Effect of the Amount of Autologous Hematopoietic Stem Cells on Survival and Engraftment in Multiple Myeloma




CD34 hematopoietic progenitor cells
Multiple myeloma

How to Cite

Batgi, H., Başcı, S., Bakırtaş, M., Uncu Ulu, B., Yiğenoğlu, T. N., Yıldız, J., İskender, D., Özcan, N., Dal, M. S., Kızıl Çakar, M., & Altuntaş, F. (2021). Effect of the Amount of Autologous Hematopoietic Stem Cells on Survival and Engraftment in Multiple Myeloma. Iranian Red Crescent Medical Journal, 23(5). https://doi.org/10.32592/ircmj.2021.23.5.613


Background: Autologous stem cell transplantation (ASCT) is currently a gold standard treatment for eligible multiple myeloma (MM) patients. The recommended dose of CD34+ hematopoietic progenitor cells (HPCs) for adequate engraftment is above 2 × 106 cells/kg.

Objectives: This study aimed to evaluate the relationship between the number of CD34+ HPCs and the survival in MM patients who underwent ASCT in the Hematology Department of Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.

Materials and Methods: The statistical population of this consisted of 200 MM patients who underwent ASCT within 2009-2019. The clinical characteristics of the patients, disease status pre-SCT, number of infused CD34+ cells, neutrophil, and platelet engraftment days were recorded. The patients were divided into two groups, based on whether the re-infused CD34+ HPCs dose was < 5 × 106 cells/kg (Group 1) or ≥ 5 × 106 cells/kg (Group 2). The groups were compared in terms of engraftment and overall survival (OS) times.

Results: A total of 200 patients were included in our study. Group 1 (n=125) included patients with < 5 × 106 cells/kg CD34+ HPC re-infusion, and Group 2 (n=75) consisted of patients with ≥ 5 × 106cells/kg CD34+ HPC re-infusion. The patients’ median age scores in Group 1 and Group 2 were 57 (25-71) and 56 (33-72) years, respectively. The median follow-up period was 33 months (6-130). The median OS of all patients was 71 months (95% confidence interval, 59.1-82.9). The median neutrophil and platelet engraftment times were similar between the groups (P=0.4 and P=0.4, respectively). In both groups, the median OS time was 71 months (P=0.8), which was similar.

Conclusion: The greater number of CD34+ HPCs re-infusion for ASCT after high dose melphalan chemotherapy in MM patients did not affect platelet and neutrophil engraftment time and OS; therefore, this amount of reinfusion was not required.



  1. Bird JM, Owen RG, D'Sa S, Snowden JA, Pratt G, Ashcroft J, et al. Guidelines for the diagnosis and management of multiple myeloma 2011. Br J Haematol. 2011;154(1):32-75. doi: 10.1111/j.1365-2141.2011.08573. [PubMed: 21569004].
  2. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, et al. Medical research council adult leukaemia working p: high-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med. 2003;348(19):1875-83. doi: 10.1056/NEJMoa022340. [PubMed: 12736280].
  3. Mohty M, Hubel K, Kroger N, Aljurf M, Apperley J, Basak GW, et al. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European group for blood and marrow transplantation. Bone Marrow Transplant. 2014;49(7):865-72. doi: 10.1038/bmt.2014.39. [PubMed: 24686988].
  4. Aladağ Karakulak E, Demiroğlu H, Büyükaşik Y, Turgut M, Aksu S, Sayinalp N, et al. CD34+ Hematopoietic progenitor cell dose as a predictor of engraftment and survival in multiple myeloma patients undergoing autologous stem cell transplantation. Turk J Med Sci. 2020;50(8):1851-6. doi: 10.3906/sag-2001-173. [PubMed: 32512672].
  5. Stiff PJ, Micallef I, Nademanee AP, Stadtmauer EA, Maziarz RT, Bolwell BJ, et al. Transplanted CD34(+) cell dose is associated with long-term platelet count recovery following autologous peripheral blood stem cell transplant in patients with non-Hodgkin lymphoma or multiple myeloma. Biol Blood Marrow Transplant. 2011;17(8):1146-53. doi: 10.1016/j.bbmt.2010.11.021. [PubMed: 21126595].
  6. Giralt S, Costa L, Schriber J, Dipersio J, Maziarz R, McCarty J, et al. Optimizing autologous stem cell mobilization strategies to improve patient outcomes: consensus guidelines and recommendations. Biol Blood Marrow Transplant. 2014;20(3):295-308. doi: 10.1016/j.bbmt.2013.10.013. [PubMed: 24141007].
  7. Yiğenoğlu TN, Başcı S, Ulu BU, Bakırtaş M, Kılınç A, Şahin D, et al. Inferior prognosis in poor mobilizing myeloma patients. Transfus Apher Sci. 2020;59(3):102722. doi: 10.1016/j.transci.2020.102722. [PubMed: 32014363].
  8. Nijhof IS, van de Donk NW, Zweegman S, Lokhorst HM. Current and new therapeutic strategies for relapsed and refractory multiple myeloma: an update. Drugs. 2018;78(1):19-37. doi: 10.1007/s40265-017-0841-y. [PubMed: 29188449].
  9. Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL, 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 2009;23(10):1904-12. doi: 10.1038/leu.2009.127. [PubMed: 19554029].
  10. Bensinger W, Appelbaum F, Rowley S, Storb R, Sanders J, Lilleby K, et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J Clin Oncol. 1995;13(10):2547-55. doi: 10.1200/JCO.1995.13.10.2547. [PubMed: 7595706].
  11. Lanza F, Campioni DC, Hellmann A, Milone G, Wahlin A, Walewski J, et al. Individual quality assessment of autografting by probability estimation for clinical endpoints: a prospective validation study from the European group for blood and marrow transplantation. Biol Blood Marrow Transplant. 2013;19(12):1670-6. doi: 10.1016/j.bbmt.2013.08.005. [PubMed: 23988403].
  12. Siena S, Schiavo R, Pedrazzoli P, Carlo-Stella C. Therapeutic relevance of CD34 cell dose in blood cell transplantation for cancer therapy. J Clin Oncol. 2000;18(6):1360-77. doi: 10.1200/JCO.2000.18.6.1360. [PubMed: 10715309].
  13. Jillella AP, Ustun C. What is the optimum number of CD34+ peripheral blood stem cells for an autologous transplant? Stem Cells Dev. 2004;13(6):598-606. doi: 10.1089/scd.2004.13.598. [PubMed: 15684827].