Increasing the economic efficacy of peripheral blood progenitor cell collections by monitoring peripheral blood CD34+ concentrations

BACKGROUND: After mobilization, the collection of peripheral blood progenitor cells (PBPCs) can either be started a fixed number of days after having passed the white blood cell nadir (fixed-day scheme) or be based on monitoring of CD34+ cells. This study was conducted to compare both approaches and to assess possible financial consequences. STUDY DESIGN AND METHODS: For 29 patients daily enumeration of CD34+ cells was used to guide leukapheresis timing. In a retrospective analysis for the same group of patients, application of a fixed-day scheme was assumed. For scenarios of beginning apheresis 2, 3, 4, or 5 days after WBC nadir, the number of apheresis days and granulocyte-colony-stimulating factor (G-CSF) application days that could be saved was calculated. RESULTS: A total of 44 apheresis procedures were performed resulting in a mean CD34+ cell content per apheresis product of 10.4 x 10 6 (range, 0.1 × 10 6 -49.5 x 10 6 )/kg of body weight. The smallest number of deviation days compared to a fixed-day scheme was found for beginning an apheresis on Day 3. In comparison to this, CD34+ monitoring reduced the number of G-CSF days by 9 and the number of apheresis procedures by 11 overall, resulting in savings of €19,965 (US$28,788) in comparison to expenses of €826 (US$1191) for CD34+ monitoring. CONCLUSIONS: Measurement of CD34+ cells has reached a precision enabling a prediction of the harvest success. In comparison to a fixed-day scheme, daily CD34+ monitoring reduces the donor's exposition to G-CSF, enables collection of a sufficient number of PBPCs in the least possible number of apheresis sessions, and improves the economic efficacy of the institution.