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Castillo-Aleman YM, Villegas-Valverde CA, Bencomo-Hernandez AA, Ventura-Carmenate Y, Lumame S, Castelo C, Al-Saadawi NA, Abu-Haleeqa MI, El-Najjar I, Al-Kaabi FM. Cell throughput and performance ratio as quality indicators on hematopoietic stem cell apheresis: A single-center experience. Transfus Apher Sci 2024; 63:104003. [PMID: 39265224 DOI: 10.1016/j.transci.2024.104003] [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: 08/01/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Benchmarking in CD34+ cell apheresis is crucial for optimizing resources, ensuring consistent collection performance, and ultimately, decision-making algorithms to improve donor safety. Key performance indicators such as the "performance ratio" (PR) are applied routinely in some apheresis centers, whereas this report identifies the "cell throughput" (CT) as another quality indicator in apheresis. MATERIAL AND METHODS This single-center study includes retrospective data from 117 aphereses. CT and PR were calculated based on the mononuclear cell collection (MNC) or continuous mononuclear cell collection (cMNC) protocols of the Spectra Optia® apheresis system, types of venous access, transplant settings, and mobilization regimens. RESULTS CTs (× 106 CD34+ cells/min) were found to be greater in cMNC compared to MNC protocols (1.4 vs. 1.0, p = 0.0037), in allogeneic versus autologous (1.3 vs. 1.1, p = 0.0274), and in the mobilization regimen of G-CSF alone versus the G-CSF combined (1.3 vs. 1.0, p = 0.0249). In contrast, PR (%) was only statistically significant in favor of the cMNC protocol (213.0 vs. 186.8 for MNC). CONCLUSIONS CT and PR are feasible quality indicators on CD34+ cell apheresis, are easy to calculate and implement, and have clinical and administrative implications. Analyzing CT and PR may strengthen the institutional criteria for selecting cMNC or MNC protocols; they may also be used to evaluate the performance of new personnel or cell separator devices or, eventually, trigger investigations for those aphereses under-collected by specific thresholds.
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Affiliation(s)
- Yandy Marx Castillo-Aleman
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates.
| | | | | | - Yendry Ventura-Carmenate
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Shinnette Lumame
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Charisma Castelo
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Nameer Abdul Al-Saadawi
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Mohamed Ibrahim Abu-Haleeqa
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Inas El-Najjar
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Fatema Mohammed Al-Kaabi
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
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2
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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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3
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Pessach I, Nagler A. Leukapheresis for CAR-T cell production and therapy. Transfus Apher Sci 2023; 62:103828. [PMID: 37838564 DOI: 10.1016/j.transci.2023.103828] [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] [Indexed: 10/16/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is an effective, individualized immunotherapy, and novel treatment for hematologic malignancies. Six commercial CAR-T cell products are currently approved for lymphatic malignancies and multiple myeloma. In addition, an increasing number of clinical centres produce CAR-T cells on-site, which enable the administration of CAR-T cells on site. The CAR-T cell products are either fresh or cryopreserved. Manufacturing CAR-T cells is a complicated process that begins with leukapheresis to obtain T cells from the patient's peripheral blood. An optimal leukapheresis product is crucial step for a successful CAR-T cell therapy; therefore, it is imperative to understand the factors that may affect the quality or T cells. The leukapheresis for CAR-T cell production is well tolerated and safe for both paediatric and adult patients and CAR-Τ cell therapy presents high clinical response rate in many studies. CAR-T cell therapy is under continuous improvement, and it has transformed into an almost standard procedure in clinical haematology and stem cell transplantation facilities that provide both autologous and allogeneic stem cell transplantations. In patients suffering from advanced haematological malignancies, CAR-T cell therapy shows incredible antitumor efficacy. Even after a single infusion of autologous CD19-targeting CAR-T cells in patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL) and acute lymphoblastic leukaemia (ALL), long lasting remission is observed, and a fraction of the patients are being cured. Future novel constructs are being developed with better T cell persistence and better expansion. New next-generation CAR-T cells are currently designed to avoid toxicities such as cytokine release syndrome and neurotoxicity.
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Affiliation(s)
- Ilias Pessach
- Hematology Department, Athens Medical Center, Athens, Greece
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Israel.
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4
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Sebastián E, Andrés Esteban EM, González‐Vicent M, González de Pablo J, Zubicaray J, Gálvez E, Guillén M, Ruiz Pato J, Molina B, Albi G, Ramírez M, Castillo A, Pérez Maroto F, Madero L, Díaz MÁ, Sevilla J. Extracorporeal photopheresis in paediatric patients: A retrospective comparison between different ‘off‐line’ protocols. Vox Sang 2022; 117:1220-1229. [DOI: 10.1111/vox.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Sebastián
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva María Andrés Esteban
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
- Applied Economics Department Universidad Rey Juan Carlos Madrid Spain
| | | | | | - Josune Zubicaray
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Eva Gálvez
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - María Guillén
- Hematology Department Hospital Universitario Miguel Servet Zaragoza Spain
| | - Julia Ruiz Pato
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Blanca Molina
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Gustavo Albi
- Radiology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Manuel Ramírez
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Ana Castillo
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Florencio Pérez Maroto
- Hematology and Oncology Laboratory Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Luis Madero
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Miguel Ángel Díaz
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
| | - Julián Sevilla
- Onco‐Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
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5
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Optimizing leukapheresis product yield and purity for blood cell-based gene and immune effector cell therapy. Curr Opin Hematol 2021; 27:415-422. [PMID: 32889828 DOI: 10.1097/moh.0000000000000611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW A critical common step for blood-based ex-vivo gene and immune effector cell (IEC) therapies is the collection of target cells for further processing and manufacturing, often accomplished through a leukapheresis procedure to collect mononuclear cells (MNCs). The purpose of this review is to describe strategies to optimize the apheresis product cell yield and purity for gene and IEC therapies. Relevant data from the conventional bone marrow transplant literature is described where applicable. RECENT FINDINGS Product yield is affected by three main factors: the peripheral blood concentration of the target cell, optimized by mobilizing agents, donor interventions or donor selection; the volume of peripheral blood processed, tailored to the desired product yield using prediction algorithms; and target cell collection efficiency, optimized by a variety of device and donor-specific considerations. Factors affecting product purity include characteristics of the donor, mobilizing agent, device, and device settings. SUMMARY Strategies to optimize product yield and purity for gene and IEC therapies are important to consider because of loss of target cell numbers or function with downstream steps and detrimental effects of nontarget cells on further manufacturing and patient outcome.
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Yoon EJ, Zhang J, Weinberg RS, Brochstein JA, Nandi V, Sachais BS, Shi PA. Validation of simple prediction algorithms to consistently achieve CD3+ and postselection CD34+ targets with leukapheresis. Transfusion 2019; 60:133-143. [PMID: 31756000 DOI: 10.1111/trf.15576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cellular therapies using engineered T cells, haploidentical transplants, and autologous gene therapy are increasing. Specified CD3+ or high CD34+ doses are typically required for subsequent manufacturing, manipulation, or CD34+ selection. Simple, practical, and reliable lymphocyte and hematopoietic progenitor cell (HPC) collection algorithms accounting for subsequent CD34+ selection have not been published. STUDY DESIGN AND METHODS In this analysis of 15 haploidentical donors undergoing tandem lymphocyte and HPC collections, we validated one-step, practical prediction algorithms (Appendix S1, available as supporting information in the online version of this paper) that use conservative facility-specific collection efficiencies, CD34+ selection efficiency, and donor-specific peripheral counts to reliably achieve the target CD3+ and CD34+ product doses. These algorithms expand on our previously published work regarding predictive HPC collection algorithms. RESULTS Ninety-three percent of lymphocyte and 93% of CD34+ collections achieved the final target CD3+ and CD34+ product dose when our algorithm-calculated process volumes were used. Linear regression analysis of our algorithms for CD3+, preselection CD34+, and postselection CD34+ showed statistically significant models with R2 of 0.80 (root mean square error [RMSE], 31.3), 0.72 (RMSE, 385.7), and 0.56 (RMSE, 326.0), respectively, all with p values less than 0.001. CONCLUSION Because achievement of CD3+ or CD34+ dose targets may be critical for safety and efficacy of cell therapies, these simple, practical, and reliable prediction algorithms for lymphocyte and HPC collections should be very useful for collection facilities.
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Affiliation(s)
- Edward J Yoon
- Clinical Services, New York Blood Center, New York, New York.,Temple University Hospital, Philadelphia, Pennsylvania
| | - Jiahao Zhang
- Clinical Services, New York Blood Center, New York, New York
| | - Rona S Weinberg
- Clinical Services, New York Blood Center, New York, New York.,Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Joel A Brochstein
- Division of Pediatric Hematology-Oncology, Northwell Health, New Hyde Park, New York
| | - Vijay Nandi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Bruce S Sachais
- Clinical Services, New York Blood Center, New York, New York.,Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Patricia A Shi
- Clinical Services, New York Blood Center, New York, New York.,Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
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7
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Ali S, Chiang K, Even‐Or E, Di Mola M, Schechter T, Ali M, McDougall E, Svajger G, Licht C, Krueger J. Comparison between intermittent and continuous leukapheresis protocols for autologous hematopoietic stem cell collections in children. J Clin Apher 2019; 34:646-655. [DOI: 10.1002/jca.21741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/03/2019] [Accepted: 08/02/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Salah Ali
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
| | - Kuang‐Yueh Chiang
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
- Department of PaediatricsUniversity of Toronto Toronto Ontario Canada
| | - Ehud Even‐Or
- Department of Bone Marrow TransplantationHadassah Medical Center Jerusalem Israel
| | - Maria Di Mola
- Division of NephrologyThe Hospital for Sick Children Toronto, Ontario Canada
| | - Tal Schechter
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
- Department of PaediatricsUniversity of Toronto Toronto Ontario Canada
| | - Muhammad Ali
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
- Department of PaediatricsUniversity of Toronto Toronto Ontario Canada
| | - Elizabeth McDougall
- Department of Pediatric Laboratory Medicine and PathobiologyThe Hospital for Sick Children Toronto, Ontario Canada
| | - Gordana Svajger
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
| | - Christoph Licht
- Department of PaediatricsUniversity of Toronto Toronto Ontario Canada
- Division of NephrologyThe Hospital for Sick Children Toronto, Ontario Canada
| | - Joerg Krueger
- Division of Hematology/Oncology/BMTThe Hospital for Sick Children Ontario Canada
- Department of PaediatricsUniversity of Toronto Toronto Ontario Canada
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8
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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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9
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Kim S, Hosoya K, Kobayashi A, Okumura M. Comparison of three mobilization protocols for peripheral blood stem cell apheresis with Spectra Optia continuous mononuclear cell protocol in healthy dogs. Vet Comp Oncol 2018; 17:61-68. [DOI: 10.1111/vco.12446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Sangho Kim
- Department of Veterinary Clinical Sciences, Laboratory of Veterinary SurgeryGraduate School of Veterinary Medicine, Hokkaido University Sapporo Japan
| | - Kenji Hosoya
- Department of Veterinary Clinical Sciences, Laboratory of Veterinary SurgeryGraduate School of Veterinary Medicine, Hokkaido University Sapporo Japan
| | - Ayumi Kobayashi
- Department of Veterinary Clinical Sciences, Laboratory of Veterinary SurgeryGraduate School of Veterinary Medicine, Hokkaido University Sapporo Japan
| | - Masahiro Okumura
- Department of Veterinary Clinical Sciences, Laboratory of Veterinary SurgeryGraduate School of Veterinary Medicine, Hokkaido University Sapporo Japan
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11
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Pfeiffer H, Völkl S, Gary R, Mackensen A, Achenbach S, Strasser E, Aigner M. Impact of collection programs for the generation of monocyte apheresis products on product quality and composition as starting material for the generation of cellular therapeutics. Transfusion 2018; 58:2175-2183. [DOI: 10.1111/trf.14817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Hella Pfeiffer
- Department of Transfusion Medicine and Haemostaseology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Simon Völkl
- Department of Medicine 5, Haematology and Oncology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Regina Gary
- Department of Medicine 5, Haematology and Oncology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Andreas Mackensen
- Department of Medicine 5, Haematology and Oncology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Susanne Achenbach
- Department of Transfusion Medicine and Haemostaseology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Erwin Strasser
- Department of Transfusion Medicine and Haemostaseology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
| | - Michael Aigner
- Department of Medicine 5, Haematology and Oncology; Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum; Erlangen Germany
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