TY - JOUR
T1 - Predicting failure of hematopoietic stem cell mobilization before it starts: The predicted poor mobilizer (pPM) score
AU - Olivieri, J
AU - Attolico, I
AU - Nuccorini, R
AU - Pascale, SP
AU - Chiarucci, M
AU - Poiani, M
AU - Corradini, P
AU - Farina, L
AU - Gaidano, G
AU - Nassi, L
AU - Sica, S
AU - Piccirillo, N
AU - Pioltelli, PE
AU - Martino, M
AU - Moscato, T
AU - Pini, M
AU - Zallio, F
AU - Ciceri, F
AU - Marktel, S
AU - Mengarelli, A
AU - Musto, P
AU - Capria, S
AU - Merli, F
AU - Codeluppi, K
AU - Mele, G
AU - Lanza, F
AU - Specchia, G
AU - Pastore, D
AU - Milone, G
AU - Saraceni, F
AU - Di Nardo, E
AU - Perseghin, P
AU - Olivieri, A
PY - 2018
Y1 - 2018
N2 - Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure. © 2017 The Author(s) 2017, under exclusive licence to Macmillan Publishers Limited, part of Springer Nature.
AB - Predicting mobilization failure before it starts may enable patient-tailored strategies. Although consensus criteria for predicted PM (pPM) are available, their predictive performance has never been measured on real data. We retrospectively collected and analyzed 1318 mobilization procedures performed for MM and lymphoma patients in the plerixafor era. In our sample, 180/1318 (13.7%) were PM. The score resulting from published pPM criteria had sufficient performance for predicting PM, as measured by AUC (0.67, 95%CI: 0.63-0.72). We developed a new prediction model from multivariate analysis whose score (pPM-score) resulted in better AUC (0.80, 95%CI: 0.76-0.84, p < 0001). pPM-score included as risk factors: increasing age, diagnosis of NHL, positive bone marrow biopsy or cytopenias before mobilization, previous mobilization failure, priming strategy with G-CSF alone, or without upfront plerixafor. A simplified version of pPM-score was categorized using a cut-off to maximize positive likelihood ratio (15.7, 95%CI: 9.9-24.8); specificity was 98% (95%CI: 97-98.7%), sensitivity 31.7% (95%CI: 24.9-39%); positive predictive value in our sample was 71.3% (95%CI: 60-80.8%). Simplified pPM-score can "rule in" patients at very high risk for PM before starting mobilization, allowing changes in clinical management, such as choice of alternative priming strategies, to avoid highly likely mobilization failure. © 2017 The Author(s) 2017, under exclusive licence to Macmillan Publishers Limited, part of Springer Nature.
U2 - 10.1038/s41409-017-0051-y
DO - 10.1038/s41409-017-0051-y
M3 - Article
SN - 0268-3369
VL - 53
SP - 461
EP - 473
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 4
ER -