis after mobilisation, and the regimen determines
whether enough cells are obtained, and at what cost.
Objective: To review mobilisation regimens, the definition of poor mobilisation, and whether graft composition beyond CD34
count predicts anything.
Methods: Narrative review of randomised trials, consensus documents and comparative cohorts.
Findings: Plerixafor raised the proportion meeting the collection target from 34.4% to 71.6% in myeloma and from 20% to
59% in lymphoma; motixafortide reached 92.5% against 26.2%. Yet median neutrophil engraftment was 12 days in both arms
of that trial. Chemomobilisation also collects more cells without changing engraftment, and CD34 subsets predict worse than
total CD34 dose.
Conclusions: The gains these trials establish are logistical. Graft composition beyond CD34 count remains
hypothesis-generating