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Yazal Erdem A, Özyörük D, Ok Bozkaya İ, Çakmakcı S, Emir S, Demir HA, Özgüner HM, Ergürhan İlhan İ, Özbek NY. Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures. Pediatr Transplant 2024; 28:e14751. [PMID: 38659194 DOI: 10.1111/petr.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.
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Affiliation(s)
- Arzu Yazal Erdem
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Derya Özyörük
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Selma Çakmakcı
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Suna Emir
- Department of Pediatrics, Atılım University Faculty of Medicine, Ankara, Turkey
| | - Hacı Ahmet Demir
- Department of Pediatric Hematology and Oncology, Memorial Private Hospital, Ankara, Turkey
| | - Habibe Meltem Özgüner
- Department of Histology and Embriology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - İnci Ergürhan İlhan
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Ersayoğlu İ, Yazıcı Özkaya P, Metin H, Hekimci H, Zararcı K, Yılmaz Karapınar D, Karapınar B. A rare complication of leukostasis with AML M4 patient: Microcirculatory dysfunction of upper extremities. Transfus Apher Sci 2023; 62:103717. [PMID: 37173209 DOI: 10.1016/j.transci.2023.103717] [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: 01/20/2023] [Revised: 04/15/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND In children with acute myeloid leukemia, the incidence of hyperleukocytosis is 5-33%. Patients with AML and hyperleukocytosis have a higher early mortality rate than patients with nonhyperleukocytic AML because of the increased risk of severe pulmonary and neurologic complications. Leukapheresis provides rapid cytoreduction and reduces early mortality rates. CASE PRESENTATION In this report, we present a case with microcirculatory failure of upper extremities as a rare symptom of hyperleukocytic AML M4 at initial presentation. CONCLUSIONS Early diagnosis and treatment of patients with AML admitted to emergency services with these symptoms is too important to prevent from loss of extremities. Most of the complications of hyperleukocytosis can be reversible with early treatment.
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Affiliation(s)
- İrem Ersayoğlu
- Ege University Medical School, Children's Hospital Pediatric Intensive Care Unit, İzmir, Turkey.
| | - Pınar Yazıcı Özkaya
- Ege University Medical School, Children's Hospital Pediatric Intensive Care Unit, İzmir, Turkey.
| | - Hamdi Metin
- Ege University Medical School, Children's Hospital Pediatric Intensive Care Unit, İzmir, Turkey.
| | - Hamiyet Hekimci
- Ege University Medical School, Children's Hospital Pediatric Hematology, İzmir, Turkey.
| | - Kazım Zararcı
- Ege University Medical School, Children's Hospital Pediatric Intensive Care Unit, İzmir, Turkey.
| | | | - Bülent Karapınar
- Ege University Medical School, Children's Hospital Pediatric Intensive Care Unit, İzmir, Turkey.
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A high-throughput microfluidic device based on controlled incremental filtration to enable centrifugation-free, low extracorporeal volume leukapheresis. Sci Rep 2022; 12:13798. [PMID: 35963876 PMCID: PMC9376077 DOI: 10.1038/s41598-022-16748-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022] Open
Abstract
Leukapheresis, the extracorporeal separation of white blood cells (WBCs) from red blood cells (RBCs) and platelets (PLTs), is a life-saving procedure used for treating patients with cancer and other conditions, and as the initial step in the manufacturing of cellular and gene-based therapies. Well-tolerated by adults, leukapheresis poses a significant risk to neonates and low-weight infants because the extracorporeal volume (ECV) of standard centrifugation-based machines represents a particularly large fraction of these patients' total blood volume. Here we describe a novel high-throughput microfluidic device (with a void volume of 0.4 mL) based on controlled incremental filtration (CIF) technology that could replace centrifugation for performing leukapheresis. The CIF device was tested extensively using whole blood from healthy volunteers at multiple hematocrits (5-30%) and flow rates (10-30 mL/min). In the flow-through regime, the CIF device separated WBCs with > 85% efficiency and 10-15% loss of RBCs and PLTs while processing whole blood diluted with saline to 10% hematocrit at a flow rate of 10 mL/min. In the recirculation regime, the CIF device demonstrated a similar level of separation performance, virtually depleting WBCs in the recirculating blood (~ 98% reduction) by the end of a 3.5-hour simulated leukapheresis procedure. Importantly, the device operated without clogging or decline in separation performance, with minimal activation of WBCs and PLTs and no measurable damage to RBCs. Compared to the typical parameters of centrifugation-based leukapheresis, the CIF device had a void volume at least 100-fold smaller, removed WBCs about twice as fast, and lost ~ 2-3-fold fewer PLTs, while operating at a flow rate compatible with the current practice. The hematocrit and flow rate at which the CIF device operated were significantly higher than previously published for other microfluidic cell separation methods. Finally, this study is the first to demonstrate a highly efficient separation of cells from recirculating blood using a microfluidic device. Overall, these findings suggest the feasibility of using high-throughput microfluidic cell separation technology to ultimately enable centrifugation-free, low-ECV leukapheresis. Such a capability would be particularly useful in young children, a vulnerable group of patients who are currently underserved.
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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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Jarisch A, Rettinger E, Sörensen J, Klingebiel T, Schäfer R, Seifried E, Bader P, Bonig H. Unstimulated apheresis for chimeric antigen receptor manufacturing in pediatric/adolescent acute lymphoblastic leukemia patients. J Clin Apher 2020; 35:398-405. [PMID: 32750197 DOI: 10.1002/jca.21812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Autologous unstimulated leukapheresis product serves as starting material for a variety of innovative cell therapy products, including chimeric antigen receptor (CAR)-modified T-cells. Although it may be reasonable to assume feasibility and efficiency of apheresis for CAR-T cell manufacture, several idiosyncrasies of these patients warrant their separate analysis: target cells (mononuclear cells [MNC] and T-cells) are relatively few which may instruct the selection of apheresis technology, low body weight, and, hence, low total blood volume (TBV) can restrict process and product volume, and patients may be in compromised health. We here report outcome data from 46 consecutive leukaphereses in 33 unique pediatric patients performed for the purpose of CD19-CAR-T-cell manufacturing. Apheresis targets of 2×109 MNC/1×109 T-cells were defined by marketing authorization holder specification. Patient weight was 8 to 84 kg; TBV was 0.6 to 5.1 L. Spectra Optia apheresis technology was used. For 23 patients, a single apheresis sufficed to generate enough cells and manufacture CAR-T-cells, the remainder required two aphereses to meet target dose and/or two apheresis series because of production failure. Aphereses were technically feasible and clinically tolerable without serious adverse effects. The median collection efficiencies for MNC and T-cells were 53% and 56%, respectively. In summary, CAR apheresis in pediatric patients, including the very young, is feasible, safe and efficient, but the specified cell dose targets can be challenging in smaller children. Continuous monitoring of apheresis outcomes is advocated in order to maintain quality.
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Affiliation(s)
- Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Peripheral blood stem cell apheresis in low-weight children: A single centre study. Transfus Apher Sci 2019; 58:300-303. [DOI: 10.1016/j.transci.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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