5c Autologous haemotherapy in malignant diseases

Evaluation of riboflavin photochemical treatment for inactivation of HCT116 tumor cells mixed in simulative intraoperative salvage blood

BACKGROUND

Radiation and filtration have achieved satisfactory results in inactivation or removal of tumor cells mixed in salvage blood, but some drawbacks remain. This study evaluated the inactivation on HCT116 cells mixed in simulative salvage blood by riboflavin photochemical treatment.

METHODS

HCT116 cells were added to the whole blood to simulate contaminated salvaged blood. The mixed blood was added with riboflavin of 50 μmol/L final concentration and illuminated by ultraviolet light. The samples were divided into control group and Experimental Groups 1 (18 J/cm² ), 2 (23.4 J/cm² ), and 3 (28.8 J/cm² ). An autotransfusion system (Cell Saver Elite, Haemonetics) was used to simulate the intraoperative blood salvage procedure to deal with whole blood. The apoptosis rate and tumorigenicity of HCT116 cells and the superimposed damage to red blood cells (RBCs) were evaluated.

RESULTS

The apoptosis rates of HCT116 in Experimental Groups 1, 2, and 3 were much higher than that in the control group. Tumor growth was found in the control group, but no tumor growth was found in the three experimental groups. The hemolysis rates in the three experimental groups were significantly higher than that in the control group, but much lower than the quality standard of RBCs at the end of preservation. The concentration of adenosine triphosphate in RBCs was comparable in the control and experimental groups.

CONCLUSION

Riboflavin at a 50 μmol/L final concentration and 18 J/cm² ultraviolet illumination can effectively inactivate HCT116 cells in salvaged blood, with minimum damage to the structure and function of RBCs, and the main quality indexes of salvaged RBCs were within the standard range.

The Effect of Storage on the Survival of Cancer Cells in Blood and Efficient Elimination of Contaminating Cancer Cells by a Leukocyte Depletion Filter

Preoperative autologous blood pooling has been employed in patients with malignant tumor. However, it has not been reported how the survival period of tumor cells contaminating the preoperative pooled blood changes corresponding to the storage period. Intraoperative blood salvage (IBS) is used together with preoperative blood pooling. However, IBS in oncologic surgery is generally regarded as a contraindication. In the current study, using cytokeratin 19 (CK-19) mRNA reverse transcription polymerase chain reaction method, we examined the survival period of cultured cancer cells in the pooled blood and the efficacy of irradiation and leukocyte depletion filter in eliminating cancer cells in the blood. Expression of CK-19 mRNA was observed in the pooled blood stored for 21 days. The number of cancer cells decreased to about 1/10 in the blood stored for 14 days. We irradiated blood with cancer cells with doses of 25 Gy or 100 Gy. No change was observed in the amplified CK-19 signal strength immediately after and 1 day after irradiation at 100 Gy. After filtration of blood with cancer cells through the leukocyte depletion filter, no CK-19 mRNA was detected. Blood filtration with the leukocyte depletion filter was effective in eliminating cancer cells in the blood.

Cytological and bacteriological studies of intraoperative autologous blood in neurosurgery

BACKGROUND

To ensure the safety of salvaged blood in neurologic surgery, reinfused blood through the Cell Saver System (CSS) (Hemonetics) was investigated cytologically and bacteriologically.

METHODS

Specimens of reinfused blood were cytologically examined with Papanicolaou or Giemsa stains. Reinfused blood and air in the operating theater were investigated by microbiologic techniques. The concentration of dust particles in the theater was determined.

RESULTS

Tumor cells were positive in reinfused blood in 5 of 9 specimens with glioblastoma, in 2 of 8 with pituitary adenoma, and 1 of 13 with meningioma. The probability of migration of meningioma cells into reinfused blood was significantly low in comparison with that of glioma cells. Of the 30 specimens studied microbiologically, the bacterial growth was detected in salvaged blood of 14 specimens (46.7%) and in the air of the operating theater for 8 specimens (26.7%). In craniotomy, the contamination rate was 10 of 26 specimens of reinfused blood (38.5%). Most microorganisms were found to be staphylococci. No statistically significant correlation could be found between salvaged blood and air as to contamination or between reinfused blood and the concentration of dust particles in the theater as to bacteriologic results. No infectious complications were found after the operation, though salvaged blood through the CSS was reinfused in 37 patients without glioblastoma or transsphenoidal approach.

CONCLUSIONS

The CSS cannot always entrap tumor cells. Salvaged blood should not be reinfused in the patients with glioblastoma or transsphenoidal surgery. None of the patients with reinfusion had any infectious complications. Reinfusion of salvaged blood seems to be safe in neurosurgery.

Blood irradiation for intraoperative autotransfusion in cancer surgery: demonstration of efficient elimination of contaminating tumor cells

BACKGROUND

Intraoperative blood salvage is contraindicated in cancer surgery because of contaminating tumor cells and the risk of systemic dissemination. On the basis of the radiosensitivity of cancer cells, irradiation of salvaged blood with 50 Gy is proposed as a way to allow return of salvaged blood.

STUDY DESIGN AND METHODS

Elimination of tumor cells by blood irradiation was studied in vitro with cells from 10 cell lines and from 14 tumor preparations after their addition to red cells in high numbers, or with blood shed during cancer surgery. Before and after gamma radiation, tumor cells were isolated by density gradient centrifugation and tested for their proliferative capacity in a cell colony assay. DNA metabolism was analyzed by incorporation of 5' bromodesoxyuridine.

RESULTS

Survival curves of cells from various tumors confirmed D0 (the dose required to reduce the fraction of surviving cells to 37 percent of the original value) values in the range of 1.2 to 2.2 Gy. After irradiation of tumor cell-contaminated blood with 50 Gy, no cell colony formation was observed, which indicates a reduction rate exceeding 10 log. Irradiated cancer cells showed viability, but no residual DNA metabolism.

CONCLUSION

The level of inactivation by a 50-Gy dose far exceeds that needed to inactivate the number of proliferating tumor cells observed or expected in wound blood. These results provide the experimental basis for the clinical application of blood irradiation for intraoperative blood salvage in cancer surgery.