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Koken G, Polat Terece S, Ertoy Karagol HI, Topuz Turkcan B, Kaya Z, Kocak U, Bakirtas A. Allogeneic Hematopoietic Stem Cell Transplantation-Induced Anaphylaxis in 2 Pediatric Cases. EXP CLIN TRANSPLANT 2024; 22:475-478. [PMID: 39072521 DOI: 10.6002/ect.2023.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Hematopoietic stem cell transplantation is a curative treatment for many malignant and nonmalignant diseases in children and adults. It is performed with peripheral blood stem cells, bone marrow, and umbilical cord blood. Anaphylaxis may occur during hematopoietic stem cell transplantation, similar to that shown with blood transfusions. In children, although a few cases of anaphylaxis have been reported with cord blood transplantation, no cases of anaphylaxis have been reported with other hematopoietic stem cell transplantations. In this case report, we present the cases of 2 children, one diagnosed with thalassemia major and the other with aplastic anemia, both of whom developed anaphylaxis associated with bone marrow transplantation products cryopreserved with dimethyl sulfoxide and hydroxyethyl starch. Hematopoietic stem cell transplantation-induced anaphylaxis could be associated with cryoprotective agents, especially dimethyl sulfoxide, and alloantigens. In both anaphy-lactic reactions, dimethyl sulfoxide was thought to be the trigger, but it could not be excluded that it was related to stem cell components, plasma, or hydroxyethyl starch.
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Affiliation(s)
- Gizem Koken
- From the Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey
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2
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Araújo AB, Schmalfuss T, Furlan JM, Speransa D, Angeli MH, Sekine L, Franz JPM. The impact of infused red blood cell volume on major and bidirectional ABO-mismatched bone marrow transplantation. Cytotherapy 2024:S1465-3249(24)00708-4. [PMID: 38795114 DOI: 10.1016/j.jcyt.2024.05.003] [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: 07/27/2023] [Revised: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AIMS ABO incompatibility does not hinder bone marrow transplantation (BMT), but it has been associated with worse outcomes and additional adverse events. This study aimed to verify the impact of incompatible red blood cells (iRBCs) in allogeneic BMT and to determine a safe number of iRBCs to be infused. METHODS We compared ABO-incompatible (iABO) allogeneic BMT (n = 42) with ABO-compatible allogeneic BMT (n = 44) and evaluated the impact of the number of infused iRBCs on outcomes and adverse events. RESULTS The iABO patients demonstrated delayed time to transfusion independence at 30 days and 60 days, increased requirement for red blood cell (RBC) transfusion and greater hemolysis signals and incidence of pure red cell aplasia. Neutrophil/platelet engraftment, length of hospitalization post-transplant, platelet units required, graft-versus-host disease occurrence and overall survival were similar in both groups. Patients in the iABO group received 1.03 × 1010 iRBCs/kg (range, 0.36-3.88). Infusion of iRBCs >1.0 × 1010 /kg was related to graft failure or death before neutrophil engraftment or platelet engraftment or both as well as increased plasma requirement and increased creatinine. Our results also suggest that antibody titers impact the transplantation scenario. CONCLUSIONS The iABO transplantation showed some unfavorable outcomes. It is important to monitor the value of iRBCs to be infused, considering the recipient antibody titers. We propose using the number of iRBCs (iRBCs/kg) as a dose parameter with regard to infused iRBCs. Further studies are necessary to clarify the maximum safe number of iRBCs in iABO transplants.
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Affiliation(s)
- Anelise Bergmann Araújo
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Laboratório de Células, Tecidos e Genes, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | - Tissiana Schmalfuss
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Monteiro Furlan
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Daniela Speransa
- Unidade de Terapia Transfusional, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa Helena Angeli
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Leo Sekine
- Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Pires Marafon Franz
- Unidade de Terapia Transfusional, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Bennett B, Hanotaux J, Pasala AR, Hasan T, Hassan D, Shor R, Allan DS, Maganti HB. Impact of lower concentrations of dimethyl sulfoxide on cryopreservation of autologous hematopoietic stem cells: a systematic review and meta-analysis of controlled clinical studies. Cytotherapy 2024; 26:482-489. [PMID: 38416086 DOI: 10.1016/j.jcyt.2024.02.006] [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: 11/10/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AIMS Cryopreservation of hematopoietic stem cells (HSCs) is crucial for autologous transplantation, cord blood banking and other special circumstances. Dimethyl sulfoxide (DMSO) is used most commonly for cryopreserving HSC products but can cause infusional toxicities and affect cell viability and engraftment after transplant. A systematic review of controlled studies using lower concentrations of DMSO to cryopreserve HSC products in clinical transplant studies is needed to determine the effect of reducing DMSO concentrations on post-thaw cell viability, initial engraftment and adverse effects on patient health. METHODS All studies identified in our systematic search (to July 11, 2023) examining the use of cryopreserved peripheral blood stem cells (PBSCs) for autologous stem cell transplantation (AHCT) were included. Meta-analysis was performed to determine how varying the concentration of DMSO during cryopreservation effects post-thaw cell viability, initial engraftment and adverse effects on patient health. RESULTS A total of 1547 studies were identified in our systematic search, with seven published articles meeting eligibility for inclusion in meta-analysis. All patients underwent AHCT using (PBSCs) to treat hematologic malignancies. The viability of CD34+ cells post thaw was greater when cryopreserved with 5% DMSO compared with 10% DMSO, with lower rates of adverse side effects in patients. DMSO concentration had minimal impact on rates of initial engraftment. Significant heterogeneity in outcome reporting was observed and the potential for bias was identified in all studies. CONCLUSIONS Reducing the concentration of DMSO from 10% to 5% during cryopreservation of autologous PBSCs may improve cell viability and reduce DMSO-associated adverse effects in patients undergoing AHCT. Data from more studies with similar patients and standard outcome reporting are needed to increase confidence in our initial observations. PROTOCOL REGISTRATION PROSPERO; registration number CRD42023476809 registered November 8, 2023.
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Affiliation(s)
- Bryenah Bennett
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - Justine Hanotaux
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - Ajay Ratan Pasala
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Tanvir Hasan
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - Dhuha Hassan
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada
| | - Risa Shor
- Information Services, The Ottawa Hospital, Ottawa, Canada
| | - David S Allan
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada; Clinical Epidemiology & Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Harinad B Maganti
- Canadian Blood Services, Stem Cells and Centre for Innovation, Ottawa, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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4
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Keyzner A, Azzi J, Jakubowski R, Sinitsyn Y, Tindle S, Shpontak S, Kwon D, Isola L, Iancu-Rubin C. Cryopreservation of Allogeneic Hematopoietic Cell Products During COVID-19 Pandemic: Graft Characterization and Engraftment Outcomes. Transplant Proc 2023; 55:1799-1809. [PMID: 37210273 PMCID: PMC10121136 DOI: 10.1016/j.transproceed.2023.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/22/2023] [Accepted: 03/30/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic triggered the deployment of unfamiliar measures to safeguard successful allogeneic hematopoietic cell transplantation (allo-HCT). Among these measures, cryopreservation offered logistical benefits that could outlast the pandemic, including graft availability and timely clinical service. The purpose of this study was to evaluate graft quality and hematopoietic reconstitution in patients transplanted with cryopreserved allogeneic stem cell products during the COVID-19 pandemic. METHODS We evaluated 44 patients who underwent allo-HCT using cryopreserved grafts consisting of hematopoietic progenitor cells (HPC) apheresis (A) and bone marrow (BM) products at Mount Sinai Hospital. Comparative analyses of 37 grafts infused fresh during the one-year period preceding the pandemic were performed. Assessment of cellular therapy products included total nucleated cell and CD34+ cell enumeration, viability, and post-thaw recovery. The primary clinical endpoint was the evaluation of engraftment (absolute neutrophil count [ANC] and platelet count) and donor chimerism (presence of CD33+ and CD3+ donor cells) at day +30 and +100 post-transplant. Adverse events related to cell infusion were also analyzed. RESULTS Patient characteristics were comparable between the fresh and cryopreserved groups with 2 exceptions in the HPC-A cohort: the number of patients in the cryopreserved group that received haploidentical grafts was 6 times that in the fresh group, and the number of patients in the fresh group with a Karnofsky performance score >90 was double that in the cryopreserved group. The quality of HPC-A and HPC-BM products was not affected by cryopreservation, and all grafts met the release criteria for infusion. The pandemic did not affect the time between collection and cryopreservation (median, 24 hours) and time in storage (median, 15 days). Median time to ANC recovery was significantly delayed in recipients of cryopreserved HPC-A (15 vs 11 days, P = .0121), and there was a trend toward delayed platelet engraftment (24 vs 19 days, P = .0712). The delay in ANC and platelet recovery was not observed when only matched graft recipients were compared. Cryopreservation did not affect the ability of HPC-BM grafts to engraft and reconstitute hematopoiesis, and there was no difference in the rates of ANC and platelet recovery. Achievement of donor CD3/CD33 chimerism was not affected by cryopreservation of either HPC-A or HPC-BM products. Graft failure was observed in only 1 case, a recipient of cryopreserved HPC-BM. Three recipients of cryopreserved HPC-A grafts died before ANC engraftment from infectious complications. Remarkably, 22% of our studied population had myelofibrosis, and almost half received cryopreserved HPC-A grafts with no graft failure observed. Finally, patients receiving cryopreserved grafts were at a higher risk of infusion-related adverse events than those receiving fresh grafts. CONCLUSIONS Cryopreservation of allogeneic grafts results in adequate product quality with minimal impact on short-term clinical outcomes, except for an increased risk of infusion-related adverse events. Cryopreservation is a safe option in terms of graft quality and hematopoietic reconstitution with logistical benefits, but additional data are needed to determine long-term outcomes and assess whether this is a suitable strategy for at-risk patients.
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Affiliation(s)
- Alla Keyzner
- Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacques Azzi
- Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Deukwoo Kwon
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Luis Isola
- Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Camelia Iancu-Rubin
- Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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5
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Schuantes-Paim SM, Roza BDA, Knihs NDS, De Oliveira PC, Pessoa JLE, Da Silva AM, Treviso P, Magalhães ALP, Wachholz LF, Schirmer J. Time Elapsed Between Cells, Tissues, and Organs Donation and Transplantation and Adverse Events Detection. Transplant Proc 2023; 55:1359-1361. [PMID: 37105826 DOI: 10.1016/j.transproceed.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND This study was designed to discuss the time elapsed between cell, tissue, and organ donation and transplantation and detection of adverse events notified in São Paulo, Brazil. METHODS This is a descriptive study with a quantitative approach. Data were provided by the Transplant Center of the state of São Paulo from the "Individual notification form of adverse reactions in Biovigilance" between 2016 and 2019. Analysis was performed using descriptive statistics. RESULTS Fifty-two notifications were analyzed, and 3 categories were formed: (1) adverse events detected on the same day of the transplant, 8; (2) adverse events detected between 1 week and 1.5 years after transplant, 40; and (3) adverse events detected 2 years after transplant, 4. CONCLUSION The discussion on the topic is beginning; however, it is important. Clinical management of transplant recipients and comprehending what is considered an adverse event and the natural course of a patient's life can impact clinical decision-making, public policies, and patient safety research. This study highlights the need to investigate related factors to adverse events, especially the time between the transplant procedure and adverse event detection, to establish clinical guidelines.
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Affiliation(s)
| | | | | | - Priscilla Caroliny De Oliveira
- Nursing School, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - João Luis Erbs Pessoa
- State Transplant Center, Secretary of Health of the State of São Paulo, São Paulo, Brazil
| | | | - Patricia Treviso
- Health Department, Vale dos Sinos University, Porto Alegre, Brazil
| | | | | | - Janine Schirmer
- Paulista School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Mohanna A, Owaidah A, Albahrani A, Aldossary S, Almulhem N, Almohanna H. Validation of long-term handling and storage conditions for hematopoietic stem cell products for autologous transplants. J Med Life 2023; 16:515-519. [PMID: 37305819 PMCID: PMC10251375 DOI: 10.25122/jml-2022-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/10/2023] [Indexed: 06/13/2023] Open
Abstract
Hematopoietic stem cells (HPSCs) are multipotent stem cells that can differentiate into lymphoid and myeloid progenitors, giving rise to white blood cells (WBCs), red blood cells (RBCs), and platelets. HPSCs are a widely used treatment for many hematological non-malignant and malignant disorders. HPSCs can be used in the fresh or cryopreserved state for future use. Fresh HPSCs are typically stored at 2-6°C for up to 72 hours and are primarily used for allogeneic transplants or autologous transplants in myeloma and lymphoma patients. However, in some cases of autologous donations, HPSC transplantation is delayed more than three days after collection. In such situations, the cells are thawed after short-term preservation, resulting in a 35% cell viability loss. This study aimed to investigate the quality of HPSCs products after long-term storage exceeding 72 hours. The quality of HPSCs products was assessed by measuring viable CD34+ cell count, the total number of nucleated cells (TNC), and HPSCs recovery after different storage intervals of up to 120 hours in hypothermal storage. The mean total cell viability decreased by 2.18% within 72 hours and 7.4% within 120 hours, while mean CD34+ cell recovery was 92.61 % at 72 hours and 83.83 % at 120 hours in hypothermal storage. The mean TNC recovery was 89.93% at 72 hours and 76.18 % at 120 hours. All products were free from bacterial contamination for up to 120 hours under hypothermal storage conditions.
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Affiliation(s)
- Anfal Mohanna
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amani Owaidah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Albahrani
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Sara Aldossary
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Norah Almulhem
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hani Almohanna
- Research Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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7
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Haubitz M, von Petersdorff VS, Helsen I, Brunold C, Oppliger Leibundgut E, Baerlocher GM. Higher Age (≥60 Years) Increases the Risk for Adverse Events during Autologous Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2023; 15:cancers15051584. [PMID: 36900376 PMCID: PMC10000699 DOI: 10.3390/cancers15051584] [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: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Autologous hematopoietic stem cell transplantation (autoHSCT) is a standard of care for patients with hemato-oncologic diseases. This procedure is highly regulated, and a quality assurance system needs to be in place. Deviations from defined processes and outcomes are reported as adverse events (AEs: any untoward medical occurrence temporally associated with an intervention that may or may not have a causal relationship), including adverse reactions (ARs: a response to a medicinal product which is noxious and unintended). Only a few reports on AEs cover the procedure of autoHSCT from collection until infusion. Our aim was to investigate the occurrence and severity of AEs in a large data set of patients who were treated by autoHSCT. In this retrospective, observational, single-center study on 449 adult patients during the years 2016-2019, AEs occurred in 19.6% of the patients. However, only 6.0% of patients had ARs, which is a low rate compared to the percentages (13.5-56.9%) found in other studies; 25.8% of the AEs were serious and 57.5% were potentially serious. Larger leukapheresis volumes, lower numbers of collected CD34+ cells and larger transplant volumes significantly correlated with the occurrence and number of AEs. Importantly, we found more AEs in patients >60 years (see graphical abstract). By preventing potentially serious AEs of quality and procedural issues, AEs could be reduced by 36.7%. Our results provide a broad view on AEs and point out steps and parameters for the potential optimization of the autoHSCT procedure, especially in elderly patients.
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Affiliation(s)
- Monika Haubitz
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Vittoria S. von Petersdorff
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Ingrid Helsen
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Claudio Brunold
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Elisabeth Oppliger Leibundgut
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Gabriela M. Baerlocher
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Meric N, Parmaksız A, Gulbas Z. Patients experienced serious adverse reactions within one hour of hematopoietic stem-cell infusion. Transfus Clin Biol 2023; 30:82-86. [PMID: 35987476 DOI: 10.1016/j.tracli.2022.08.141] [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: 03/21/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
METHODS SARs were examined occurred within 1 hour after initiating HSC product infusions in all HSCT done in Turkey's Anadolu Medical Center Hospital accredited for HSCTs between 2013 and 2015, targeting 315 patients. RESULTS SARs were carefully evaluated in this study based on a comparison of the amount of stem cells infused, age, frozen sample (FS) / non-frozen samples (NFS) between HSCs sources. Rate of SARs is significantly higher in FS infusions supports the hypothesis that DMSO plays an important role in the development of SAR. CONCLUSION The rate of SARs is significantly higher in infusions given using FSs confirms the hypothesis that the preservative agent DMSO plays an important role in the development of SAR. Our study provides guidance for future studies on the necessity of reducing the amount of DMSO in the HSCT product and using other alternative freezing agents instead of DMSO.
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Affiliation(s)
- Neslihan Meric
- Faculty of Engineering and Natural Sciences, Department of Molecular Biology and Genetics, Kütahya University of Health Sciences, Kütahya, Turkey.
| | - Ayhan Parmaksız
- Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey
| | - Zafer Gulbas
- Anadolu Health Center, Bone Marrow Transplantation Center, Kocaeli, Turkey
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Dimethyl sulfoxide toxicity in umbilical cord blood transplantation in patients less than 4.5 kilos of weigh. Hematol Transfus Cell Ther 2023; 45:106-109. [PMID: 34244108 PMCID: PMC9938455 DOI: 10.1016/j.htct.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
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10
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Hashimoto S, Kato K, Kai S, Sekimoto T, Minemoto M, Ishii H, Mori T, Azuma F, Ishimaru F, Kimura T, Miyata S, Satake M, Takanashi M. Adverse events caused by cord blood infusion in Japan during a 5-year period. Vox Sang 2023; 118:84-92. [PMID: 36454585 DOI: 10.1111/vox.13379] [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: 06/12/2022] [Revised: 09/09/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES In Japan, cord blood is used for more than half of all unrelated stem cell transplantations. The public cord blood banks (CBBs) have been collecting information on cord blood transplantation-related adverse events from physicians on a voluntary basis, without common definitions of the adverse reactions. The aims of this study were to compare two classification systems to improve the reporting system and to clarify the actual risk from cord blood infusion, which can then provide the impetus to take appropriate measures to reduce adverse events. MATERIALS AND METHODS We classified the reports according to existing criteria; one is the Proposed Standard Definitions for Surveillance of Non-Infectious Adverse Transfusion Reactions by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance, and the other is the Common Terminology Criteria for Adverse Events (CTCAE). There were 140 cases with adverse events reported from April 2014 through March 2019. RESULTS Twelve cases, such as donor-derived leukaemia/myelodysplastic syndromes (MDS) and chromosomal aberrations reported after engraftment, were excluded from this analysis. Of the 128 cases with adverse events at cord blood infusion, the CTCAE and ISBT criteria could not classify 6 cases and 68 cases, respectively. Classifying by the CTCAE, the most common side effect was hypertension in 35 cases, followed by anaphylaxis, allergic reactions, nausea, urticaria, etc. Serious adverse events (grades 4 and 5) were mainly anaphylaxis, with a frequency of 0.23%. CONCLUSION It is necessary not only to provide information on adverse events but also to standardize the reporting of adverse events to support measures to reduce them.
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Affiliation(s)
- Shiho Hashimoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koji Kato
- Central Japan Cord Blood Bank, Aichi, Japan
| | | | - Tatsuya Sekimoto
- Japanese Red Cross Society Hokkaido Cord Blood Bank, Hokkaido, Japan
| | - Mutsuko Minemoto
- Japanese Red Cross Society Kanto-Koshinetsu Cord Blood Bank, Tokyo, Japan
| | - Hiroyuki Ishii
- Japanese Red Cross Society Kinki Cord Blood Bank, Osaka, Japan
| | - Tetsuo Mori
- Japanese Red Cross Society Kyushu Cord Blood Bank, Fukuoka, Japan
| | - Fumihiro Azuma
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Fumihiko Ishimaru
- Japanese Red Cross Society Kanto-Koshinetsu Cord Blood Bank, Tokyo, Japan
| | - Takafumi Kimura
- Japanese Red Cross Society Kinki Cord Blood Bank, Osaka, Japan
| | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Minoko Takanashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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11
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Araújo AB, Soares TB, Schmalfuss T, Angeli MH, Furlan JM, Salton GD, Burin MM, Röhsig LM. Non-cryopreserved peripheral blood stem cells as a safe and effective alternative for autologous transplantation in multiple myeloma. Transfusion 2022; 62:1967-1972. [PMID: 36052689 DOI: 10.1111/trf.17090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Autologous stem cell transplantation is the standard procedure for multiple myeloma and the grafts are usually cryopreserved. Previous studies reported advantages in the use of fresh peripheral blood stem cells (PBSC) autotransplantation compared to cryopreservation of the grafts. This study compared the transplant-related outcomes of two graft preservation methods: fresh storage (4°C/72 h) and cryopreservation (-80°C). STUDY DESIGN AND METHODS We performed an analysis of 45 patients with multiple myeloma under autotransplantation (17 fresh and 28 cryopreserved) from 2017 to 2021. Fresh PBSC were maintained in the refrigerator for three days in a concentration up to 300 × 103 TNC/μL. Cryopreserved PBSC were concentrated by plasma reduction after centrifugation (950 g/10 min/4°C) and an equal volume of cryoprotection solution was added for a final concentration of 300 × 103 TNC/μL, 5% DMSO, 6% hydroxyethyl starch, and 3% human albumin. RESULTS Neutrophil engraftment was significantly faster with fresh PBSCs (10 vs. 11.5 days, p = 0.045). Adverse effects were more common in cryopreserved PBSC transplantation (75% vs. 35.3% patients; p = 0.013). Post transplantation hospital stay was 20 and 22 days for fresh and cryopreserved PBSCs respectively (p = 0.091). There was no difference in platelet engraftment time (10.5 days for both; p = 0.133), number of antibiotics used after transplantation (3 for fresh and 2.5 for cryopreserved; p = 0.828), days of antibiotic use after transplantation (12.2 days for fresh and 13.3 days for cryopreserved, p = 0.579), and overall survival (p = 0.736). CONCLUSION The infusion of fresh PBSC refrigerated for up to three days is effective and safe for autologous transplantation in patients with multiple myeloma, which is a useful alternative to cryopreserved PBSC.
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Affiliation(s)
- Anelise Bergmann Araújo
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tahiane Brum Soares
- Serviço de Hematologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tissiana Schmalfuss
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa Helena Angeli
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Monteiro Furlan
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabrielle Dias Salton
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Liane Marise Röhsig
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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12
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Sumii Y, Fujii N, Fujii K, Kondo T, Urata T, Kimura M, Washio K, Fujiwara H, Asada N, Ennishi D, Nishimori H, Matsuoka K, Otsuka F, Maeda Y. Red blood cell depletion in small‐volume bone marrow processing using manipulation with third‐party red blood cells: A comparison of the performance of the
COBE
spectra and the spectra Optia systems. Transfusion 2022; 62:1829-1838. [DOI: 10.1111/trf.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yuichi Sumii
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Keiko Fujii
- Division of Clinical Laboratory Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology Okayama University Hospital Okayama Japan
| | - Takumi Kondo
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Tomohiro Urata
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Maiko Kimura
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Kana Washio
- Department of Pediatrics/Pediatric Hematology and Oncology Okayama University Hospital Okayama Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology Okayama University Hospital Okayama Japan
| | - Noboru Asada
- Department of Hematology and Oncology Okayama University Hospital Okayama Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
- Center for Comprehensive Genomic Medicine Okayama University Hospital Okayama Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Ken‐ichi Matsuoka
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Fumio Otsuka
- Division of Clinical Laboratory Okayama University Hospital Okayama Japan
- Department of General Medicine Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Okayama Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
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13
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Comments on the article "Allogeneic platelet-derived growth factors local injection in treatment of tennis elbow: a prospective randomized controlled study" by Kandil et al. INTERNATIONAL ORTHOPAEDICS 2022; 46:1905-1906. [PMID: 35641791 DOI: 10.1007/s00264-022-05451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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14
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Ikeda K, Minakawa K, Yamahara K, Yamada-Fujiwara M, Okuyama Y, Fujiwara SI, Yamazaki R, Kanamori H, Iseki T, Nagamura-Inoue T, Kameda K, Nagai K, Fujii N, Ashida T, Hirose A, Takahashi T, Ohto H, Ueda K, Tanosaki R. Comparison of cryoprotectants in hematopoietic cell infusion-related adverse events. Transfusion 2022; 62:1280-1288. [PMID: 35396716 DOI: 10.1111/trf.16877] [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: 12/16/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The standard cryoprotectant for human cellular products is dimethyl sulfoxide (DMSO), which is associated with hematopoietic cell infusion-related adverse events (HCI-AEs) in hematopoietic stem cell transplantation including peripheral blood stem cell (PBSC) transplantation (PBSCT). DMSO is often used with hydroxyethyl starch (HES), which reduces DMSO concentration while maintaining the postthaw cell recovery. The cryoprotectant medium CP-1 (Kyokuto Pharmaceutical Industrial) is widely used in Japan. After mixture of a product with CP-1, DMSO and HES concentrations are 5% and 6%, respectively. However, the safety profile of CP-1 in association with HCI-AEs has not been investigated. STUDY DESIGN AND METHODS To compare CP-1 with other cryoprotectants, we conducted a subgroup analysis of PBSCT recipients in a prospective surveillance study for HCI-AEs. Moreover, we validated the toxicity of CP-1 in 90 rats following various dose administration. RESULTS The PBSC products cryopreserved with CP-1 (CP-1 group) and those with other cryoprotectants, mainly 10% DMSO (non-CP-1 group), were infused into 418 and 58 recipients, respectively. The rate of ≥grade 2 HCI-AEs was higher in the CP-1 group, but that of overall or ≥grade 3 HCI-AEs was not significantly different, compared to the non-CP-1 group. Similarly, after propensity score matching, ≥grade 2 HCI-AEs were more frequent in the CP-1 group, but the ≥grade 3 HCI-AE rate did not differ significantly between the groups. No significant toxicity was detected regardless of the CP-1 dose in the 90 rats. CONCLUSIONS Infusion of a CP-1-containing PBSC product is feasible with the respect of HCI-AEs.
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Affiliation(s)
- Kazuhiko Ikeda
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiji Minakawa
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Yamahara
- Laboratory of Medical Innovation, Institute for Advanced Medical Sciences, Hyogo College of Medicine, Nishinomiya, Japan
| | - Minami Yamada-Fujiwara
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Division of Blood Transfusion and Cell Therapy, Tohoku University Hospital, Sendai, Japan
| | - Yoshiki Okuyama
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Division of Transfusion and Cell Therapy, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Shin-Ichiro Fujiwara
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Rie Yamazaki
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Heiwa Kanamori
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tohru Iseki
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan
| | - Tokiko Nagamura-Inoue
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Institution of Medical Science, University of Tokyo, Tokyo, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Nobuharu Fujii
- Department of Transfusion Medicine, Okayama University Hospital, Okayama, Japan
| | - Takashi Ashida
- Center for Transfusion and Cell Therapy, Kindai University Hospital, Osakasayama, Japan
| | - Asao Hirose
- Department of Hematology, Osaka City University, Osaka, Japan
| | - Tsutomu Takahashi
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Hitoshi Ohto
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koki Ueda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ryuji Tanosaki
- Cell Therapy Committee, Japan Society of Transfusion Medicine and Cell Therapy, Tokyo, Japan.,Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
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15
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Elsemary MT, Maritz MF, Smith LE, Warkiani M, Bandara V, Napoli S, Barry SC, Coombs JT, Thierry B. Inertial Microfluidic Purification of CAR-T-Cell Products. Adv Biol (Weinh) 2021; 6:e2101018. [PMID: 34881810 DOI: 10.1002/adbi.202101018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy is rapidly becoming a frontline cancer therapy. However, the manufacturing process is time-, labor- and cost-intensive, and it suffers from significant bottlenecks. Many CAR-T products fail to reach the viability release criteria set by regulators for commercial cell therapy products. This results in non-recoupable costs for the manufacturer and is detrimental to patients who may not receive their scheduled treatment or receive out-of-specification suboptimal formulation. It is demonstrated here that inertial microfluidics can, within minutes, efficiently deplete nonviable cells from low-viability CAR-T cell products. The percentage of viable cells increases from 40% (SD ± 0.12) to 71% (SD ± 0.09) for untransduced T cells and from 51% (SD ± 0.12) to 71% (SD ± 0.09) for CAR-T cells, which meets the clinical trials' release parameters. In addition, the processing of CAR-T cells formulated in CryStor yields a 91% reduction in the amount of the cryoprotectant dimethyl sulfoxide. Inertial microfluidic processing has no detrimental effects on the proliferation and cytotoxicity of CAR-T cells. Interestingly, ≈50% of T-regulatory and T-suppressor cells are depleted, suggesting the potential for inertial microfluidic processing to tune the phenotypical composition of T-cell products.
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Affiliation(s)
- Mona T Elsemary
- Future Industries Institute, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, Cell Therapy Manufacturing Cooperative Research Centre, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, 5095, Australia
| | - Michelle F Maritz
- Future Industries Institute, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, 5095, Australia
| | - Louise E Smith
- Future Industries Institute, Cell Therapy Manufacturing Cooperative Research Centre, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, 5095, Australia
| | - Majid Warkiani
- School of Biomedical Engineering, University of Technology Sydney, Broadway, Ultimo, NSW, 2007, Australia
| | | | - Silvana Napoli
- Women's and Children's Hospital, Adelaide, SA, 5006, Australia
| | - Simon C Barry
- Women's and Children's Hospital, Adelaide, SA, 5006, Australia
| | | | - Benjamin Thierry
- Future Industries Institute, ARC Centre of Excellence in Convergent Bio-Nano Science and Technology, University of South Australia Mawson Lakes Campus, Mawson Lakes, SA, 5095, Australia
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16
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Huvarová L, Kořístek Z, Jelínek T, Černá L, Smejkalová J, Navrátil M, Grebeníček L, Tvrdá I, Michalíková M, Hájek R. Washing transplants with Sepax 2 reduces the incidence of side effects associated with autologous transplantation and increases patients' comfort. Transfusion 2021; 61:2430-2438. [PMID: 34197635 DOI: 10.1111/trf.16566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) is routinely used in various hematologic malignancies. However, dimethylsulfoxide contained in cryopreserved grafts can cause adverse events (AEs). STUDY DESIGN AND METHODS Forty-three ASCTs were performed with Sepax 2 washed grafts between 7/2016 and 10/2019. The aim of this study was to determine whether washing out dimethyl sulfoxide (DMSO) from transplants using the Sepax 2 (S-100) device is safe and reduces the incidence of DMSO-associated AEs. RESULTS The washing procedure was automated and that resulted in the satisfactory recovery of total nucleated cells, CD34+ cells, and colony forming units of granulocyte and macrophages (85%, 80%, and 84%, medians). Time to engraftment of leukocytes, granulocytes, and platelets as well as the number of neutropenic days did not differ when compared to 20 consecutive ASCTs without washing. The AE occurrence was lower compared to unwashed grafts: 81% versus 78% during and shortly after grafts administration, 76% versus 69% in the following day. CONCLUSION We conclude that the washing of cryopreserved transplants using Sepax 2 was feasible with a high recovery of hematopoietic cells, did not influence time to engraftment, and resulted in the satisfactory reduction of AEs and improved tolerance of the procedure.
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Affiliation(s)
- Lucie Huvarová
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Zdeněk Kořístek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tomáš Jelínek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lucie Černá
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jana Smejkalová
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Milan Navrátil
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukáš Grebeníček
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ivana Tvrdá
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Magda Michalíková
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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17
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Yasui K, Enami T, Okamura-Shiki I, Ueda T, Fukushima K, Matsuyama N, Kimura T, Takanashi M, Hosen N, Ikeda T, Takihara Y, Hirayama F. Passive immune basophil activation test for the identification of allergic episodes from various adverse events elicited by haematopoietic cell transplantation: A pilot study. Vox Sang 2021; 117:119-127. [PMID: 34081781 DOI: 10.1111/vox.13131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Haematopoietic cell transplantation (HCT) therapy tends to be associated with various complications including engraftment failure, regimen-related toxicities, and infectious diseases. In addition, HC infusion itself occasionally elicits adverse events (AEs), one of the most common AEs is an allergic reaction. As appropriate laboratory tests have not yet been established to distinguish allergy-mediated AEs from other complications, clinical responses for HCT-related AEs can only be nonspecific. In this pilot study, using passive immune basophil activation test (pi-BAT), we attempted to distinguish an HC infusion-induced allergic reaction from various HCT-related AEs. MATERIALS AND METHODS Using pi-BAT, we examined 34 patients who underwent HCT, that is, 11 with AEs and 23 without AEs as controls. RESULTS Two of the eleven AE cases were pi-BAT positive and, the rest of nine AE cases were negative, while all non-AE cases were negative. Both of the two positive cases showed erythema, tachycardia, plus cough. Because erythema is one of the representative symptom of allergy, those cases could be classified as allergic reaction cases or anaphylaxis cases if tachycardia and cough were concomitant symptoms of erythema. Among the nine AEs with pi-BAT negative result, four cases showed urticaria, four showed vomiting plus diarrhoea, and one showed cough. Urticaria case was strongly suspected of allergy, however, the AE cases were pi-BAT negative. CONCLUSION The pi-BAT may be useful as an auxiliary diagnostic tool to confirm the possible involvement of HC infusion in HCT-related AEs and identify an immunologic mechanism for HCT-related hypersensitivity reactions.
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Affiliation(s)
- Kazuta Yasui
- Research and Development, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Terukazu Enami
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Nagaizumi-chou, Japan
| | - Ikue Okamura-Shiki
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Nagaizumi-chou, Japan
| | - Tomoaki Ueda
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuki Matsuyama
- Research and Development, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Takafumi Kimura
- Research and Development, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Minoko Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Naoki Hosen
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Nagaizumi-chou, Japan
| | - Yoshihiro Takihara
- Research and Development, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Fumiya Hirayama
- Research and Development, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
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18
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Kanda Y, Inoue M, Uchida N, Onishi Y, Kamata R, Kotaki M, Kobayashi R, Tanaka J, Fukuda T, Fujii N, Miyamura K, Mori SI, Mori Y, Morishima Y, Yabe H, Kodera Y. Cryopreservation of Unrelated Hematopoietic Stem Cells from a Blood and Marrow Donor Bank During the COVID-19 Pandemic: A Nationwide Survey by the Japan Marrow Donor Program. Transplant Cell Ther 2021; 27:664.e1-664.e6. [PMID: 33964514 PMCID: PMC8098035 DOI: 10.1016/j.jtct.2021.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
During the COVID-19 pandemic, donor hematopoietic stem cell grafts are frequently cryopreserved to ensure the availability of graft before starting a conditioning regimen. However, the safety of cryopreservation has been controversial in unrelated hematopoietic stem cell transplantation (HSCT), especially for bone marrow (BM) grafts. In addition, in unrelated HSCT, the effect of the time from harvest to cryopreservation of donor grafts required for the transportation of donor graft has not been fully clarified. In this study, we retrospectively analyzed the first 112 patients with available data who underwent cryopreserved unrelated blood and marrow transplantation through the Japan Marrow Donor Program during the COVID-19 pandemic. There were 112 patients, including 83 who received BM grafts and 29 who received peripheral blood stem cell (PBSC) grafts. The median time from stem cell harvest to cryopreservation was 9.9 hours (range, 2.6 to 44.0 hours), and the median time from cryopreservation to infusion was 231.2 hours. The incidence of neutrophil engraftment at day 28 after HSCT was 91.1%, and among 109 patients (excluding 3 patients with early death), all but 1 patient achieved neutrophil engraftment within 60 days after HSCT. The time to neutrophil engraftment and time to platelet engraftment were shorter in PBSC transplantation compared with BM transplantation (BMT), but the differences were not statistically significant (P = .064 and .18). Multivariate analysis among BM recipients revealed that a higher number of frozen nucleated cells and the absence of HLA mismatch were associated with faster neutrophil engraftment. The time to neutrophil engraftment after unrelated cryopreserved BMT was not different from that after unrelated BMT without cryopreservation. Our findings suggest that unrelated donor BM and PBSC grafts can be safely cryopreserved even after transit from the harvest center to the transplantation center. In the current COVID-19 pandemic, cryopreservation can be considered as an option while balancing the risks and benefits of the procedure.
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Affiliation(s)
- Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
| | - Reiko Kamata
- Nonprofit Organization Blood Disorder Information and Support Service "Tsubasa", Tokyo, Japan
| | - Mika Kotaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Shin-Ichiro Mori
- Hematology Department, St Luke's International Hospital, Tokyo, Japan
| | - Yasuo Mori
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuo Morishima
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiromasa Yabe
- Department of Innovative Medical Science, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihisa Kodera
- Japan Marrow Donor Program, Aichi Medical University School of Medicine, Nagakute, Japan
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19
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Cryoimmunology: Opportunities and challenges in biomedical science and practice. Cryobiology 2021; 100:1-11. [PMID: 33639110 DOI: 10.1016/j.cryobiol.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/26/2022]
Abstract
Autologous and allogeneic cryoimmunological medicine is a brand new branch of biomedical science and clinical practice that examines the features and formation of the immune response to immunogenic properties of normal and malignant biological structures altered by ultralow temperature, as well as specific changes in the structural and functional characteristics of immune cells and tissues after cryopreservation. Cryogenic protein denaturation phenomenon provides important insights into the mechanisms underlying the damage to cryogenic lesions immediately after freeze-thawing sessions in bioscience and medicine applications. The newly formed cryocoagulated protein components (cryomodified protein components) are crucial in cryoimmunology from the perspective of the formation of immunological substances at ultralow temperatures. Dendritic cells and cryocell detritus (cryocell debris) formed in living biological tissue after exposure to ultralow temperature in vivo may be an indication of one of the essential mechanisms involved in the cryoimmunological response of living structures to the impact of ultralow temperature exposure. Hence, the formation of new autologous and allogeneic cryoinduced immunogenic substances is a novel concept in biomedical research globally. Accordingly, this review focuses on issues concerning the peculiarities of the interaction of the immune system with a dominant malignant neoplasm tissue after exposure to subzero temperatures, considering the original cryogenic technical approaches. We present an overview of the state-of-the-art methods of cryoimmunology, and their major developments, past and present. The need for the delineation of structural and functional characteristics of the biological substrates of the immune system after cryopreservation that can be used in adoptive cell therapy, especially in cancer patients, is emphasized.
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20
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Tanaka A, Yokohama A, Fujiwara SI, Fujii Y, Kaneko M, Ueda Y, Abe T, Kato Y, Hasegawa Y, Ikeda K, Fujino K, Matsumoto M, Makino S, Kino S, Takeshita A, Muroi K. Transfusion-associated circulatory overload and high blood pressure: A multicentre retrospective study in Japan. Vox Sang 2021; 116:785-792. [PMID: 33529383 DOI: 10.1111/vox.13063] [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: 05/04/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion-associated circulatory overload (TACO) is an adverse reaction associated with a high risk of mortality. The actual incidence of TACO and hypertension associated with transfusion in Japan is unknown. METHODS A multicentre retrospective observational study was conducted across 23 institutions during the 1-year period of 2016. Patients were included if they developed TACO or their blood pressure (either systolic or diastolic) increased by at least 30 mmHg during the transfusion. TACO was confirmed by the primary physicians and transfusion medicine teams and recorded in the data on passive surveillance, and additional data were extracted from electronic medical records. RESULTS In our patient cohort of 31 384 patients who underwent transfusion, the incidence of TACO and hypertension was 0·03% and 0·2%, respectively. However, 43% of the participating institutions didn't report any cases. When comparing risk factors between the TACO and hypertension groups, there were significant differences in comorbidities, such as abnormal findings on chest x-ray. Significant differences between the two groups were observed post-transfusion pulse rate, body temperature and oxygen saturation (P < 0·01). In the group of patients with hypertension, the level of BNP increased significantly after transfusion in 45% (5/11) of the patients. We identified 4 patients in the hypertension group who met the new ISBT's TACO criteria. CONCLUSION Our study suggests that more attention should be given to TACO in Japan, particularly in terms of improving surveillance systems. For the early diagnosis of TACO, it is crucial to carefully monitor vital signs including blood pressure.
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Affiliation(s)
- Asashi Tanaka
- Department of Clinical Laboratory Medicine and Department of Transfusion Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Akihiko Yokohama
- Division of Blood Transfusion Service, Gunma University Hospital, Gunma, Japan
| | - Shin-Ichiro Fujiwara
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Tochigi, Japan
| | - Yasuhiko Fujii
- Department of Transfusion Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Makoto Kaneko
- Division of Cell Transplantation and Transfusion, University of Yamanashi Hospital, Yamanashi, Japan
| | - Yasunori Ueda
- Department of Hematology and Oncology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Abe
- Department of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Yoko Kato
- Division of Transfusion and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Yuichi Hasegawa
- Department of Transfusion Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keizo Fujino
- Department of Transfusion Medicine, Osaka City University Hospital, Osaka, Japan
| | | | - Shigeyoshi Makino
- Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan
| | - Shuichi Kino
- Hokkaido Block Blood Center Japanese Red Cross, Hokkaido, Japan
| | - Akihiro Takeshita
- Transfusion and Cell Therapy, Hamamatsu University School of Medicine, Shizuokoa, Japan
| | - Kazuo Muroi
- Division of Cell Transplantation and Transfusion, Jichi Medical University Hospital, Tochigi, Japan
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Meneghel J, Kilbride P, Morris GJ. Cryopreservation as a Key Element in the Successful Delivery of Cell-Based Therapies-A Review. Front Med (Lausanne) 2020; 7:592242. [PMID: 33324662 PMCID: PMC7727450 DOI: 10.3389/fmed.2020.592242] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
Cryopreservation is a key enabling technology in regenerative medicine that provides stable and secure extended cell storage for primary tissue isolates and constructs and prepared cell preparations. The essential detail of the process as it can be applied to cell-based therapies is set out in this review, covering tissue and cell isolation, cryoprotection, cooling and freezing, frozen storage and transport, thawing, and recovery. The aim is to provide clinical scientists with an overview of the benefits and difficulties associated with cryopreservation to assist them with problem resolution in their routine work, or to enable them to consider future involvement in cryopreservative procedures. It is also intended to facilitate networking between clinicians and cryo-researchers to review difficulties and problems to advance protocol optimization and innovative design.
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Affiliation(s)
- Julie Meneghel
- Asymptote, Cytiva, Danaher Corporation, Cambridge, United Kingdom
| | - Peter Kilbride
- Asymptote, Cytiva, Danaher Corporation, Cambridge, United Kingdom
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22
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López-Pereira P, Sola Aparicio E, Vicuña Andrés I, Cámara Montejano C, Muñoz Calleja C, Alegre Amor A, Aguado Bueno B. Retrospective comparison between COBE SPECTRA and SPECTRA OPTIA apheresis systems for hematopoietic progenitor cells collection for autologous and allogeneic transplantation in a single center. J Clin Apher 2020; 35:453-459. [PMID: 32798328 DOI: 10.1002/jca.21826] [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: 11/02/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION COBE SPECTRA [COBE] (Terumo, BCT Lakewood CO) apheresis system has been the most used device for hematopoietic progenitor cells (HPC) collection. Recently, it has been replaced by the SPECTRA OPTIA [OPTIA] (Terumo, BCT Lakewood CO) apheresis system. The aim of our study is to compare both methods for HPC collection. MATERIAL AND METHODS We retrospectively compared 302 HPC collection apheresis procedures (115 allogeneic donors and 187 autologous). The study cohort was divided according to the apheresis system used to analyze the differences between COBE and OPTIA, specifically efficacy of apheresis procedure and product characteristics. RESULTS OPTIA collections result in a higher CD34+ collection efficiency in both groups (autologous 45.3% vs 41%, P < .006; allogeneic 54.9% vs 45%, P < .0001). The total of CD34+ cells ×106 /kg recipient collected in the product were comparable in both groups (autologous 2.9 in OPTIA group vs 2.8 in COBE group, P = .344; allogeneic 6.2 in OPTIA group vs 5.8 in COBE group, P = .186). The percentage of platelet loss in autologous donors was significantly lower (35.7% vs 40.8%, P < .01). Regarding quality of the product, we observed a significantly lower hematocrit in products collected with OPTIA in both groups (1.8% vs 4%, P < .0001) as well as significantly lower amount of leukocytes (median 153.4 vs 237.2 × 109 /L in autologous, P < .0001; 239.5 vs 340.2 × 109 /L in allogeneic P < .0001). CONCLUSION Both apheresis systems are comparable in collection of hematopoietic progenitor cells, with significantly higher collection efficiency with the OPTIA system. Collection products obtained with OPTIA contain significantly lower hematocrit and leukocytes.
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Affiliation(s)
| | | | | | | | | | - Adrián Alegre Amor
- Hematology Department, Hospital Universitario La Princesa, Madrid, Spain
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23
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Adkins BD, Booth GS, Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol 2020; 57:51-56. [PMID: 32892843 DOI: 10.1053/j.seminhematol.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell patients regularly require transfusion support. Indications for transfusion in this population are similar to other patients being treated with chemoradiation; however, special considerations must be made in regards to pretransfusion testing, ABO compatibility, product modifications, and anticipated challenges while patients undergo engraftment. Additionally, infusion of hematopoietic stem cells requires acute understanding of product collection, modification, and potential side effects. As these patients often require numerous platelet transfusions, platelet refractoriness may be encountered and practice options are discussed. We review current indications and guidelines for transfusion in hematopoietic stem cell patients and make recommendations for best practice based on current literature.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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24
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Jennane S, Hasnaoui N, Mahtat EM, Merimi F, Bougar S, El Maaroufi H, Belmekki A, Zafad S, Essakalli M, Mikdame M, Doghmi K. Non-cryopreserved peripheral blood stem cells autologous transplantation in multiple myeloma: Bicentric study. Transfus Clin Biol 2020; 27:152-156. [PMID: 32334934 DOI: 10.1016/j.tracli.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the toxicity of autologous transplantation of non-frozen peripheral blood stem cells in Moroccan patients with multiple myeloma. MATERIAL AND METHODS This was a bicentric retrospective study conducted in the Clinical Haematology Department of Mohammed V Military Teaching Hospital and at the Al Madina Clinic in Casablanca. The study period was from January 2015 to June 2019. All patients with multiple myeloma who had undergone an autologous peripheral stem cell transplant without freezing were included. Mobilisation was performed with lenograstim alone and the collected stem cells were stored for 24-48hours in a blood bank refrigerator at a temperature of 4°C. After standard conditioning with high-dose melphalan, the peripheral blood stem cells were reinjected 24 h following conditioning. RESULTS Over the study period, 55 patients received an autologous transplant using non-frozen peripheral blood stem cells. The median richness of the CD34 cells collected was 4.5×106 CD34/kg (range: 2-12.2). The time required for neutrophil recovery was 12 days (range: 7-19). The time required for platelet recovery was 14 days (range: 9-32). The mortality rate within 100 days post-transplant was 3.6%. We did not observe any cases of graft failure. CONCLUSION Our study finds good feasibility and low toxicity of autologous peripheral stem cell transplantation without freezing in patients with multiple myeloma.
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Affiliation(s)
- S Jennane
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc.
| | - N Hasnaoui
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
| | - E M Mahtat
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
| | - F Merimi
- Clinique privée Al Madina, Casablanca, Maroc
| | - S Bougar
- Service de Transfusion et d'Immunologie, Banque de Tissus et Cellules, Centre Hospitalier Universitaire Ibn Sina, Université Mohammed V de Rabat, Rabat, Maroc
| | - H El Maaroufi
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
| | - A Belmekki
- Centre de Transfusion Sanguine Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
| | - S Zafad
- Clinique privée Al Madina, Casablanca, Maroc
| | - M Essakalli
- Service de Transfusion et d'Immunologie, Banque de Tissus et Cellules, Centre Hospitalier Universitaire Ibn Sina, Université Mohammed V de Rabat, Rabat, Maroc
| | - M Mikdame
- Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
| | - K Doghmi
- Service d'Hématologie Clinique, Hôpital Militaire d'Instruction Mohammed V de Rabat, Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Rabat, Maroc
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Ikeda K, Ohto H, Yamada‐Fujiwara M, Okuyama Y, Fujiwara S, Muroi K, Mori T, Kasama K, Kanamori H, Iseki T, Nagamura‐Inoue T, Kameda K, Kanda J, Nagai K, Fujii N, Ashida T, Hirose A, Takahashi T, Minakawa K, Tanosaki R. Hematopoietic cell infusion‐related adverse events in pediatric/small recipients in a prospective/multicenter study. Transfusion 2020; 60:1015-1023. [DOI: 10.1111/trf.15786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/02/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Kazuhiko Ikeda
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Hitoshi Ohto
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Minami Yamada‐Fujiwara
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Blood Transfusion and Cell TherapyTohoku University Hospital Sendai Japan
| | - Yoshiki Okuyama
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Transfusion and Cell TherapyTokyo Metropolitan Komagome Hospital Tokyo Japan
| | - Shin‐ichiro Fujiwara
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Hematology, Department of MedicineJichi Medical University Shimotsuke Japan
| | - Kazuo Muroi
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Cell Transplantation and TransfusionJichi Medical University Tochigi Japan
| | - Takehiko Mori
- Division of Hematology, Department of MedicineKeio University School of Medicine Tokyo Japan
| | - Kinuyo Kasama
- Department of Transfusion MedicineTokyo Jikei University Hospital Tokyo Japan
| | - Heiwa Kanamori
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of HematologyKanagawa Cancer Center Yokohama Japan
| | - Tohru Iseki
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Transfusion Medicine and Cell TherapyChiba University Hospital Chiba Japan
| | - Tokiko Nagamura‐Inoue
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Institution of Medical ScienceUniversity of Tokyo Tokyo Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical CenterJichi Medical University Saitama Japan
| | - Junya Kanda
- Department of Hematology and OncologyGraduate School of Medicine, Kyoto University Kyoto Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy UnitNagasaki University Hospital Nagasaki Japan
| | - Nobuharu Fujii
- Department of Transfusion MedicineOkayama University Hospital Okayama‐shi Japan
| | - Takashi Ashida
- Center for Transfusion and Cell TherapyKindai University Hospital Osakasayama Japan
| | - Asao Hirose
- Department of HematologyOsaka City University Osaka Japan
| | - Tsutomu Takahashi
- Department of Oncology/HematologyShimane University Hospital Shimane Japan
| | - Keiji Minakawa
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Ryuji Tanosaki
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
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26
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Impact of blood pressure early after allogeneic hematopoietic cell transplantation on clinical outcomes. Ann Hematol 2020; 99:1369-1376. [PMID: 32173768 DOI: 10.1007/s00277-020-03990-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/08/2020] [Indexed: 01/20/2023]
Abstract
Allogeneic hematopoietic transplantation (allo-HCT) is still associated with significant morbidity and mortality, and risk stratification is critical. In this study, we analyzed the relationship between blood pressure control early after allo-HCT and survival outcomes. All patients who survived longer than 28 days after allo-HCT at our center between June 2007 and June 2018 (n = 353) were included, and the average systolic blood pressure (asBP) from 1 to 28 days after allo-HCT was calculated. According to the results of a ROC curve analysis, an asBP of 131 mmHg was defined as a cut-off value between high and low asBP groups. Non-relapse mortality (NRM) and OS were significantly inferior in the high asBP group (2-year-NRM 28.0% vs 11.1%, P < 0.001; 2-year-OS 46.7% vs 65.7%, P = 0.001). In addition, baseline asBP before commencement of the conditioning regimen and elevation of asBP (asBP - baseline asBP) were both associated with inferior NRM. While these results were also observed in the younger patients (≤ 50 years), no relationship was observed in the older patients (> 50 years). High blood pressure within 28 days after allo-HCT was associated with inferior survival outcomes, especially in patients younger than 50 years.
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27
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Hunt CJ. Technical Considerations in the Freezing, Low-Temperature Storage and Thawing of Stem Cells for Cellular Therapies. Transfus Med Hemother 2019; 46:134-150. [PMID: 31244583 PMCID: PMC6558338 DOI: 10.1159/000497289] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/26/2019] [Indexed: 12/31/2022] Open
Abstract
The commercial and clinical development of cellular therapy products will invariably require cryopreservation and frozen storage of cellular starting materials, intermediates and/or final product. Optimising cryopreservation is as important as optimisation of the cell culture process in obtaining maximum yield and a consistent end-product. Suboptimal cryopreservation can lead not only to batch-to-batch variation, lowered cellular functionality and reduced cell yield, but also to the potential selection of subpopulations with genetic or epigenetic characteristics divergent from the original cell line. Regulatory requirements also impact on cryopreservation as these will require a robust and reproducible approach to the freezing, storage and thawing of the product. This requires attention to all aspects of the application of low temperatures: from the choice of freezing container and cryoprotectant, the cooling rate employed and its mode of de-livery, the correct handling of the frozen material during storage and transportation, to the eventual thawing of the product by the end-user. Each of these influences all of the others to a greater or lesser extent and none should be ignored. This paper seeks to provide practical insights and alternative solutions to the technical challenges faced during cryopreservation of cells for use in cellular therapies.
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28
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Chen LN, Collins-Johnson N, Sapp N, Pickett A, West K, Stroncek DF, Panch SR. How do I structure logistic processes in preparation for outsourcing of cellular therapy manufacturing? Transfusion 2019; 59:2506-2518. [PMID: 31135995 DOI: 10.1111/trf.15349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
As cell and gene therapies (CGT) assume center stage in early-phase clinical trials for several acute and chronic diseases, there is heightened interest in the standardization and automation of manufacturing processes in preparation for commercialization. Toward this goal, a hybrid and oftentimes geographically separated model comprising regional cell procurement and infusion facilities and a centralized cell manufacturing unit is gaining traction in the field. Although CGT processing facilities in academic institutions are not involved directly in the manufacturing of these therapies, they must be prepared to collaborate with commercial or contract manufacturing organizations (CMOs) and be ready to address several supply-chain challenges that have emerged for autologous and allogeneic CGT. Academic center cell-processing facilities must handle many events up- and downstream of manufacturing such as donor screening, cell collection, product labeling, cryopreservation, transportation, and thaw infusion. These events merit closer evaluation in the context of multifacility manufacturing since standard procedures have yet to be established. Based on our institutional experience, we summarize logistical challenges encountered in the handling and distribution of CGT products in early phase studies, specifically those involving CMO (outsourced) manufacturing. We also make recommendations to standardize processes unique to the CGT supply chain, emphasizing the need to maintain needle-to-needle traceability from product collection to infusion. These guidelines will inform the development of more complex supply-chain models for larger-scale cell and gene therapeutics.
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Affiliation(s)
- Leonard N Chen
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Naoza Collins-Johnson
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Nasheda Sapp
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Angela Pickett
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kamille West
- Blood Services Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Sandhya R Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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