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Ros-Soto J, Pryce A, Zoubek E, Burlton C, Szydlo R, Anthias C. Favorable recovery profiles and good reliability among youngest unrelated stem cell donors supports lowering the minimum donor registration age. J Clin Apher 2023; 38:562-572. [PMID: 37309733 DOI: 10.1002/jca.22066] [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: 01/27/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Younger donor age in hematopoietic cell transplantation has been associated with improved overall and disease-free survival. Safety data on peripheral blood stem cell (PBSC) and bone marrow (BM) donation is well established, including in the <18-year old age group in the related setting. In response, Anthony Nolan became the first stem cell donor registry to lower the minimum age for unrelated donors to 16-years. MATERIALS AND METHODS This retrospective study reviewed unrelated donors donating PBSC or BM for the first time between April 2015 and October 2017 since adoption of the lowered recruitment age. Data were collected from registry electronic database and structured follow-up questionnaires. Primary outcomes were turnaround time from VT to donation, optimal cell yield achievement, and physical and emotional recovery. RESULTS Out of a total of 1013 donors, there were no differences between the different age groups in proportion of donors achieving optimal CD34+ or TNC (PBSC and BM, respectively). There was no increased central line requirement for younger donors or increased emergency telephone support. Youngest donors were more likely to report physical recovery 2 and 7 days post-PBSC (P = .024 and P = .015, respectively) as well as an earlier emotional recovery (P = .001) and fewer physical symptoms 1 week BM donation (P = .04). CONCLUSION This study shows that younger donors are as reliable as older donors, and have favorable recovery profiles without need for increased support at any stage of the donation, supporting Anthony Nolan recruitment strategy and offering reassurance to donor registries considering the same.
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Affiliation(s)
- Jose Ros-Soto
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Angharad Pryce
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | | | | | - Richard Szydlo
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Chloe Anthias
- Anthony Nolan, London, UK
- The Royal Marsden Healthcare Trust, London, UK
- Institute of Cancer Research London, London, UK
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Basic characteristics and safety of donation in related and unrelated haematopoietic progenitor cell donors - first 10 years of prospective donor follow-up of Swiss donors. Bone Marrow Transplant 2022; 57:918-924. [PMID: 35379914 DOI: 10.1038/s41409-022-01656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Since July 2007 prospective life-long follow-up (FU) for unrelated (URD) and related donors (RD) is mandatory in Switzerland and data on every allogeneic haematopoietic progenitor cell (HPC) donation are collected prospectively. We report the real-world experience of HPC donation during a 10-year study period (01.07.2007-30.06.2017) with basic characteristics and FU data. 1105 donors underwent 1155 HPC donation procedures. Eighty percent of first donations performed by 802 (73%) RDs and 303 (27%) URDs were peripheral blood stem cells (PBSC), 20% bone marrow (BM). Male donors were over-represented as URD (60% male vs 40% female). Main differences between RDs and URDs concerned age and pre-existing health disorders. RDs were significantly older at first donation (median age 48 years) compared to URD (34 years, p < 0.0001) and had more pre-existing health problems: 25% vs 9% in URD (p < 0.0001). No fatal complications occurred, collection related severe adverse events (SAE) after first donation were not significantly different between groups (RD 1.2%, URD 0.99%), incidence rates for neoplastic and autoimmune diseases did not exceed the rates of the general population. RDs are a more heterogeneous and potentially more vulnerable group, but if donor evaluation is performed appropriately, HPC donation is still safe.
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Heyn J, Bräuninger S, Dimova-Dobreva M, Mathieson N, Koptelova N, Kolpakova A, Seidl C, Reinhardt P, Tsamadou C, Schrezenmeier H, Nakov R, Seifried E, Bonig H. Superior physical and mental health of healthy volunteers before and five years after mobilized stem cell donation. J Transl Med 2022; 20:121. [PMID: 35287672 PMCID: PMC8919626 DOI: 10.1186/s12967-022-03322-w] [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: 08/06/2021] [Accepted: 02/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Safety, tolerability and efficacy of granulocyte colony-stimulating factor (G-CSF) for mobilization of hematopoietic stem and progenitor cells (HSPCs) from healthy donors have been conclusively demonstrated. This explicitly includes, albeit for smaller cohorts and shorter observation periods, biosimilar G-CSFs. HSPC donation is non-remunerated, its sole reward being “warm glow”, hence harm to donors must be avoided with maximal certitude. To ascertain, therefore, long-term physical and mental health effects of HSPC donation, a cohort of G-CSF mobilized donors was followed longitudinally.
Methods
We enrolled 245 healthy volunteers in this bi-centric long-term surveillance study. 244 healthy volunteers began mobilization with twice-daily Sandoz biosimilar filgrastim and 242 underwent apheresis after G-CSF mobilization. Physical and mental health were followed up over a period of 5-years using the validated SF-12 health questionnaire.
Results
Baseline physical and mental health of HSPC donors was markedly better than in a healthy reference population matched for ethnicity, sex and age. Physical, but not mental health was sharply diminished at the time of apheresis, likely due to side effects of biosimilar G-CSF, however had returned to pre-apheresis values by the next follow-up appointment after 6 months. Physical and mental health slightly deteriorated over time with kinetics reflecting the known effects of aging. Hence, superior physical and mental health compared to the general healthy non-donor population was maintained over time.
Conclusions
HSPC donors are of better overall physical and mental health than the average healthy non-donor. Superior well-being is maintained over time, supporting the favorable risk–benefit assessment of volunteer HSPC donation.
Trial registration National Clinical Trial NCT01766934
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Hahn-Klimroth M, Loick P, Kim-Wanner SZ, Seifried E, Bonig H. Generation and validation of a formula to calculate hemoglobin loss on a cohort of healthy adults subjected to controlled blood loss. J Transl Med 2021; 19:116. [PMID: 33743699 PMCID: PMC7981850 DOI: 10.1186/s12967-021-02783-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The ability to approximate intra-operative hemoglobin loss with reasonable precision and linearity is prerequisite for determination of a relevant surgical outcome parameter: This information enables comparison of surgical procedures between different techniques, surgeons or hospitals, and supports anticipation of transfusion needs. Different formulas have been proposed, but none of them were validated for accuracy, precision and linearity against a cohort with precisely measured hemoglobin loss and, possibly for that reason, neither has established itself as gold standard. We sought to identify the minimal dataset needed to generate reasonably precise and accurate hemoglobin loss prediction tools and to derive and validate an estimation formula. Methods Routinely available clinical and laboratory data from a cohort of 401 healthy individuals with controlled hemoglobin loss between 29 and 233 g were extracted from medical charts. Supervised learning algorithms were applied to identify a minimal data set and to generate and validate a formula for calculation of hemoglobin loss. Results Of the classical supervised learning algorithms applied, the linear and Ridge regression models performed at least as well as the more complex models. Most straightforward to analyze and check for robustness, we proceeded with linear regression. Weight, height, sex and hemoglobin concentration before and on the morning after the intervention were sufficient to generate a formula for estimation of hemoglobin loss. The resulting model yields an outstanding R2 of 53.2% with similar precision throughout the entire range of volumes or donor sizes, thereby meaningfully outperforming previously proposed medical models. Conclusions The resulting formula will allow objective benchmarking of surgical blood loss, enabling informed decision making as to the need for pre-operative type-and-cross only vs. reservation of packed red cell units, depending on a patient’s anemia tolerance, and thus contributing to resource management. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02783-9.
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Affiliation(s)
| | - Philipp Loick
- Goethe University Mathematics Institute, Frankfurt, Germany
| | - Soo-Zin Kim-Wanner
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany. .,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany. .,Department of Medicine/Hematology, University of Washington, Seattle, WA, USA.
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Kim-Wanner SZ, Lee SY, Seifried E, Bonig H. Donor-intrinsic variables determine mobilization efficiency: analyses from a cohort of sixty twice-mobilized stem cell donors. J Transl Med 2020; 18:487. [PMID: 33339515 PMCID: PMC7749495 DOI: 10.1186/s12967-020-02634-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Healthy volunteer registry donors have become the backbone of stem cell transplantation programs. While most registrants will never become actual donors, a small minority are called upon twice, most commonly for the same patient because of poor graft function. Anecdotal evidence provides no hard reasons to disallow second-time mobilized apheresis, but few centers have treated enough two-time donors for definitive conclusions. Moreover, for reasons unknown, the efficiency of G-CSF varies greatly between donations. Methods Comparison of outcomes of first vs. second donations can formally confirm G-CSF responsiveness as intrinsically, likely genetically, determined. In our database, we identified 60 donors (1.3%) who received two cycles of G-CSF 24 days to 4 years apart and systematically compared mobilization outcomes. Results First and second mobilization and collection proceeded without severe or unusual adverse effects. First-time mobilization efficiency was highly predictive of second-time mobilization. Neither mobilization efficiency nor time lag between donations affected the similarity of first- and second-time mobilization outcomes. Conclusions With the caveat that only donors with an unremarkable first donation were cleared for a second, our data indicate that a second donation is feasible, equally tolerable as a first donation, and efficient. Moreover, the data strongly support the notion of donor-intrinsic variables dictating mobilization response and argue against relevant damage to the stem cell compartment during mobilization with rhG-CSF.
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Affiliation(s)
- Soo-Zin Kim-Wanner
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Department of Regional Evaluation and Accounting, Hessian Cancer Registry, Office of State Examination and Examination in the Health Service, Frankfurt, Germany
| | - Seo-Youn Lee
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Institute for Transfusion Medicine, Goethe University Medical School, Haus 76, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Institute Frankfurt, Frankfurt, Germany. .,Institute for Transfusion Medicine, Goethe University Medical School, Haus 76, Sandhofstr. 1, 60528, Frankfurt, Germany. .,Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Kim-Wanner SZ, Luxembourg B, Schmidt AH, Schäfer R, Möller N, Herbert E, Poppe C, Hümmer C, Bunos M, Seifried E, Bonig H. Introduction of principles of blood management to healthy donor bone marrow harvesting. Vox Sang 2020; 115:802-812. [PMID: 32633825 DOI: 10.1111/vox.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient blood (more accurately: haemoglobin, Hb) management (PBM) aims to optimize endogenous Hb production and to minimize iatrogenic Hb loss while maintaining patient safety and optimal effectiveness of medical interventions. PBM was adopted as policy for patients by the World Health Organization (WHO), and, all the more, should be applied to healthy donors. MATERIALS AND METHODS Observational data from 489 bone marrow (BM) donors were retrospectively analysed, and principles of patient blood management were applied to healthy volunteer BM donations. RESULTS AND CONCLUSION We managed to render BM aspiration safe for donors, notably completely avoiding the collection of autologous blood units and blood transfusions through iron management, establishment and curation of high-yield aspiration technique, limitation of collection volume to 1·5% of donor body weight and development of volume prediction algorithms for the requested cell dose.
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Affiliation(s)
- Soo-Zin Kim-Wanner
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Beate Luxembourg
- Department of Hemostaseology, Justus Liebig University, Giessen, Germany
| | | | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Nadine Möller
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Eva Herbert
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Carolin Poppe
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Christiane Hümmer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Milica Bunos
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Goethe University, Institute for Transfusion Medicine and Immunohematology, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Frankfurt, Germany.,Goethe University, Institute for Transfusion Medicine and Immunohematology, Frankfurt, Germany.,Department of Medicine/Hematology, University of Washington, Seattle, WA, USA
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Balassa K, Griffiths A, Winstone D, Li Y, Rocha V, Pawson R. Attrition at the final donor stage among unrelated haematopoietic stem cell donors: the British Bone Marrow Registry experience. Transfus Med 2019; 29:332-337. [DOI: 10.1111/tme.12613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 05/24/2019] [Indexed: 12/30/2022]
Affiliation(s)
- K. Balassa
- British Bone Marrow RegistryNHS Blood and Transplant Bristol UK
- Department of Clinical Haematology, Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
| | - A. Griffiths
- Statistics and Clinical StudiesNHS Blood and Transplant Bristol UK
| | - D. Winstone
- British Bone Marrow RegistryNHS Blood and Transplant Bristol UK
| | - Y. Li
- British Bone Marrow RegistryNHS Blood and Transplant Bristol UK
| | - V. Rocha
- British Bone Marrow RegistryNHS Blood and Transplant Bristol UK
- Department of Clinical Haematology, Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
| | - R. Pawson
- British Bone Marrow RegistryNHS Blood and Transplant Bristol UK
- Department of Clinical Haematology, Cancer and Haematology CentreOxford University Hospitals NHS Foundation Trust Oxford UK
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9
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Kim-Wanner SZ, Bug G, Steinmann J, Ajib S, Sorg N, Poppe C, Bunos M, Wingenfeld E, Hümmer C, Luxembourg B, Seifried E, Bonig H. Erythrocyte depletion from bone marrow: performance evaluation after 50 clinical-scale depletions with Spectra Optia BMC. J Transl Med 2017; 15:174. [PMID: 28800741 PMCID: PMC5553998 DOI: 10.1186/s12967-017-1277-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Red blood cell (RBC) depletion is a standard graft manipulation technique for ABO-incompatible bone marrow (BM) transplants. The BM processing module for Spectra Optia, "BMC", was previously introduced. We here report the largest series to date of routine quality data after performing 50 clinical-scale RBC-depletions. METHODS Fifty successive RBC-depletions from autologous (n = 5) and allogeneic (n = 45) BM transplants were performed with the Spectra Optia BMC apheresis suite. Product quality was assessed before and after processing for volume, RBC and leukocyte content; RBC-depletion and stem cell (CD34+ cells) recovery was calculated there from. Clinical engraftment data were collected from 26/45 allogeneic recipients. RESULTS Median RBC removal was 98.2% (range 90.8-99.1%), median CD34+ cell recovery was 93.6%, minimum recovery being 72%, total product volume was reduced to 7.5% (range 4.7-23.0%). Products engrafted with expected probability and kinetics. Performance indicators were stable over time. DISCUSSION Spectra Optia BMC is a robust and efficient technology for RBC-depletion and volume reduction of BM, providing near-complete RBC removal and excellent CD34+ cell recovery.
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Affiliation(s)
- Soo-Zin Kim-Wanner
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Gesine Bug
- Division of Stem Cell Transplantation, Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Juliane Steinmann
- Division of Stem Cell Transplantation, Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Salem Ajib
- Division of Stem Cell Transplantation, Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Nadine Sorg
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Carolin Poppe
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Milica Bunos
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Eva Wingenfeld
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Christiane Hümmer
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Beate Luxembourg
- Department of Hemostaseology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Erhard Seifried
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Sandhofstr. 1, 60528, Frankfurt, Germany
| | - Halvard Bonig
- Institute Frankfurt, German Red Cross Blood Service Baden-Württemberg-Hessen, Sandhofstr. 1, 60528, Frankfurt, Germany. .,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Sandhofstr. 1, 60528, Frankfurt, Germany. .,Department of Medicine/Hematology, University of Washington, Seattle, WA, USA.
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Karpova D, Bräuninger S, Wiercinska E, Krämer A, Stock B, Graff J, Martin H, Wach A, Escot C, Douglas G, Romagnoli B, Chevalier E, Dembowski K, Hooftman L, Bonig H. Mobilization of hematopoietic stem cells with the novel CXCR4 antagonist POL6326 (balixafortide) in healthy volunteers-results of a dose escalation trial. J Transl Med 2017; 15:2. [PMID: 28049490 PMCID: PMC5209880 DOI: 10.1186/s12967-016-1107-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/08/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Certain disadvantages of the standard hematopoietic stem and progenitor cell (HSPC) mobilizing agent G-CSF fuel the quest for alternatives. We herein report results of a Phase I dose escalation trial comparing mobilization with a peptidic CXCR4 antagonist POL6326 (balixafortide) vs. G-CSF. METHODS Healthy male volunteer donors with a documented average mobilization response to G-CSF received, following ≥6 weeks wash-out, a 1-2 h infusion of 500-2500 µg/kg of balixafortide. Safety, tolerability, pharmacokinetics and pharmacodynamics were assessed. RESULTS Balixafortide was well tolerated and rated favorably over G-CSF by subjects. At all doses tested balixafortide mobilized HSPC. In the dose range between 1500 and 2500 µg/kg mobilization was similar, reaching 38.2 ± 2.8 CD34 + cells/µL (mean ± SEM). Balixafortide caused mixed leukocytosis in the mid-20 K/µL range. B-lymphocytosis was more pronounced, whereas neutrophilia and monocytosis were markedly less accentuated with balixafortide compared to G-CSF. At the 24 h time point, leukocytes had largely normalized. CONCLUSIONS Balixafortide is safe, well tolerated, and induces efficient mobilization of HSPCs in healthy male volunteers. Based on experience with current apheresis technology, the observed mobilization at doses ≥1500 µg/kg of balixafortide is predicted to yield in a single apheresis a standard dose of 4× 10E6 CD34+ cells/kg from most individuals donating for an approximately weight-matched recipient. Exploration of alternative dosing regimens may provide even higher mobilization responses. Trial Registration European Medicines Agency (EudraCT-Nr. 2011-003316-23) and clinicaltrials.gov (NCT01841476).
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Affiliation(s)
- Darja Karpova
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
- Department of Internal Medicine, Division of Oncology, Section of Stem Cell Biology, Washington University Medical School, St. Louis, MO, USA
| | - Susanne Bräuninger
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Eliza Wiercinska
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Ariane Krämer
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Belinda Stock
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - Jochen Graff
- Clinical Trial Center Rhein-Main (KSRM), Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University, Frankfurt, Germany
| | - Hans Martin
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | | | | | | | | | | | | | | | - Halvard Bonig
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany.
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstr. 1, 60528, Frankfurt, Germany.
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.
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Becker P, Schwebig A, Brauninger S, Bialleck H, Luxembourg B, Schulz M, Tsamadou C, Wiesneth M, Reinhardt P, Mytilineos J, Seidl C, Gattu S, Kaliakina N, Singh P, Schrezenmeier H, Seifried E, Bonig H. Healthy donor hematopoietic stem cell mobilization with biosimilar granulocyte-colony-stimulating factor: safety, efficacy, and graft performance. Transfusion 2016; 56:3055-3064. [PMID: 27633122 DOI: 10.1111/trf.13853] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Biosimilar granulocyte-colony-stimulating factors (G-CSFs) have been available in the European Union since 2008, and Sandoz' biosimilar filgrastim was approved in the United States in March 2015 for all of the reference product's indications except acute radiation syndrome. Biosimilar G-CSFs have been largely embraced by the medical community, except for some reservations about healthy-donor stem cell mobilization, for which use outside of clinical studies was cautioned against by some members of the scientific community. STUDY DESIGN AND METHODS In a two-center safety surveillance study (National Clinical Trial NCT01766934), 245 healthy volunteer stem cell donors were enrolled. Of 244 donors who began mobilization with twice-daily Sandoz biosimilar filgrastim, 242 received a full (n = 241) or partial (n = 1) course of G-CSF and underwent apheresis. Efficacy and safety were assessed and are reported here. RESULTS Biosimilar filgrastim was accompanied by the typical G-CSF class-related adverse effects of expected frequency and severity. Median mobilization for CD34-positive stem cells was 97/µL (range, 20-347/µL); after one apheresis (91%) or two aphereses (9%) from all but three donors (1.2%), cell doses in excess of the typical 4 × 106 CD34-positive cells/kg of the recipient had been collected (range, 3-52 × 106 /kg). Biochemical and hematologic alterations were consistent with previous reports; all had normalized by the first follow-up 1 month after mobilization. Stem cell products engrafted with typical probability and kinetics for G-CSF-mobilized stem cell products. CONCLUSION These data support the use of biosimilar filgrastim for healthy-donor stem cell mobilization as safe and effective.
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Affiliation(s)
- Petra Becker
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | | | - Susanne Brauninger
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Heike Bialleck
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Beate Luxembourg
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Miriam Schulz
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Chrysanthi Tsamadou
- Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Donor Service and University Hospital Ulm, Ulm, Germany
| | - Markus Wiesneth
- Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Donor Service and University Hospital Ulm, Ulm, Germany
| | - Peter Reinhardt
- Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Donor Service and University Hospital Ulm, Ulm, Germany
| | - Joannis Mytilineos
- Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Donor Service and University Hospital Ulm, Ulm, Germany
| | - Christian Seidl
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | | | | | | | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics, German Red Cross Blood Donor Service and University Hospital Ulm, Ulm, Germany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Donor Service, Frankfurt am Main, Germany.,Department of Medicine/Hematology, University of Washington, Seattle, Washington
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12
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Hümmer C, Poppe C, Bunos M, Stock B, Wingenfeld E, Huppert V, Stuth J, Reck K, Essl M, Seifried E, Bonig H. Automation of cellular therapy product manufacturing: results of a split validation comparing CD34 selection of peripheral blood stem cell apheresis product with a semi-manual vs. an automatic procedure. J Transl Med 2016; 14:76. [PMID: 26983643 PMCID: PMC4793541 DOI: 10.1186/s12967-016-0826-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Automation of cell therapy manufacturing promises higher productivity of cell factories, more economical use of highly-trained (and costly) manufacturing staff, facilitation of processes requiring manufacturing steps at inconvenient hours, improved consistency of processing steps and other benefits. One of the most broadly disseminated engineered cell therapy products is immunomagnetically selected CD34+ hematopoietic “stem” cells (HSCs). Methods As the clinical GMP-compliant automat CliniMACS Prodigy is being programmed to perform ever more complex sequential manufacturing steps, we developed a CD34+ selection module for comparison with the standard semi-automatic CD34 “normal scale” selection process on CliniMACS Plus, applicable for 600 × 106 target cells out of 60 × 109 total cells. Three split-validation processings with healthy donor G-CSF-mobilized apheresis products were performed; feasibility, time consumption and product quality were assessed. Results All processes proceeded uneventfully. Prodigy runs took about 1 h longer than CliniMACS Plus runs, albeit with markedly less hands-on operator time and therefore also suitable for less experienced operators. Recovery of target cells was the same for both technologies. Although impurities, specifically T- and B-cells, were 5 ± 1.6-fold and 4 ± 0.4-fold higher in the Prodigy products (p = ns and p = 0.013 for T and B cell depletion, respectively), T cell contents per kg of a virtual recipient receiving 4 × 106 CD34+ cells/kg was below 10 × 103/kg even in the worst Prodigy product and thus more than fivefold below the specification of CD34+ selected mismatched-donor stem cell products. The products’ theoretical clinical usability is thus confirmed. Conclusions This split validation exercise of a relatively short and simple process exemplifies the potential of automatic cell manufacturing. Automation will further gain in attractiveness when applied to more complex processes, requiring frequent interventions or handling at unfavourable working hours, such as re-targeting of T-cells.
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Affiliation(s)
- Christiane Hümmer
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany
| | - Carolin Poppe
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany
| | - Milica Bunos
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany
| | - Belinda Stock
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany
| | - Eva Wingenfeld
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany
| | | | | | | | - Mike Essl
- Miltenyi Biotec GmbH, Bergisch-Gladbach, Germany
| | - Erhard Seifried
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - Halvard Bonig
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service Baden-Württemberg-Hesse, Institute Frankfurt, Frankfurt, Germany. .,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany. .,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.
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Mobilization of hematopoietic stem cells with highest self-renewal by G-CSF precedes clonogenic cell mobilization peak. Exp Hematol 2016; 44:303-14.e1. [PMID: 26827874 DOI: 10.1016/j.exphem.2016.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 01/10/2023]
Abstract
Harvest of granulocyte colony-stimulating factor (G-CSF)-mobilized hematopoietic stem cells (HSCs) begins at day 5 of G-CSF administration, when most donors have achieved maximal mobilization. This is based on surrogate markers for HSC mobilization, such as CD34(+) cells and colony-forming activity in blood. However, CD34(+) cells or colony-forming units in culture (CFU-C) are heterogeneous cell populations with hugely divergent long-term repopulation potential on transplantation. HSC behavior is influenced by the vascular bed in the vicinity of which they reside. We hypothesized that G-CSF may mobilize sequentially cells proximal and more distal to bone marrow venous sinuses where HSCs enter the blood. We addressed this question with functional serial transplantation assays using blood and bone marrow after specific time points of G-CSF treatment in mice. We found that in mice, blood collected after only 48 hours of G-CSF administration was as enriched in serially reconstituting HSCs as blood collected at 5 days of G-CSF treatment. Similarly, mobilized Lin(-)CD34(+) cells were relatively enriched in more primitive Lin(-)CD34(+)CD38(-) cells at day 2 of G-CSF treatment compared with later points in half of human donors tested (n = 6). This suggests that in both humans and mice, hematopoietic progenitor and stem cells do not mobilize uniformly according to their maturation stage, with most potent HSCs mobilizing as early as day 2 of G-CSF.
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Chow KU, Luxembourg B, Seifried E, Bonig H. Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals. Radiology 2015; 279:306-13. [PMID: 26509293 DOI: 10.1148/radiol.2015150887] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To define height- and sex-corrected normal values for spleen length and volume determined with ultrasonography (US). MATERIALS AND METHODS The authors performed a retrospective data review of stem cell donors who had provided written informed consent for stem cell donation and use of anonymized data and biologic materials for scientific and quality control purposes. Spleen length, spleen volume, and anthrophometric data were correlated in 1230 healthy volunteers to identify variables that affect spleen size. Multiple linear regression analysis was performed to weight effects of various variables on spleen size. Linear regression through the 95th percentile for men and women of different height cohorts generated the formula for the upper limit of normal for spleen length and volume. For validation, the upper limit of normal was calculated for each volunteer and compared with the observed value. Formulae to calculate the additional percentiles were similarly generated and validated. A cohort of 75 volunteers was analyzed twice to assess the stability of spleen length and volume over time. RESULTS Spleen length and volume were significantly and independently associated with sex (length: P < .001; volume: P = .012), body height (P < .001 for both), and weight (P < .001 for both), with men and taller and heavier individuals having longer and larger spleens. The spleen length of 20 of 324 women (6%) and 234 of 906 men (26%) exceeded the previously reported upper limit of normal of 12 cm. Repeat measurements indicated that spleen length (median difference, 0.10 cm; range, -1.8 to 1.7 cm) and volume (median difference, 3 cm(3); range, -106 to 142 cm(3)) were quite stable. A mobile application that performs these calculations is available for download. CONCLUSION The authors define height- and sex-corrected normal values for spleen length and volume for women with a body height of 155-179 cm and men with a body height of 165-199 cm and propose validated algorithms to gauge the percentile of an individual's spleen size.
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Affiliation(s)
- Kai Uwe Chow
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Beate Luxembourg
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Erhard Seifried
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
| | - Halvard Bonig
- From the Ambulantes Krebszentrum, Private Practice for Hematology and Oncology, Frankfurt, Germany (K.U.C.); German Red Cross Blood Service Baden-Württemberg-Hesse, Frankfurt, Germany (B.L., E.S., H.B.); Institute for Transfusion Medicine and Immunohematology, Goethe University, Sandhofstrasse 1, 60528 Frankfurt, Germany (E.S., H.B.); and Department of Medicine, Division of Hematology, University of Washington, Seattle, Wash (H.B.)
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