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Vieira L, Teixeira S, Reis C, Salselas A, Bordalo F, Lopes S, Pinho C, Amado F, Roncon S. Peripheral blood stem cells collection by apheresis in very low-weight children with malignant diseases-A single center experience. J Clin Apher 2023; 38:24-32. [PMID: 36210642 DOI: 10.1002/jca.22021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/18/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation is used in the treatment of children with malignant and non-malignant diseases. However, apheresis of peripheral blood stem cells (PBSC) represents a challenge in children below 10 kg. METHODS A retrospective trial was conducted in the Cellular Therapy Department of Portuguese Oncology Institute of Porto. INCLUSION CRITERIA children with body weight inferior to 10 kg who underwent autologous PBSC apheresis until 2021. Demographic and clinical data were collected and our institutional protocol was described. COBE Spectra apheresis system (TerumoBCT, Lakewood, Colorado) until 2012 and then Spectra Optia (TerumoBCT) were used. RESULTS Sixteen leukocytaphereses were performed in 13 patients-nine females (69%). Mean age and weight were 13.31 months (±5.26) and 8.31 kg (±1.17), respectively. The initial CD34+ cells/μL in peripheral blood was 70.8 (±61.9). A central venous catheter (CVC) was exclusively used in all but one patient, in whom a peripheral vein was also required. In 10 procedures, both heparin and anticoagulant citrate dextrose solution-formula A (ACD-A) were used; in the remaining ones, only ACD-A was employed. The median duration of each procedure was 168 minutes (±45) and 2.96 blood volumes (±0.31) were processed. Median CD34+ cells yield per leukocytapheresis was 6.52 × 106 /kg (±9.87 × 106 ). CD34+ cell extraction rates were not significantly different between the two apheresis systems. Platelet and magnesium levels were significantly lower after collection (P < .001 and P = .009, respectively). CONCLUSIONS Although recommendations are lacking, we have successfully and safely performed leukocytaphereses in children with body weight below 10 kg. The authors believe that a permanent and dynamic comprehensive evaluation of each child is paramount for attaining good results.
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Affiliation(s)
- Lúcia Vieira
- Immunohemotherapy Department, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sofia Teixeira
- Immunohemotherapy Department, University Hospital Center of São João, Porto, Portugal
| | - Conceição Reis
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Ana Salselas
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Filipa Bordalo
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sérgio Lopes
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Catarina Pinho
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Fátima Amado
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Susana Roncon
- Cellular Therapy Department, Portuguese Oncology Institute of Porto, Porto, Portugal
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2
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Pasko BE, DomBourian M, Helander L, Sanders M, Annen K. Safe peripheral blood stem cell collection in patients less than
10 kg
: A single‐center review. J Clin Apher 2022. [DOI: 10.1002/jca.22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/10/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Bryce E. Pasko
- Department of Pathology University of Colorado‐Anschutz Medical Campus Aurora Colorado USA
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Melkon DomBourian
- Department of Pathology University of Colorado‐Anschutz Medical Campus Aurora Colorado USA
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Louise Helander
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
- ClinImmune Cell and Gene Therapy, Department of Medicine University of Colorado‐Anschutz Medical Campus Aurora Colorado USA
| | - Mary Sanders
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
| | - Kyle Annen
- Department of Pathology University of Colorado‐Anschutz Medical Campus Aurora Colorado USA
- Department of Pathology and Laboratory Medicine Children's Hospital Colorado Aurora Colorado USA
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3
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Considerations for Peripheral Blood Stem Cell Apheresis in a Low Body Weight Infant. J Pediatr Hematol Oncol 2022; 44:e816-e818. [PMID: 34966095 DOI: 10.1097/mph.0000000000002380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Peripheral blood stem cell (PBSC) apheresis in infants (<10 kg body weight) requires specific precautions to prevent periprocedural complications. CASE REPORT A 9 month old child was diagnosed with high-risk neuroblastoma and planned for autologous stem cell transplantation after induction chemotherapy. We illustrate the precautions and technical details observed while performing PBSC collection in this patient. DISCUSSION Use of continuous flow devices, priming of apheresis circuits, appropriate flow rates and continuous monitoring can help to mitigate several procedure related complications. CONCLUSIONS PBSC apheresis in infants (<10 Kg) is safe and feasible with appropriate precautions detailed above.
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Grèze V, Rouel N, Rochette E, Merlin E, Halle P, Plantaz D, Deméocq F, Kanold J. Peripheral blood stem cell collection in children with extremely low body weight (≤8 kg). What have we learned over the past 25 years and where are the limits? J Clin Apher 2020; 36:322-331. [PMID: 33382142 DOI: 10.1002/jca.21863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/23/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022]
Abstract
Hematopoietic progenitor cells-apheresis (HPC-A) collection is now a routine procedure for autologous hematopoietic stem cell transplantation. Here we present our 25 years' experience of HPC-A collection in children weighing 8 kg or less, with a focus on the evolution of our standard operating procedures, and the safety limits for these young patients, in the Pediatric Apheresis Unit of Clermont-Ferrand University Hospital (France). Fifteen children weighing 8 kg or less underwent 26 HPC-A collections over 25 years. Median CD34+ cell yield by leukapheresis was 4.4 106 /kg. No procedure-related complications were encountered during or after the collection. No patient had profound thrombocytopenia or anemia that needed post-collection transfusions. Our experience in pediatric oncology patients who underwent HPC-A collections shows that this procedure can be performed even in the smallest of children with no increase in toxicity provided all precautions are taken to ensure that the procedure is carried out under the ideal conditions.
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Affiliation(s)
- Victoria Grèze
- CHU Clermont-Ferrand, Service Hématologie Oncologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre de Biothérapie d'Auvergne, Clermont-Ferrand, France
| | - Nadège Rouel
- CHU Clermont-Ferrand, Service Hématologie Oncologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CHU Clermont-Ferrand, Service Hématologie Oncologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, France
| | - Etienne Merlin
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre de Biothérapie d'Auvergne, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, Clermont-Ferrand, France
| | - Pascale Halle
- CHU Clermont-Ferrand, Service Hématologie Oncologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France
| | - Dominique Plantaz
- CHU Grenoble, département de pédiatrie, Hôpital couple-enfant, Grenoble, France
| | - François Deméocq
- Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, Clermont-Ferrand, France
| | - Justyna Kanold
- CHU Clermont-Ferrand, Service Hématologie Oncologie Pédiatrique, Hôpital Estaing, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre de Biothérapie d'Auvergne, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, Clermont-Ferrand, France
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5
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Becherucci V, Ermini S, Piccini L, Bisin S, Gori V, Gentile F, Ceccantini R, De Rienzo E, Bindi B, Pavan P, Cunial V, Allegro E, Brugnolo F, Maggio D, Calzolari D, Maccarelli E, Galli S, Muricci S, Berchielli M, Tintori V, Sardi I, Bambi F. An alternative procedure to leukapheresis for peripheral hematopoietic progenitor cell collection in very-low-weight children: A single pediatric center experience. J Clin Apher 2020; 35:406-412. [PMID: 32710805 DOI: 10.1002/jca.21813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND PBSC collection using a blood cell separator in very low weight patients can be frequently complicated by severe adverse effects and technical difficulties. MATERIAL AND METHODS From March 2013 to January 2017, 14 PBSC collections were performed in 12 children weighing less than 10 kg, affected by different solid tumours. PBSC collection was performed with a "homemade" aseptically assembled circuit. The circuit is composed by a 150 mL collection bag connected with a 4 stopcock ramp, perfused with ACD. This circuit allows collection of a specific total blood amount from CVC, depending on CD34+ /kg target. RESULTS Mean CD34+ cell performance per collection was 9.3 × 106 /kg. Tolerance to the procedure was very good as none of the patients experienced complications, with the exception of a patient who showed mild cyanosis and pallor after collection. Moreover, no bleeding or thrombotic complications have been observed. To date, 16 PBSC reinfusions have been performed in 7 children with a mean CD34+ cells viability of 98.1% ± 2.7 and mean WBC viability of 57% ± 10. Cell recovery after thawing was 87% ± 10.8. A rapid graft intake for both neutrophils and platelets, between day 7 and 20 after reinfusion was observed. DISCUSSION The procedure of total blood collection without the use of a cell separator is feasible and allows a good PBSC collection without significant side effects in very low-weight children. Moreover, this method could represent a valid and safe alternative to leukapheresis in patients where classic procedure could be difficult to apply.
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Affiliation(s)
- Valentina Becherucci
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Stefano Ermini
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Luisa Piccini
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Silvia Bisin
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Valentina Gori
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Francesca Gentile
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Riccardo Ceccantini
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Elena De Rienzo
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Barbara Bindi
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Paola Pavan
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Vanessa Cunial
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Elisa Allegro
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Francesca Brugnolo
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Daniela Maggio
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Daniela Calzolari
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Erika Maccarelli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Silvia Galli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Sonia Muricci
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Marco Berchielli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Veronica Tintori
- Transplantation Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Iacopo Sardi
- Neuro-oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Franco Bambi
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
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Abstract
Apheresis procedures are standard of care for a wide range of indications in children, collection of hematopoietic stem cells being the most frequent one. With increasing numbers of hematopoietic stem cell transplants, advances in graft manipulation techniques and the development of innovative therapies using immune effector cells and gene therapy, apheresis within the pediatric population is growing in demand. While young children have higher circulating white blood cell counts and robustly mobilize hematopoietic stem cells, apheresis machines were designed for use within the adult population and apheresis procedures in children, particularly small children, can be more challenging as vascular access, collection techniques and impact of extracorporeal volumes increase the rate of adverse events. In this article we review topics of particular relevance to hematopoietic stem cell and immune effector cell collections in small children.
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7
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Karow A, Wilhelm A, Ammann RA, Baerlocher GM, Pabst T, Mansouri Taleghani B, Roessler J, Leibundgut K. Peripheral blood progenitor cell collection in pediatric patients optimized by high pre-apheresis count of circulating CD34+ cells and high blood flow. Bone Marrow Transplant 2018; 54:885-893. [DOI: 10.1038/s41409-018-0353-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/05/2018] [Accepted: 09/20/2018] [Indexed: 01/09/2023]
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8
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Procedure-related complications and adverse events associated with pediatric autologous peripheral blood stem cell collection. J Clin Apher 2016; 32:35-48. [DOI: 10.1002/jca.21465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 02/06/2023]
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9
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Salazar-Riojas R, García-Lozano JA, Valdés-Galván M, Martínez-González O, Cantú-Rodríguez OG, González-Llano O, Gómez-De León A, Jaime-Pérez JC, Gómez-Almaguer D, Gutiérrez-Aguirre CH. Effective collection of peripheral blood stem cells in children weighing 20 kilogram or less in a single large-volume apheresis procedure. J Clin Apher 2014; 30:281-7. [PMID: 25557252 DOI: 10.1002/jca.21375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/30/2014] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Peripheral blood stem cell (PBSC) transplantation has become a routine procedure in pediatric oncology. A special group of PBSC donors are children weighing 20 kg or less. Limited vascular access and low blood volume puts them at a higher risk. Central line placement and a priming apheresis machine are recommended to avoid these complications. PATIENTS AND METHODS PBSC collections performed from July 2006 to May 2013 in children weighing less than 20 kg were included. All donors had a central venous catheter (CVC). An apheresis machine was primed with packet red blood cells. RESULTS Twenty-seven PBSC collections were performed in 22 children weighing 20 kg or less, 14 for allogeneic and 8 for autologous transplantation, in order to collect at least 2 × 10(6) CD34+ cells/kg. In the allogeneic group, median age and weight were 3 years (0.8-7) and 15.5 kg (8-20). In the autologous group, median age and weight were 3 years (2-7) and 15.35 kg (12.5-19.5). A single large-volume apheresis was sufficient to obtain the CD34+ cells needed in 78.5% and 75% of the allogeneic and autologous groups, respectively, with a median 11.84 × 10(6) and 5.79 × 10(6) CD34+ cells collected per kilogram of weight of the recipient. No serious complications related to the apheresis procedure or CVC placement occurred. CONCLUSION PBSC collection in a single large-volume apheresis for allogeneic and autologous transplants in children weighing 20 kg or less is a safe and effective procedure when based on standardized protocols.
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Affiliation(s)
- Rosario Salazar-Riojas
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - José Alberto García-Lozano
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Mayra Valdés-Galván
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Odra Martínez-González
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Olga Graciela Cantú-Rodríguez
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Oscar González-Llano
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - Andrés Gómez-De León
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - José Carlos Jaime-Pérez
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
| | - David Gómez-Almaguer
- Servicio De Hematología, Hospital Universitario "Dr. José Eleuterio González," U.A.N.L., Monterrey, Nuevo Leon, México
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Gooskens SL, Braakman E, van den Boom AL, So-Osman C, de Winter F, Pieters R, van den Heuvel-Eibrink MM. Peripheral stem cell harvest using regular chemotherapy schedules in childhood cancer. Pediatr Transplant 2012; 16:758-65. [PMID: 22882589 DOI: 10.1111/j.1399-3046.2012.01754.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prediction of the best moment for the harvest of PBSCs after standard chemotherapy followed by filgrastim in children with cancer is difficult. We retrospectively analyzed the moment of harvesting of 152 procedures in 94 patients. The start of apheresis was guided by WBC count and CD34+ cell measurement in peripheral blood. We defined the first day of filgrastim administration, after completion of mobilizing chemotherapy, as day 1. Median time to harvest in different subgroups is as follows: neuroblastoma 11 days (range, 6-29 days), Ewing's sarcoma nine days (range, 7-15 days), brain tumor 10 days (range, 7-15 days), relapsed Wilms' tumor 16 days (range, 9-20 days), and extracranial GCT seven days (range, 6-14 days). Patients harvested after cyclophosphamide priming (time to harvest within a range of 8-9 days) were analyzed as a separate group. The optimal moment for harvesting in different types of tumors was highly variable, although most consistent in patients diagnosed with Ewing's sarcoma or brain tumors and after cyclophosphamide priming.
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Affiliation(s)
- Saskia L Gooskens
- Department of Pediatric Oncology/Hematology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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11
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Veljkovic D, Vujic D, Nonkovic OS, Jevtic D, Zecevic Z, Lazic E. Mobilization and Harvesting of Peripheral Blood Stem Cells in Pediatric Patients With Solid Tumors. Ther Apher Dial 2011; 15:579-86. [DOI: 10.1111/j.1744-9987.2011.00990.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Peinemann F, Smith LA, Kromp M, Bartel C, Kröger N, Kulig M. Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas. Cochrane Database Syst Rev 2011:CD008216. [PMID: 21328307 DOI: 10.1002/14651858.cd008216.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a highly heterogeneous group of rare malignant solid tumors. Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) comprise all STS except rhabdomyosarcoma. In patients with advanced local or metastatic disease, autologous hematopoietic stem cell transplantation (HSCT) applied after high-dose chemotherapy (HDCT) is a planned rescue therapy for HDCT-related severe hematologic toxicity. OBJECTIVES To assess the effectiveness and safety of HDCT followed by autologous HSCT for all stages of soft tissue sarcomas in children and adults. SEARCH STRATEGY We searched the electronic databases CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE and EMBASE (February 2010). Online trial registers, congress abstracts and reference lists of reviews were searched and expert panels and authors were contacted. SELECTION CRITERIA Terms representing STS and autologous HSCT were required in the title, abstract or keywords. In studies with aggregated data, participants with NRSTS and autologous HSCT had to constitute at least 80% of the data. Comparative non-randomized studies were included because randomized controlled trials (RCTs) were not expected. Case series and case reports were considered for an additional descriptive analysis. DATA COLLECTION AND ANALYSIS Study data were recorded by two review authors independently. For studies with no comparator group, we synthesised results for studies reporting aggregate data and conducted a pooled analysis of individual participant data using the Kaplan-Meyer method. The primary outcomes were overall survival (OS) and treatment-related mortality (TRM). MAIN RESULTS We included 54 studies, from 467 full texts articles screened (11.5%), reporting on 177 participants that received HSCT and 69 participants that received standard care. Only one study reported comparative data. In the one comparative study, OS at two years after HSCT was estimated as statistically significantly higher (62.3%) compared with participants that received standard care (23.2%). In a single-arm study, the OS two years after HSCT was reported as 20%. In a pooled analysis of the individual data of 54 participants, OS at two years was estimated as 49% (95% CI 34% to 64%). Data on TRM, secondary neoplasia and severe toxicity grade 3 to 4 after transplantation were sparse. All 54 studies had a high risk of bias. AUTHORS' CONCLUSIONS Due to a lack of comparative studies, it is unclear whether participants with NRSTS have improved survival from autologous HSCT following HDCT. Owing to this current gap in knowledge, at present HDCT and autologous HSCT for NRSTS should only be used within controlled trials.
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Affiliation(s)
- Frank Peinemann
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, Cologne, Germany, 51105
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13
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Kim SR, Choung HK, Kim DW, Sung KW, Kang ES. Evaluation of a new cell separator for collection of peripheral blood CD34+ progenitor cells in pediatric patients. Transfusion 2010; 51:306-12. [PMID: 20804528 DOI: 10.1111/j.1537-2995.2010.02864.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was conducted to evaluate the performance of the COM.TEC cell separator (Fresenius HemoCare GmbH) for collecting CD34+ cells in pediatric patients who were intended to have autologous peripheral blood progenitor cell transplantation, with respect to collection variables, prediction power of CD34+ cell yield, and influence on donors. STUDY DESIGN AND METHODS A total of 26 pediatric solid tumor patients who received mobilization chemotherapy and granulocyte-colony-stimulating factor underwent CD34+ cell collection (n = 96) using the COM.TEC auto mononuclear cell (MNC) program. Patients were divided into a neuroblastoma (NBL) group and a brain tumor group according to the intensity of prior chemotherapy regimens. The collection variables, cellular variables of leukapheresis products, and the peripheral blood cell counts of patients were compared with those acquired using the COBE Spectra (GambroBCT). The CD34+ cell collection efficiency (CE) and the percentage ratios of actual to predicted CD34+ cell yield indicating prediction power were analyzed. RESULTS Using the COM.TEC auto MNC program, the processing rate was higher and the product volume was smaller (p < 0.05) than those of the COBE Spectra. Platelet (PLT) reduction in peripheral blood and PLT contamination of the products were significantly lower (p < 0.01). The median CE was less than 60% in both patient groups (50.0 and 48.4%, respectively). The actual collected CD34+ cell yields were medians of 66.9 and 76.1% of the predicted values in NBL group and brain tumor group, respectively. CONCLUSION PBPC collections by the COM.TEC cell separator had advantages of high processing rate, low product volume, and low contamination by PLTs of product. Low PLT loss was observed in pediatric patients who need to collect autologous PBPCs. However, applying CD34+ cell yield prediction was not practical for prospective scheduling of the next collection. More specified data need to be accumulated for more accurate prediction of CD34+ cell yield in pediatric patients.
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Affiliation(s)
- Suk-Ran Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Alex J, Bahl MJ, Schlueter AJ. Peripheral blood stem cell recovery following early termination of apheresis due to hypotension in a 4.8-kg infant. J Clin Apher 2009; 24:120-1. [DOI: 10.1002/jca.20195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Sevilla J, Plaza SF, González-Vicent M, Lassaletta A, Ramírez M, Madero L, Díaz MA. PBSC collection in extremely low weight infants: a single-center experience. Cytotherapy 2007; 9:356-61. [PMID: 17573611 DOI: 10.1080/14653240701320270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peripheral blood progenitor cell (PBPC) collection has become the main source of hematopoietic cells for high-dose chemotherapy with stem cell rescue and, in some protocols, for allogeneic hematopoietic transplantation. This procedure is complicated in the smallest children because of difficulties related to their weight, and there is little published experience. We have conducted a prospective study to analyze the incidence of adverse events during PBPC collection in the smallest children (< or = 10 kg). METHODS From January 2000 to November 2005, 257 leukapheresis were performed in our unit, and 13 of them (5%) in 12 children weighing up to 10 kg (median 9 kg, range 5.8-10.9 kg). RESULTS Most cases had hypovolemic signs during the procedure (usually tachycardia); six cases had hypotension, five of them with pallor and diaphoresis, and, of those, two also had nausea. In all these cases infusion of saline or plasma volume expanders resolved the clinical findings. In two cases the nausea related to hypocalcemia was resolved after calcium gluconate infusion. Changes in platelet counts were also remarkable, with a median platelet loss of 52%. DISCUSSION Leukapheresis with continuous-flow cell separators has frequent complications related to volume shift in the smallest children. These adverse events are mild and easily resolved with standard measures for hypovolemia, as plasma expander or normal saline infusions. However, we recommend that the procedure should only be performed by teams with extensive experience in the field.
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Affiliation(s)
- J Sevilla
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
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