Collection of adequate hematopoietic stem cells (HSCs) is necessary for successful
autologous transplantation; however, a proportion of patients fail to collect the minimum number of cells required. We summarized the efficacy and safety of HSC mobilization strategies. We performed a systematic review of randomized controlled trials comparing HSC mobilization strategies before
autologous transplantation for
hematologic malignancies. The primary outcome was CD34+ cell yield. Secondary outcomes included number of
aphereses, proportion of failures, rate of count recovery, and adverse events. We identified 28 articles within 3 broad strategies. Using a
cyclophosphamide with
growth factor strategy (10 articles), CD34+ cell yield is improved by addition of
molgramostim to
cyclophosphamide (1.4 vs 0.5 × 10(6)/kg; P = .0165), addition of
cyclophosphamide to
filgrastim (7.2 vs 2.5 × 10(6)/kg; P = .004), and addition of
ancestim to
cyclophosphamide and
filgrastim (12.4 vs 8.3 × 10(6)/kg; P = .007). Within a
growth factor-based strategy (6 articles), addition of
plerixafor improves CD34+ cell yield over
filgrastim alone in
multiple myeloma (MM; 11.0 vs 6.2 × 10(6)/kg; P < .001) and
non-Hodgkin lymphoma (5.69 vs 1.98 × 10(6)/kg; P < .01). With combination or noncyclophosphamide-based
chemotherapy (12 articles), higher-dose
filgrastim (8.2 vs 4.7 × 10(6)/kg for 16 vs 8/mcg/kg daily of
filgrastim, respectively; P < .0001) and addition of
rituximab to
etoposide and
filgrastim (9.9 vs 5.6 × 10(6)/kg; P = .021) improve CD34+ cell yield.
Growth factor alone after
chemotherapy,
ancestim, or
plerixafor provide adequate autologous HSC grafts for the majority of patients. Although some strategies result in higher CD34+ cell yield, this potentially comes at the expense of increased toxicity. As all strategies are reasonable, programmatic, and patient-specific considerations must inform the approach to autologous graft mobilization.