High D-index during mobilization predicts poor mobilization of CD34+ cells after anti-lymphoma salvage chemotherapy.

BACKGROUND: Performing stem cell collection after mobilization chemotherapy was a well-balanced strategy between anti-tumor effect and efficient collection of CD34+ cells, but deep and prolonged nadir exposed patients to risk of febrile neutropenia. Febrile neutropenia was known to be associated with lower yields of CD34+ cells, but quantitative data referring to association between yields of CD34+ cells and severity of neutropenia was lacking. We hypothesized that D-index, which was developed for quantitative evaluation of severity of neutropenia especially in the field of hematologic malignancies, could predict yields of CD34+ cells. METHODS: We performed a single center, retrospective analysis of patients with relapsed or refractory aggressive lymphoma who were mobilized with ESHAP or modified ESHAP. We evaluated the association between yields of CD34+ cells at first apheresis and D-index. RESULTS: Thirty-six patients were included, and we demonstrated that yields of CD34+ cells from patients with higher D-index were significantly lower than those from patients with lower D-index. Multivariate linear regression analysis and logistic regression analysis also demonstrated the significant predictive power of D-index. Further, D-index was significantly correlated to platelet count before starting mobilization chemotherapy. Platelet count was known to predict yields of CD34+ cells, and combination of platelet count and D-index could identify patients with lowest CD34+ yields. CONCLUSION: D-index could predict yields of CD34+ cells and it seemed that its predictive power was not less than that of platelet count. Prospective studies including more heterogeneous patients were needed to validate our study.

Hemoglobin and C-reactive protein levels as predictive factors for long-term successful glucocorticoid treatment for multicentric Castleman's disease.

Although anti-interleukin-6 therapy with tocilizumab and siltuximab is recommended for multicentric Castleman's disease (MCD), burdens caused by frequent hospital visits and high drug payments is an issue to be considered. Although glucocorticoid monotherapy might be less effective compared to these agents, substantial proportions of patients can be successfully treated for years. Therefore, we conducted a retrospective analysis of Castleman's disease patients to explore predictors of glucocorticoid responsiveness and revealed that higher hemoglobin and/or lower C-reactive protein levels before starting glucocorticoid monotherapy were associated with lower probability of requirements for second-line treatment among patients initially treated with glucocorticoid. We concluded that glucocorticoids had a potential to induce sustained disease control for indolent MCD patients with specific clinical characteristics.