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Decision‐tree algorithm for optimized hematopoietic progenitor cell–based predictions in peripheral blood stem cell mobilization
Author(s) -
Wu ChiaYun,
Chiou TzeonJye,
Liu ChunYu,
Lin FengChang,
Lin JeongShi,
Hung ManHsin,
Hsiao LiangTsai,
Yen ChuehChuan,
Gau JyhPyng,
Yen HsiuJu,
Hung GiunYi,
Hsu HuiChi,
Tzeng ChengHwai,
Liu JingHwang,
Yu YuanBin
Publication year - 2016
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13666
Subject(s) - cart , medicine , cd34 , mobilization , haematopoiesis , logistic regression , cyclophosphamide , oncology , stem cell , hematology , hematopoietic stem cell transplantation , progenitor cell , peripheral blood mononuclear cell , immunology , chemotherapy , transplantation , biology , mechanical engineering , biochemistry , genetics , archaeology , engineering , in vitro , history
BACKGROUND Enumerating hematopoietic progenitor cells (HPCs) by using an automated hematology analyzer is a rapid, inexpensive, and simple method for predicting a successful harvest compared with enumerating circulating CD34+ cells. However, the optimal HPC cutoff count and the indicating factors to be considered for improved predicting have not yet been determined. STUDY DESIGN AND METHODS Between 2007 and 2012, a total of 189 consecutive patients who proceeded to peripheral blood stem cell (PBSC) harvesting were retrospectively recruited. Baseline characteristics were analyzed to identify the risk factors for a failed harvest, which were defined as less than 2 × 10 6 CD34+ cells/kg. Variables identified by multivariate logistic regression and correlation analysis for predicting a successful harvest were subjected to classification and regression tree (CART) analysis. RESULTS PBSCs were successfully harvested in 154 (81.5%) patients. An age of at least 60 years, a diagnosis of a solid tumor, at least five prior chemotherapy cycles, prior radiotherapy, and mobilization with granulocyte–colony‐stimulating factor alone or high‐dose cyclophosphamide were independent baseline predictors of poor mobilization. In CART analysis, patients with zero to two host risk factors and either higher HPC (≥28 × 10 6 /L) or mononuclear cell (MNC; ≥3.5 × 10 9 /L) counts were categorized as good mobilizers and their harvest success rate was 92.3%. By contrast, 30.3% of harvests were adequate in the patients with three to five host risk factors and lower HPC and MNC counts. CONCLUSION A CART algorithm incorporating host predictors and HPC and MNC counts improves predictions in a successful harvest and might reduce the necessity of monitoring peripheral CD34+ cells.