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Bougar S, Atouf O, Ouadghiri S, Bourhanbour AD, Brick C, Essakalli M. Collection, cryopreservation and thawing of stem cells for children weighing less than 25 Kg with high-risk neuroblastoma: A single center results in Morocco. Hematol Transfus Cell Ther 2022; 44:535-541. [PMID: 35216961 PMCID: PMC9605889 DOI: 10.1016/j.htct.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/07/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction An important component of the advances made in neuroblastoma treatment has been the use of peripheral blood stem cells to support high-dose chemotherapy. In this study, we report our experience on a series of small children who have undergone standard and large volume leukaphersis (LVL) procedures, provide an update on a single institution's experience with cryopreservation of autologous peripheral blood stem cells (PBSCs), using 10% dimethyl sulfoxide (DMSO) and applying post-thaw DMSO depletion and analyze a number of variables that may affect viability. Methods A total of 36 aphereses were performed on 29 children weighing less than 25 kg between July 2016 and October 2019 at the Ibn Sina university hospital. Results Seven females and twenty-two males, median bodyweight 14 kg (9 - 22). A single apheresis was sufficient to obtain at least 3 × 10⁶/kg body weight (BW) of CD34+ cells in 82.8% of the cases. The LVL was performed in 22 aphereses. A median number of 5.9 × 10⁶/kg CD34 cells were collected per apheresis. A total of 60 PBSC samples were cryopreserved and 46 samples were infused. The mean cell viability percentage decreased from 94.75 ± 1.14% before freezing to 70.84 ± 8.6% after thawing (p < 0.001). No correlation was found between post-thaw viability and storage time (r = -0.233; p = 0.234) or number of total nucleated cells (r = 0.344; p = 0.073). Conclusion Leukapheresis is safe and feasible in small pediatric patients if the appropriate measures are used. Cryopreservation poses numerous challenges, especially a decrease in cell viability after thawing.
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Affiliation(s)
- Sara Bougar
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco.
| | - Ouafa Atouf
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | - Sanae Ouadghiri
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | | | - Chehrazade Brick
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco
| | - Malika Essakalli
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
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Becherucci V, Ermini S, Piccini L, Bisin S, Gori V, Gentile F, Ceccantini R, De Rienzo E, Bindi B, Pavan P, Cunial V, Allegro E, Brugnolo F, Maggio D, Calzolari D, Maccarelli E, Galli S, Muricci S, Berchielli M, Tintori V, Sardi I, Bambi F. An alternative procedure to leukapheresis for peripheral hematopoietic progenitor cell collection in very-low-weight children: A single pediatric center experience. J Clin Apher 2020; 35:406-412. [PMID: 32710805 DOI: 10.1002/jca.21813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND PBSC collection using a blood cell separator in very low weight patients can be frequently complicated by severe adverse effects and technical difficulties. MATERIAL AND METHODS From March 2013 to January 2017, 14 PBSC collections were performed in 12 children weighing less than 10 kg, affected by different solid tumours. PBSC collection was performed with a "homemade" aseptically assembled circuit. The circuit is composed by a 150 mL collection bag connected with a 4 stopcock ramp, perfused with ACD. This circuit allows collection of a specific total blood amount from CVC, depending on CD34+ /kg target. RESULTS Mean CD34+ cell performance per collection was 9.3 × 106 /kg. Tolerance to the procedure was very good as none of the patients experienced complications, with the exception of a patient who showed mild cyanosis and pallor after collection. Moreover, no bleeding or thrombotic complications have been observed. To date, 16 PBSC reinfusions have been performed in 7 children with a mean CD34+ cells viability of 98.1% ± 2.7 and mean WBC viability of 57% ± 10. Cell recovery after thawing was 87% ± 10.8. A rapid graft intake for both neutrophils and platelets, between day 7 and 20 after reinfusion was observed. DISCUSSION The procedure of total blood collection without the use of a cell separator is feasible and allows a good PBSC collection without significant side effects in very low-weight children. Moreover, this method could represent a valid and safe alternative to leukapheresis in patients where classic procedure could be difficult to apply.
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Affiliation(s)
- Valentina Becherucci
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Stefano Ermini
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Luisa Piccini
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Silvia Bisin
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Valentina Gori
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Francesca Gentile
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Riccardo Ceccantini
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Elena De Rienzo
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Barbara Bindi
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Paola Pavan
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Vanessa Cunial
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Elisa Allegro
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Francesca Brugnolo
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
| | - Daniela Maggio
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Daniela Calzolari
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Erika Maccarelli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Silvia Galli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Sonia Muricci
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Marco Berchielli
- Stem cell collection and Therapeutic Apheresis unit, Meyer Children's Hospital, Florence, Italy
| | - Veronica Tintori
- Transplantation Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Iacopo Sardi
- Neuro-oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Franco Bambi
- Immunohematology, Transfusion Medicine and Laboratory, Meyer Children's Hospital, Florence, Italy
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Abstract
Apheresis procedures are standard of care for a wide range of indications in children, collection of hematopoietic stem cells being the most frequent one. With increasing numbers of hematopoietic stem cell transplants, advances in graft manipulation techniques and the development of innovative therapies using immune effector cells and gene therapy, apheresis within the pediatric population is growing in demand. While young children have higher circulating white blood cell counts and robustly mobilize hematopoietic stem cells, apheresis machines were designed for use within the adult population and apheresis procedures in children, particularly small children, can be more challenging as vascular access, collection techniques and impact of extracorporeal volumes increase the rate of adverse events. In this article we review topics of particular relevance to hematopoietic stem cell and immune effector cell collections in small children.
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Karakukcu M, Unal E. Stem cell mobilization and collection from pediatric patients and healthy children. Transfus Apher Sci 2015; 53:17-22. [PMID: 26116046 DOI: 10.1016/j.transci.2015.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Today, hematopoietic stem cell transplantation (HSCT) is a standard treatment for a variety of conditions in children, including certain malignancies, hemoglobinopathies, bone marrow failure syndromes, immunodeficiency and inborn metabolic disease. Two fundamentally different types of HSCT are categorized by the source of the stem cells. The first, autologous HSCT represents infusion of patient's own hematopoietic stem cells (HSCs) obtained from the patient; the second, allogeneic HSCT refers to the infusion of HSCs obtained from a donor via bone marrow harvest or apheresis. Bone marrow has been the typical source for HSCs for pediatric donors. Bone marrow harvest is a safe procedure mainly related to mild and transient side effects. Recently, a dramatically increased use of mobilized peripheral blood stem cells (PBSCs) in the autologous as well as allogeneic setting has been seen worldwide. There are limited data comparing mobilization regimens; also mobilization practices vary widely in children. The most commonly used approach includes granulocyte colony stimulating factor (G-CSF) at 10 mg/kg/day as a single daily dose for 4 days before the day of leukapheresis. G-CSF induced pain was less reported in children compared to adult donors. For the collection, there are several technical problems, derived from the size of the patient or donor, which must be considered before and during the apheresis. Vascular access, extracorporeal circuit volume, blood flow rates are the main limiting factors for PBSC collection in small children. Most children younger than 12 years require central vascular access for apheresis; line placement may require either general anesthesia or conscious sedation and many of the complications arise from the central venous catheter. In this review, we discuss that the ethical considerations and some principals regarding children serving as stem cell donors and the commonest sources of HSCs are presented in children, together with a discussion of how to collect and process these cells.
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Affiliation(s)
- Musa Karakukcu
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey.
| | - Ekrem Unal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey
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Gooskens SL, Braakman E, van den Boom AL, So-Osman C, de Winter F, Pieters R, van den Heuvel-Eibrink MM. Peripheral stem cell harvest using regular chemotherapy schedules in childhood cancer. Pediatr Transplant 2012; 16:758-65. [PMID: 22882589 DOI: 10.1111/j.1399-3046.2012.01754.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prediction of the best moment for the harvest of PBSCs after standard chemotherapy followed by filgrastim in children with cancer is difficult. We retrospectively analyzed the moment of harvesting of 152 procedures in 94 patients. The start of apheresis was guided by WBC count and CD34+ cell measurement in peripheral blood. We defined the first day of filgrastim administration, after completion of mobilizing chemotherapy, as day 1. Median time to harvest in different subgroups is as follows: neuroblastoma 11 days (range, 6-29 days), Ewing's sarcoma nine days (range, 7-15 days), brain tumor 10 days (range, 7-15 days), relapsed Wilms' tumor 16 days (range, 9-20 days), and extracranial GCT seven days (range, 6-14 days). Patients harvested after cyclophosphamide priming (time to harvest within a range of 8-9 days) were analyzed as a separate group. The optimal moment for harvesting in different types of tumors was highly variable, although most consistent in patients diagnosed with Ewing's sarcoma or brain tumors and after cyclophosphamide priming.
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Affiliation(s)
- Saskia L Gooskens
- Department of Pediatric Oncology/Hematology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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6
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Abstract
Hematopoietic stem cell transplants are procedures with curative potential for patients with diseased, damaged, or absent stem cells. Because a sibling has the best chance of immunocompatibility with one in need of a transplant, siblings are the most suitable donors of stem cells. However, when siblings are stem cell donors, various ethical issues arise concerning the risks and benefits to the pediatric donor. Because of the critical and potential rapid deterioration of the recipient's condition, the needs of the sibling donor may be overlooked. This potential lack of advocacy for the pediatric sibling donor creates a role for the primary care provider to assess the child's physical and psychological ability to undergo the donation procedure, examine the ethical issues in choosing to use the pediatric sibling as the stem cell donor, prepare the child for the procedure, and follow-up with the sibling donor once the procedure is completed.
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Kim SR, Choung HK, Kim DW, Sung KW, Kang ES. Evaluation of a new cell separator for collection of peripheral blood CD34+ progenitor cells in pediatric patients. Transfusion 2010; 51:306-12. [PMID: 20804528 DOI: 10.1111/j.1537-2995.2010.02864.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was conducted to evaluate the performance of the COM.TEC cell separator (Fresenius HemoCare GmbH) for collecting CD34+ cells in pediatric patients who were intended to have autologous peripheral blood progenitor cell transplantation, with respect to collection variables, prediction power of CD34+ cell yield, and influence on donors. STUDY DESIGN AND METHODS A total of 26 pediatric solid tumor patients who received mobilization chemotherapy and granulocyte-colony-stimulating factor underwent CD34+ cell collection (n = 96) using the COM.TEC auto mononuclear cell (MNC) program. Patients were divided into a neuroblastoma (NBL) group and a brain tumor group according to the intensity of prior chemotherapy regimens. The collection variables, cellular variables of leukapheresis products, and the peripheral blood cell counts of patients were compared with those acquired using the COBE Spectra (GambroBCT). The CD34+ cell collection efficiency (CE) and the percentage ratios of actual to predicted CD34+ cell yield indicating prediction power were analyzed. RESULTS Using the COM.TEC auto MNC program, the processing rate was higher and the product volume was smaller (p < 0.05) than those of the COBE Spectra. Platelet (PLT) reduction in peripheral blood and PLT contamination of the products were significantly lower (p < 0.01). The median CE was less than 60% in both patient groups (50.0 and 48.4%, respectively). The actual collected CD34+ cell yields were medians of 66.9 and 76.1% of the predicted values in NBL group and brain tumor group, respectively. CONCLUSION PBPC collections by the COM.TEC cell separator had advantages of high processing rate, low product volume, and low contamination by PLTs of product. Low PLT loss was observed in pediatric patients who need to collect autologous PBPCs. However, applying CD34+ cell yield prediction was not practical for prospective scheduling of the next collection. More specified data need to be accumulated for more accurate prediction of CD34+ cell yield in pediatric patients.
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Affiliation(s)
- Suk-Ran Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Witt V, Stegmayr B, Ptak J, Wikström B, Berlin G, Axelsson CG, Griskevicius A, Centoni PE, Liumbruno GM, Molfettini P, Audzijoniene J, Mokvist K, Sojka BN, Norda R, Ramlow W, Blaha M, Evergren M, Tomaz J. World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry. Transfus Apher Sci 2008; 39:255-60. [PMID: 19010084 DOI: 10.1016/j.transci.2008.09.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Paediatric patients are a special group in apheresis. It is general accepted to use adult indications in paediatric patients, but data in this age group are rare. In order to provide more information of apheresis practise in children and young adults (<21a) we will report of knowledge learnt by data from the registry from 2003 until 2007. METHODS This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 12,448 procedures have been included. Six hundred and twelve procedures were performed in 135 children and young adults (308 procedures<16a, 237 from 17 to 20a, and 67 with 21a) representing 5% of the total population. The median age was 14 years (range 1-21 years), 74 male and 61 female. These data were entered by 15 centres with a frequency of in median 18 aphereses in young patients per centre (range 1-287) from 2003 to 2007. RESULTS Main indications: haematological diseases and also nephrological, and neurological. The type of aphereses was mainly Leukapheresis (196, 33%), plasma exchange (149, 25%), photopheresis (127, 21%), and lipid aphereses (79, 13%). Blood access: peripheral vessels in 305 procedures (50%, compared to 73% in adults), central venous catheter in 239 (38%), and AV-fistula in 2% and 0.3%, and in 8 (1.31%) procedures an arterial line was used. Anticoagulation was mostly by ACD (71%), heparin (18% or the combination of both (3%). 39 adverse events (AE) were registered in 22 (=3.59%) of the procedures, mostly graded as mild. Treatment was interrupted in 14 procedures (2.29%). AE's were abdominal pain, anaphylactic shock, flush, hyper- and hypotension, nausea, vertigo, cephalea and need for sedation and technical problems with the device and problems with the venous access. The rate of AE's was similar for stem cell harvesting and for plasma exchange (4% and 4.7%, respectively). CONCLUSION The paediatric data compared to the whole registry data set are showing that aphereses are performed as safe in paediatrics as in adults. Centres are mostly handling only a few cases younger than 21. Therefore more exchange of information and experience in paediatric apheresis is warranted.
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Wiener LS, Steffen-Smith E, Battles HB, Wayne A, Love CP, Fry T. Sibling stem cell donor experiences at a single institution. Psychooncology 2008; 17:304-7. [PMID: 17534868 PMCID: PMC2293127 DOI: 10.1002/pon.1222] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Allogeneic bone marrow (BM) and cytokine mobilized peripheral blood stem cell (PBSC) transplantation can be curative for patients with malignant and nonmalignant hematologic diseases. Siblings are most often selected as a donor match; however, research on sibling donors is limited and has focused primarily on conventional BM donors. This exploratory study describes the experiences of PBSC sibling donors at a single institution. Through retrospective interviews, 14 sibling donors shared their perceived needs and concerns before and after their stem cell collection. Donors identified fears about the donation procedure, and expressed the need for more information about transplant outcome and complications. The inclusion of the sibling donors themselves, rather than the report of their parents or health-care providers and the qualitative nature of the structured design allowed sibling donors to describe their concerns and thoughts without being restrained by the beliefs of the participant's parents, researcher or sibling's medical team. Suggestions for visual educational tools, psychosocial interventions and future research are provided.
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Affiliation(s)
- Lori S Wiener
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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10
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Abstract
The rapid growth of the use of recombinant human granulocyte colony-stimulating factor (rhG-CSF) to mobilize and collect allogeneic peripheral blood stem cells (PBSCs) for transplantation has made it a new international standard. While the procedure remains safe, older donors, donors with significant comorbidities and pediatric donors are now often employed. This brings a new set of challenges in the donor evaluation, medical clearance, informed consent and collection process. Rare and unexpected severe adverse events related to rhG-CSF administration and PBSC apheresis have been described. Proper PBSC donor counseling, evaluation and care have become even more important.
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Affiliation(s)
- Beverly Rhodes
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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Michon B, Moghrabi A, Winikoff R, Barrette S, Bernstein ML, Champagne J, David M, Duval M, Hume HA, Robitaille N, Bélisle A, Champagne MA. Complications of apheresis in children. Transfusion 2007; 47:1837-42. [PMID: 17880609 DOI: 10.1111/j.1537-2995.2007.01405.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the frequency of complications in adults undergoing therapeutic apheresis is low, there are little data in children. STUDY DESIGN AND METHODS A retrospective study of 186 children who had undergone a total of 1632 apheresis procedures between 1994 and 2002 was conducted. Adverse reactions were prospectively documented. The procedures were plasma exchange (67%), hematopoietic progenitor cell collection (18%), red blood cell exchange (6.9%), leukodepletion (0.7%), and plasma exchange with immunoadsorption (6.7%). RESULTS Adverse reactions, most minor, were reported in 55 percent of procedures in 82 percent of patients. The most frequent complications, per procedure and per patient during an entire course of therapy, were hypotension (14 and 48.4%), hypotension requiring fluid bolus (4.8 and 26.9%), symptomatic hypocalcemia (9.7 and 28.5%), allergic reactions (4.4 and 5.9%), catheter-related thrombosis (1.7 and 12.4%), catheter-related infection (2.1 and 16.1%), and severe anemia (hemoglobin [Hb] level, <7 g/dL; 2.5 and 17.2%). There were two deaths (1% of patients). Risk factors for complications by multivariate analysis were lower body weight, lower preapheresis Hb level, apheresis in a critical care unit, and number of procedures per patient. The 55 percent incidence of complications per procedure in our pediatric cohort is much higher than the 4.3 to 28 percent incidence reported in adults. The excess of adverse reactions in children are mostly related to citrate toxicity, higher relative vascular volume shifts, and the need for vascular access. CONCLUSION Pediatric apheresis presents unique challenges and is associated with higher complication rate compared to adults. It is recommended that this procedure be performed in specialized centers.
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Affiliation(s)
- Bruno Michon
- Division of Hematology-Oncology, University Hospital Center Sainte-Justine, University of Montreal, 3175 chemin de la Côte Sainte-Catherine, Montreal, Quebec, Canada
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Wiener LS, Steffen-Smith E, Fry T, Wayne A. Hematopoietic stem cell donation in children: a review of the sibling donor experience. J Psychosoc Oncol 2007; 25:45-66. [PMID: 17360315 PMCID: PMC2367259 DOI: 10.1300/j077v25n01_03] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematopoietic Stem Cell Transplant (HSCT) represents the second most frequent major organ transplant in the United States. Compared with other family members, siblings are more likely to be immunologically matched with the recipient and therefore are often the most suitable donors. Due to a dearth of information on the positive and adverse effects of HSCT on pediatric sibling donors, we sought to examine available data. Eight published reports assessing the pediatric sibling donor experience were identified in the literature. Studies were predominately small (n < 44) and cross-sectional. Results suggest a range of psychological distress responses with higher distress in pediatric donor than non-donor siblings. Recommendations include future longitudinal research on sibling donor psychosocial adjustment, identification of sibling donors at high risk for maladaptive responses, and development of educational and psychosocial interventions for this overlooked pediatric population.
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Affiliation(s)
- Lori S. Wiener
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Emilie Steffen-Smith
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Terry Fry
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
| | - Alan Wayne
- Lori Wiener, Ph.D., ACSW, is Coordinator Pediatric Psychosocial Support & Research Program Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute. . Emilie Steffen-Smith, B.A., is a clinical research fellow, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Terry Fry, M.D., is a staff clinician, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail: . Alan S. Wayne, M.D., is Clinical Director and Head, Hematologic Diseases Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, e-mail:
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Ravagnani F, Coluccia P, Notti P, Arienti F, Bompadre A, Avella M, Bozzi F, Barzanò E, Podda M, Pupa S, Luksch R. Peripheral blood stem cell collection in pediatric patients: feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors. J Clin Apher 2006; 21:85-91. [PMID: 16035098 DOI: 10.1002/jca.20058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34(+) cell target was achieved at a single harvest; the median number of CD 34(+) cells was 10.8 x 10(6)/kg/leukapheresis (range 1-117) and the median collection efficiency was 63.4% (range 25-100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease.
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Affiliation(s)
- Fernando Ravagnani
- Immunohematology and Transfusion Medicine Service, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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