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Lee CY, Yu TY, Lin FL, Hung GY, Hou MH, Ho CY, Liu CY, Chiou TJ, Yen HJ. Peripheral blood stem cell harvesting in young children weighing less than 15 kg. Cytotherapy 2024:S1465-3249(24)00709-6. [PMID: 38795116 DOI: 10.1016/j.jcyt.2024.05.008] [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: 08/23/2023] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/27/2024]
Abstract
Autologous peripheral blood stem cell (PBSC) transplantation is crucial in pediatric cancer treatment, and tandem transplantation is beneficial in certain malignancies. Collecting PBSCs in small children with low body weight is challenging. We retrospectively analyzed data of pediatric cancer patients weighing <15 kg who underwent autologous PBSC harvesting in our hospital. Collections were performed in the pediatric intensive care unit over 2 or 3 consecutive days, to harvest sufficient stem cells (goal ≥2 × 106 CD34+ cells/kg per apheresate). From April 2006 to August 2021, we performed 129 collections after 50 mobilizations in 40 patients, with a median age of 1.9 (range, 0.6-5.6) years and a body weight of 11.0 (range, 6.6-14.7) kg. The median CD34+ cells in each apheresate were 4.2 (range, 0.01-40.13) × 106/kg. 78% and 56% of mobilizations achieved sufficient cell dose for single or tandem transplantation, respectively, without additional aliquoting. The preapheresis hematopoietic progenitor cell (HPC) count was highly correlated with the CD34+ cell yield in the apheresate (r = 0.555, P < 0.001). Granulocyte colony-stimulating factor alone was not effective for mobilization in children ≥2 years of age, even without radiation exposure. By combining the preapheresis HPC count ≥20/μL and the 3 significant host factors, including age <2 years, no radiation exposure and use of chemotherapy, the prediction rate of goal achievement was increased (area under the curve 0.787).
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Affiliation(s)
- Chih-Ying Lee
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ting-Yen Yu
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Fen-Lan Lin
- Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ming-Hsin Hou
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Yin Ho
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.; Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Department of Medicine, Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan..
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Yazal Erdem A, Özyörük D, Ok Bozkaya İ, Çakmakcı S, Emir S, Demir HA, Özgüner HM, Ergürhan İlhan İ, Özbek NY. Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures. Pediatr Transplant 2024; 28:e14751. [PMID: 38659194 DOI: 10.1111/petr.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.
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Affiliation(s)
- Arzu Yazal Erdem
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Derya Özyörük
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Selma Çakmakcı
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Suna Emir
- Department of Pediatrics, Atılım University Faculty of Medicine, Ankara, Turkey
| | - Hacı Ahmet Demir
- Department of Pediatric Hematology and Oncology, Memorial Private Hospital, Ankara, Turkey
| | - Habibe Meltem Özgüner
- Department of Histology and Embriology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - İnci Ergürhan İlhan
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Jones JM, Kiss JE, Chibisov I, Horvei P, Stanczak H, Burda C, Clark W, Sevcik J, Kilonsky C, Kaplan A. Effective peripheral blood stem cell collection in a 4.6-kg child. Transfusion 2024; 64:400-405. [PMID: 38155507 DOI: 10.1111/trf.17687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Due to unique technical challenges, effective peripheral blood stem cell collections (PBSCs) have not been consistently reported in patients weighing less than 5 kg. We describe three PBSCs performed in a 4.6-kg child undergoing myeloablative chemotherapy for high-grade glioma. STUDY DESIGN AND METHODS A multidisciplinary group representing the clinical and apheresis teams adapted a PBSC protocol to accommodate the patient's size and collection targets. Special considerations included timing of the collection relative to chemotherapy, vascular access, strategies for monitoring adverse events during collection, and contingencies. RESULTS AND DISCUSSION The patient underwent three PBSC procedures over 2 days due to suboptimal collection after the first two procedures. For procedure 1, a conservative inlet: anticoagulant (AC) ratio and AC infusion rate of 15 and 0.6 mL/min/L total blood volume (TBV) resulted in premature discontinuation due to clotting. A ratio of 8 and AC infusion rate of 1.5-1.7 mL/min/L TBV with subsequent titration to higher levels were adopted for the second and third procedures. These changes resulted in greater acid-citrate-dextrose exposure, that was managed by continuous calcium chloride infusion. There was no hypocalcemia, hypotension, or distress during any procedure. A total of 15 × 106 CD34+ cells/kg were collected. This retrospective review illustrates that PBSC can be safely undertaken in children weighing less than 5 kg.
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Affiliation(s)
- Jennifer M Jones
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Joseph E Kiss
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Irina Chibisov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Paulina Horvei
- Division of Blood and Marrow Transplantation and Cellular Therapies, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Heather Stanczak
- Division of Blood and Marrow Transplantation and Cellular Therapies, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carol Burda
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Wei Clark
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Joan Sevcik
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Carolyn Kilonsky
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
| | - Alesia Kaplan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Vitalant Specialty Lab and Therapeutics, Pittsburgh, Pennsylvania, USA
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Chen L, Wen J, Xu X, Du J, Ruan Y, Feng X, Li J, He Y, Wu X. Safety and efficacy of peripheral blood stem cells collection in healthy children and pediatric patients with thalassemia major weighing 20 kg or less. J Clin Apher 2024; 39:e22102. [PMID: 38186371 DOI: 10.1002/jca.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Peripheral blood stem cell (PBSC) collection in children poses challenges due to their small size, low body weight (BW), and unique pediatric physiology, especially among children weighing 20 kg (kg) or less. METHODS PBSC collection data of both healthy children and patients with thalassemia major (TM) weighing 20 kg or less between January 2013 and December 2020 were reviewed. Moreover, PBSCs characteristics along with various aspects of efficiency and safety between healthy donors and patients with TM were compared. RESULTS A total of 262 PBSC procedures were performed on 255 children. Of these, 91 procedures were carried out on 85 allogeneic healthy donors, and 171 auto-backup collections were performed on 170 patients with TM to ensure PBSC availability and prevent transplantation failure. A minimum pre-apheresis hemoglobin (HGB) level of 60 g/L was discovered to be safe and feasible in patients with TM. The median CD34+ cell dose in the PBSC product during the initial apheresis procedure was higher in healthy donors compared to patients with TM (7.29 ± 5.28 × 106 cells/kg vs5.88 ± 4.23 × 106 cells/kg, P = .043). The total CD34+ cells/kg recipient weight exhibited a positive correlation with pre-apheresis monocyte counts, but a negative correlation with donor weight. Apheresis significantly reduced hematocrit and platelet counts in the allogeneic group compared to the autologous group. Patients with TM experienced a higher occurrence of bone pain related to granulocyte colony-stimulating factor treatment. Notably, no serious complications related to PBSCs mobilization, central venous catheter placement, or the apheresis procedure were observed in either group. CONCLUSIONS PBSCs collection was both safe and effective in healthy children and pediatric patients with TM weighing 20 kg or less.
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Affiliation(s)
- Libai Chen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jianyun Wen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoxiao Xu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jing Du
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yongsheng Ruan
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoqin Feng
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Juan Li
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yuelin He
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xuedong Wu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
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Maitta RW. Apheresis collection of mononuclear cells for chimeric-antigen receptor therapies. Eur J Haematol 2024; 112:36-40. [PMID: 37525900 DOI: 10.1111/ejh.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
Collections of lymphocytes to be genetically modified to treat hematologic malignancies have seen a dramatic increase over the last few years as commercial products have been approved. Reports of new products in development that can possibly treat solid organ malignancies represent a massive change in the field. Apheresis is at the center of the collection of cells for the manufacture of these chimeric-antigen receptor therapy products. The expansion of these collections represents one of the areas of apheresis procedures growth. This review will summarize concepts important to this type of collection and variables that need to be optimized to obtain desired cell yields while increasing patients' safety.
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Affiliation(s)
- Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Rahim MQ, Goebel WS, Delph J, Soundar E. Primed for change: The effect of a blood prime on peripheral blood stem cell collection and accuracy of a prediction tool in pediatric patients. J Clin Apher 2023; 38:540-547. [PMID: 37243380 DOI: 10.1002/jca.22057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Pediatric apheresis collection of peripheral blood stem cells for autologous transplantation often requires use of a blood prime. We evaluated the relationship between pre-apheresis blood CD34+ counts and final CD34+ yield with use of a blood prime. Forty patients underwent apheresis stem cell collection in a 5 year period in our hospital, of which 27 required blood priming of the apheresis machine. Despite the blood prime group having significantly higher pre-apheresis CD34+ cell counts, this group processed a relatively higher volume of blood due to a higher dilutional effect and collected significantly less than predicted CD34+ cell yield. Use of weight-specific collection efficiencies and dilution-adjusted pre-apheresis CD34+ counts will help in accurately estimating the whole blood volume to process for PBSC collection and therefore increase efficiency and decrease the overall cost of collection.
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Affiliation(s)
- Mahvish Q Rahim
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Indianapolis, Indiana, USA
| | - W Scott Goebel
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Indianapolis, Indiana, USA
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
| | - John Delph
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
| | - Esther Soundar
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
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Bougar S, Atouf O, Ouadghiri S, Bourhanbour AD, Brick C, Essakalli M. Collection, cryopreservation and thawing of stem cells for children weighing less than 25 Kg with high-risk neuroblastoma: A single center results in Morocco. Hematol Transfus Cell Ther 2022; 44:535-541. [PMID: 35216961 PMCID: PMC9605889 DOI: 10.1016/j.htct.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/07/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction An important component of the advances made in neuroblastoma treatment has been the use of peripheral blood stem cells to support high-dose chemotherapy. In this study, we report our experience on a series of small children who have undergone standard and large volume leukaphersis (LVL) procedures, provide an update on a single institution's experience with cryopreservation of autologous peripheral blood stem cells (PBSCs), using 10% dimethyl sulfoxide (DMSO) and applying post-thaw DMSO depletion and analyze a number of variables that may affect viability. Methods A total of 36 aphereses were performed on 29 children weighing less than 25 kg between July 2016 and October 2019 at the Ibn Sina university hospital. Results Seven females and twenty-two males, median bodyweight 14 kg (9 - 22). A single apheresis was sufficient to obtain at least 3 × 10⁶/kg body weight (BW) of CD34+ cells in 82.8% of the cases. The LVL was performed in 22 aphereses. A median number of 5.9 × 10⁶/kg CD34 cells were collected per apheresis. A total of 60 PBSC samples were cryopreserved and 46 samples were infused. The mean cell viability percentage decreased from 94.75 ± 1.14% before freezing to 70.84 ± 8.6% after thawing (p < 0.001). No correlation was found between post-thaw viability and storage time (r = -0.233; p = 0.234) or number of total nucleated cells (r = 0.344; p = 0.073). Conclusion Leukapheresis is safe and feasible in small pediatric patients if the appropriate measures are used. Cryopreservation poses numerous challenges, especially a decrease in cell viability after thawing.
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Affiliation(s)
- Sara Bougar
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco.
| | - Ouafa Atouf
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | - Sanae Ouadghiri
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | | | - Chehrazade Brick
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco
| | - Malika Essakalli
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
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Peripheral Blood Stem Cell Mobilization and Collection in Pediatric Healthy Sibling Donors Weighing 20 Kilograms or Less; Algerian Experience. Transfus Apher Sci 2020; 59:102987. [DOI: 10.1016/j.transci.2020.102987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jimenez-Antolinez YV, Gonzalez-Lopez EE, Ruiz IYV, Cantu-Moreno M, Gomez-Almaguer D, Gonzalez-Llano O. Concordant acute myeloblastic leukemia in identical twins treated with allogeneic transplantation from a younger HLA-identical sibling following a single apheresis procedure. Int J Hematol Oncol 2020; 10:IJH32. [PMID: 34136123 PMCID: PMC8191650 DOI: 10.2217/ijh-2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A concordant leukemia is that which occurs in a pair of monozygotic twins; a similar genetic background suggests an in utero monoclonal origin. We present the case of a pair of monozygotic infants with concordant acute myeloid leukemia who underwent a peripheral blood hematopoietic stem-cell transplant (HSCT) from a single, younger human leukocyte antigen-identical sibling donor, using a fractioned graft collected during only one apheresis procedure. Twin A relapsed at +456 and received a second haploidentical HSCT from his father, twin B has been in complete remission since the first HSCT. Both children are in complete remission and with negative minimal residual disease at +900 (after second transplant) and +1488, respectively.
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Affiliation(s)
| | - Elias Eugenio Gonzalez-Lopez
- Hematology Service, Hospital Universitario 'Dr. Jose E. Gonzalez', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ileana Yazmín Velasco Ruiz
- Hematology Service, Hospital Universitario 'Dr. Jose E. Gonzalez', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Marcela Cantu-Moreno
- Hematology Service, Hospital Universitario 'Dr. Jose E. Gonzalez', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - David Gomez-Almaguer
- Hematology Service, Hospital Universitario 'Dr. Jose E. Gonzalez', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Oscar Gonzalez-Llano
- Hematology Service, Hospital Universitario 'Dr. Jose E. Gonzalez', Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Zubicaray J, Galvez E, Sebastian E, Molina B, González-Vicent M, Castillo A, Ramírez M, Madero L, Díaz MA, Sevilla J. Plerixafor-based mobilization in pediatric healthy donors with unfavorable donor/recipient body weight ratio resulted in a better CD34 + collection yield: A retrospective analysis. J Clin Apher 2020; 36:78-86. [PMID: 33079424 DOI: 10.1002/jca.21844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In order to propose risk-adapted mobilization algorithms, several authors have tried to look for predictive factors of the CD34+ yield in healthy pediatric donors. Donor recipient body weight ratio (D/R ratio) was identified as one of the main variables related with the success to achieve the target cell dose for transplantation. According to this variable we modified the mobilization schedule. MATERIAL AND METHODS We report the results of 46 mobilizations and apheresis procedures performed in our center with unfavorable D/R ratio. Mobilization was attempted by the standard regime of G-CSF (10 mcg/kg/24 hours) in 28 cases (60.9%), with high dose G-CSF (10 mcg/kg/12 hours) in 9 cases (19.6%), and with plerixafor and G-CSF single dose regime in 9 cases (19.6%). RESULTS CD34+ cell quantification before apheresis is closely related to CD34+ yield, being the only factor related to collected CD34+ cells (beta .71; P < .0001). The mobilization efficiency was higher in plerixafor group compared to the other two schedules (P < .0001). By using plerixafor for mobilization, we achieved the target CD34+ cell dose of ≥2 × 106 /kg per recipient body weight in all cases with unfavorable D/R ratio. It was observed that 17.4% of cases that not reached the established target cell dose were located in the standard or high-dose mobilization regimes. This difference is even greater for optimal collections (≥5 × 106 /kg), since of the 54.3% cases that did not reach this goal none was mobilized by plerixafor. CONCLUSION Tailoring the mobilization regime we can reach the target cell dose, even in those cases with the worst D/R ratio.
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Affiliation(s)
- Josune Zubicaray
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva Galvez
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena Sebastian
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Blanca Molina
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Castillo
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramírez
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Miguel Angel Díaz
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julian Sevilla
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Aravindan N, Somasundaram DB, Herman TS, Aravindan S. Significance of hematopoietic surface antigen CD34 in neuroblastoma prognosis and the genetic landscape of CD34-expressing neuroblastoma CSCs. Cell Biol Toxicol 2020; 37:461-478. [PMID: 32979173 DOI: 10.1007/s10565-020-09557-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
High-risk neuroblastoma (HR-NB) is branded with hematogenous metastasis, relapses, and dismal long-term survival. Intensification of consolidation therapy with tandem/triple autologous stem cell (SC) rescue (with bone marrow [BM]/peripheral blood [PB] CD34+ selection) after myeloablative chemotherapy has improved long-term survival. However, the benefit is limited by the indication of NB cells in CD34+ PBSCs, CD34 expression in NB cells, and the risk of reinfusing NB cancer stem cells (NB CSCs) that could lead to post-transplant relapse. We investigated the association of CD34 surface expression (92 patients) with NB evolution/clinical outcomes. CD34 gene-level status in NB was assessed through RNA-Seq data mining (18 cohorts, n, 3324). Genetic landscape of CD34-expressing NB CSCs (CD133+CD34+) was compared with CD34- CSCs (CD133+CD34-). RNA-seq data revealed equivocal association patterns of CD34 expression with patient survival. Our immunohistochemistry data revealed definite, but rare (mean, 0.73%; range 0.00-7.87%; median, 0.20%) CD34 positivity in NB. CD34+ significantly associated with MYCN amplification (p, 0.003), advanced disease stage (p, 0.016), and progressive disease (PD, p < 0.0009) after clinical therapy. A general high-is-worse tendency was observed in patients with relapsed disease. High CD34+ correlated with poor survival in patients with N-MYC-amplified HR-NB. Gene expression analysis of CD34+-NB CSCs identified significant up (4631) and downmodulation (4678) of genes compared with NB CSCs that lack CD34. IPA recognized the modulation of crucial signaling elements (EMT, stemness maintenance, differentiation, inflammation, clonal expansion, drug resistance, metastasis) that orchestrate NB disease evolution in CD34+ CSCs compared with CD34- CSCs. While the function of CD34 in NB evolution requires further in-depth investigation, careful consideration should be exercised for autologous stem cell rescue with CD34+ selection in NB patients. Graphical abstract.
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Affiliation(s)
- Natarajan Aravindan
- Department of Radiation Oncology, The University of Oklahoma Health Sciences Center, BMSB 737, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA. .,Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA. .,Department of Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Dinesh Babu Somasundaram
- Department of Radiation Oncology, The University of Oklahoma Health Sciences Center, BMSB 737, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA
| | - Terence S Herman
- Department of Radiation Oncology, The University of Oklahoma Health Sciences Center, BMSB 737, 940 Stanton L. Young Boulevard, Oklahoma City, OK, 73104, USA.,Stephenson Cancer Center, Oklahoma City, OK, 73104, USA
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12
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Furlong E, Jensen J, Woodard M, Griffiths K, Knight G, Sturm M, Kerr F, Gough H, Bear N, Carter TL, Cole CH, Kotecha RS, Ramachandran S. Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies. Pediatr Transplant 2020; 24:e13602. [PMID: 31631445 DOI: 10.1111/petr.13602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/15/2019] [Accepted: 09/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. PATIENTS/METHODS A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. RESULTS Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. CONCLUSION Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.
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Affiliation(s)
- Eliska Furlong
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Jesper Jensen
- PathWest Laboratory Medicine WA, Perth, WA, Australia
| | - Mark Woodard
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Katherine Griffiths
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia
| | - Geoff Knight
- Paediatric Intensive Care Unit, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Marian Sturm
- Cell and Tissue Therapy, Royal Perth Hospital, Perth, WA, Australia
| | - Fiona Kerr
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Hazel Gough
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Perth Children's Hospital, Perth, WA, Australia
| | - Tina L Carter
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,PathWest Laboratory Medicine WA, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Catherine H Cole
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia.,Paediatric Haematology and Oncology, Sidra Medicine, Doha, Qatar
| | - Rishi S Kotecha
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia.,Division of Children's Leukaemia and Cancer Research, Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA, Australia
| | - Shanti Ramachandran
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
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13
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Peripheral blood stem cell apheresis in low-weight children: A single centre study. Transfus Apher Sci 2019; 58:300-303. [DOI: 10.1016/j.transci.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Doberschuetz N, Soerensen J, Bonig H, Willasch A, Rettinger E, Pfirrmann V, Salzmann-Manrique E, Schäfer R, Klingebiel T, Bader P, Jarisch A. Mobilized peripheral blood stem cell apheresis via Hickman catheter in pediatric patients. Transfusion 2019; 59:1061-1068. [PMID: 30610749 DOI: 10.1111/trf.15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Autologous stem cell transplantation remains an integral treatment tool for certain childhood malignancies. In children, a central venous catheter is typically necessary to provide adequate flow rates for preparative apheresis. In this study, the feasibility and efficiency of collecting CD34+ cells via an indwelling Hickman catheter, preimplanted for chemotherapy, instead of placing an additional temporary central venous catheter was evaluated. STUDY DESIGN AND METHODS Forty-eight pediatric leukaphereses for autologous hematopoietic stem cell transplantation using Spectra Optia MNC, Version 3.0 were reviewed. We compared preimplanted Hickman catheters with a temporary Shaldon catheter, inserted for apheresis. Apheresis was considered successful if a dose of 2 × 106 CD34+ peripheral blood stem cells/kg BW was achieved. RESULTS In 43 (89.6%) of the 48 patients, a Hickman catheter was used for leukapheresis. Only 5 patients (10.4%) received a temporary Shaldon catheter. In both groups, apheresis was performed without apparent adverse reactions. The dose of collected CD34+ peripheral blood stem cells was 12.7 × 106 (range, 2.3-70.7 × 106 ) cells/kg BW in the Hickman group and 16.2 × 106 (range, 3.8-48.4 × 106 ) cells/kg BW in the Shaldon group, showing no statistically significant difference (p = 0.58). In both groups, the primary endpoint of a minimal CD34+ cell concentration of 2 × 106 cells/kg BW was achieved at a maximum of two leukapheresis sessions. Apheresis efficacy was further confirmed by the collection efficiency of 40.2% in the Hickman group and 27.8% in the Shaldon group (p = 0.32). CONCLUSION These data indicate the reliable feasibility and efficacy of mobilized apheresis via an indwelling Hickman catheter. In light of this, the routine insertion of a dialysis catheter for the purpose of leukapheresis should be critically reconsidered.
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Affiliation(s)
- Nora Doberschuetz
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany.,Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Andre Willasch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Verena Pfirrmann
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Richard Schäfer
- Department for Cellular Therapeutics, German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Thomas Klingebiel
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Department for Children and Adolescents, Division for Pediatric Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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15
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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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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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18
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Cooling L, Hoffmann S, Webb D, Yamada C, Davenport R, Choi SW. Performance and safety of femoral central venous catheters in pediatric autologous peripheral blood stem cell collection. J Clin Apher 2017; 32:501-516. [PMID: 28485045 DOI: 10.1002/jca.21548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in children typically requires placement of a central venous catheter (CVC) for venous access. There is scant published data regarding the performance and safety of femoral CVCs in pediatric A-HPCC. METHODS Seven-year, retrospective study of A-HPCC in pediatric patients collected between 2009 and January 2017. Inclusion criteria were an age ≤ 21 years and A-HPCC using a femoral CVC for venous access. Femoral CVC performance was examined by CD34 collection rate, inlet rate, collection efficiency (MNC-FE, CD34-FE), bleeding, flow-related adverse events (AE), CVC removal, and product sterility testing. Statistical analysis and graphing were performed with commercial software. RESULTS A total of 75/119 (63%) pediatric patients (median age 3 years) met study criteria. Only 16% of children required a CVC for ≥ 3 days. The CD34 collect rate and CD34-FE was stable over time whereas MNC-FE decreased after day 4 in 80% of patients. CD34-FE and MNC-FE showed inter- and intra-patient variability over time and appeared sensitive to plerixafor administration. Femoral CVC showed fewer flow-related AE compared to thoracic CVC, especially in pediatric patients (6.7% vs. 37%, P = 0.0005; OR = 0.12 (95%CI: 0.03-0.45). CVC removal was uneventful in 73/75 (97%) patients with hemostasis achieved after 20-30 min of pressure. In a 10-year period, there were no instances of product contamination associated with femoral CVC colonization. CONCLUSION Femoral CVC are safe and effective for A-HPCC in young pediatric patients. Femoral CVC performance was maintained over several days with few flow-related alarms when compared to thoracic CVCs.
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Affiliation(s)
- Laura Cooling
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Sandra Hoffmann
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Dawn Webb
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Chisa Yamada
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Robertson Davenport
- Department of Pathology, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
| | - Sung Won Choi
- Department of Pediatric, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan
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19
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Even-Or E, Eden-Walker A, Di Mola M, McDougall E, Schechter T, Ali M, Svajger G, Gassas A, Licht C, Krueger J. Comparison of two apheresis systems for autologous stem cell collections in pediatric oncology patients. Transfusion 2016; 57:122-130. [PMID: 27696435 DOI: 10.1111/trf.13859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peripheral stem cell collections can be challenging in the pediatric population and respective experience is limited. Since February 2015 our institution is utilizing the new Spectra Optia (Optia) apheresis device, which has replaced the former COBE Spectra (COBE) device. As a quality initiative we collected and compared collection efficiency (CE2) and other collection variables between the two devices. STUDY DESIGN AND METHODS In this retrospective study we collected and compared clinical, laboratory, and technical collection data from stem cell collection procedures done with the Optia and COBE devices. The collected data included patient demographics, precollection peripheral CD34+ cell counts, total CD34+ cells collected, complete blood count, electrolytes before and after collection, side effects attributed to the collection, total blood volumes processed (TBVs), collection times, and calculated CE2 and collection ratios. RESULTS Forty-one collection procedures performed on 29 pediatric patients with the Optia device were compared to 41 collections performed on 27 patients with the COBE device. The TBVs through the Optia device were significantly smaller than the COBE (3.9 ± 0.2 × TBV vs. 5.5 ± 0.1 × TBV, respectively; p < 0.001), requiring significantly less anticoagulant and providing similar amounts of stem cells while collection times were significantly shorter (mean, 238 ± 9 min vs. 264 ± 9 min, respectively; p < 0.05). Collections on the Optia caused significantly smaller reductions of plasma calcium and magnesium. No significant side effects attributed to the procedure were noted. CONCLUSION Stem cell apheresis with the Optia device in children is safe and feasible with smaller blood volumes with shorter collection times.
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Affiliation(s)
- Ehud Even-Or
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexandra Eden-Walker
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Di Mola
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth McDougall
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Ali
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gordana Svajger
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam Gassas
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christoph Licht
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joerg Krueger
- Division of Hematology/Oncology/BMT, Division of Nephrology, and the Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Ohara Y, Ohto H, Tasaki T, Sano H, Mochizuki K, Akaihata M, Kobayashi S, Waragai T, Ito M, Hosoya M, Nollet KE, Ikeda K, Ogawa C, Kanno T, Shikama Y, Kikuta A. Comprehensive technical and patient-care optimization in the management of pediatric apheresis for peripheral blood stem cell harvesting. Transfus Apher Sci 2016; 55:338-343. [PMID: 27765663 DOI: 10.1016/j.transci.2016.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. STUDY DESIGN AND METHODS We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg. RESULTS The median CD34+ cell yield per apheresis procedure was 2.3 × 106 CD34+ cells/kg (0.2-77.9 × 106 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990-1997 versus 5.8% during 1998-2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration. CONCLUSION By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg.
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Affiliation(s)
- Yoshihiro Ohara
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
| | - Tetsunori Tasaki
- Department of Transfusion Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuko Akaihata
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Tomoko Waragai
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Masaki Ito
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan
| | - Chitose Ogawa
- Division of Pediatric Oncology, The National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kanno
- Japanese Red Cross Fukushima Blood Center, Fukushima, Japan
| | - Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
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