1
|
Thompson TZ, Krull AA, Strasburg DJ, Adamski J, Jacob EK, DiGuardo MA. Collection and processing of hematopoietic progenitor cell products at risk of presenting with cold agglutination. Cytotherapy 2023:S1465-3249(23)00065-8. [PMID: 37045729 DOI: 10.1016/j.jcyt.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AIMS Cold agglutinins are commonly identified in transfusion laboratories and are defined by their ability to agglutinate erythrocytes at 3-4°C, with most demonstrating a titer >64. Similarly, cryoglobulins can precipitate from plasma when temperatures drop below central body temperature, resulting in erythrocyte agglutination. Thankfully, disease associated from these autoantibodies is rare, but unfortunately, such temperature ranges are routinely encountered outside of the body's circulation, as in an extracorporeal circuit during hematopoietic progenitor cell (HPC) collection or human cell therapy laboratory processing. When agglutination occurs ex vivo, complications with the collection and product may be encountered, resulting in adverse events or product loss. Here, we endeavor to share our experience in preventing and responding to known cases at risk of or spontaneous HPC agglutination in our human cell therapy laboratory. CASE REPORTS Four cases of HPC products at risk for, or spontaneously, agglutinating were seen at our institution from 2018 to 2020. Planned modifications occurred, including ambient room temperature increases, tandem draw and return blood warmers, warm product transport and extended post-thaw warming occurred. In addition, unplanned modifications were undertaken, including warm HPC product processing and plasma replacement of the product when spontaneous agglutination of the product was identified. All recipients successfully engrafted after infusion. CONCLUSIONS While uncommon, cold agglutination of HPC products can disrupt standard processes of collection and processing. Protocol modifications can circumvent adverse events for the donor and minimize product loss. Such process modifications should be considered in individuals with known risks for agglutination going to HPC donation/collection.
Collapse
Affiliation(s)
- Thomas Z Thompson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Ashley A Krull
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dustin J Strasburg
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Eapen K Jacob
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Margaret A DiGuardo
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
| |
Collapse
|
2
|
Krull A, Thompson T, Strasburg D, DiGuardo M, Jacob EK. How do I warm HPC(A) products to maximize cell viability in the setting of cold agglutinin disease? Transfusion 2022; 62:1942-1947. [PMID: 35946488 DOI: 10.1111/trf.17038] [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: 04/23/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND High titers of cold agglutinins jeopardize the quality of an apheresis product meant for autologous or allogeneic transplant. Management of transplant patients with cold agglutinin disease (CAD) is often experience-based and under reported, yet decisions must be made quickly to optimize product management and patient outcomes. There remains a lack of data quantifying cell recovery and viability when using various warming methodologies. STUDY DESIGN AND METHODS To expand the published experimental data on this subject, our human cellular therapy lab compared cellular recoveries and viabilities after manipulation of cryopreserved apheresis products through various warming methodologies: (1) extended warming in a water bath, (2) warming via blood warmer and infusion pump, and (3) warming in a water bath followed by infusion pump as a control to assess potential shear stress effects. RESULTS The presented studies demonstrate that all methods of product warming produce the same rates of recovery of total and viable cells across vital cell types prior to patient administration. Statistically, use of an extended water bath protocol provided a marginal benefit in recovery of total nucleated cells, though this effect is diminished when products are held for an extended period to simulate a delay in administration. DISCUSSION These results can inform decisions to improve patient care and minimize product manipulation and loss. Centers are encouraged to use this information to guide proactive measures to establish a standard operating procedure to manage CAD cases.
Collapse
Affiliation(s)
- Ashley Krull
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Thomas Thompson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dustin Strasburg
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Margaret DiGuardo
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Eapen K Jacob
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| |
Collapse
|
3
|
Nelson R, Mathews R, Palesi C, Carter J, Szymanski J, Uehlinger J, Weinberg R, Paroder M. Mysterious clumping in a cell therapy product. Transfusion 2021; 61:2232-2233. [PMID: 34273121 DOI: 10.1111/trf.16569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Randin Nelson
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Carlo Palesi
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jamal Carter
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - James Szymanski
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joan Uehlinger
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Monika Paroder
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
4
|
Li A, Kusuma GD, Driscoll D, Smith N, Wall DM, Levine BL, James D, Lim R. Advances in automated cell washing and concentration. Cytotherapy 2021; 23:774-786. [PMID: 34052112 DOI: 10.1016/j.jcyt.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Abstract
The successful commercialization of cell therapies requires thorough planning and consideration of product quality, cost and scale of the manufacturing process. The implementation of automation can be central to a robust and reproducible manufacturing process at industrialized scales. There have been a number of wash-and-concentrate devices developed for cell manufacturing. These technologies have arisen from transfusion medicine, hematopoietic stem cell and biologics manufacturing where operating mechanisms are distinct from manual centrifugation. This review describes the historical origin and fundamental technologies underlying each currently available wash-and-concentrate device as well as their relative advantages and disadvantages in cell therapy applications. Understanding the specific attributes and limitations of these technologies is essential to optimizing cell therapy manufacturing.
Collapse
Affiliation(s)
- Anqi Li
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Gina D Kusuma
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | | | | | - Dominic M Wall
- Cell Therapies Pty Ltd, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Bruce L Levine
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
| |
Collapse
|
5
|
Morigi A, Casadei B, Argnani L, Stefoni V, Sergio E, Cavo M, Zinzani PL. Successful stem cell harvest and autologous transplantation in a patient with cold agglutinin syndrome and aggressive lymphoma. Leuk Lymphoma 2020; 62:1007-1009. [PMID: 33274685 DOI: 10.1080/10428194.2020.1855342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alice Morigi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| | - Emanuela Sergio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Istituto di Ematologia "Seràgnoli", Università degli Studi, Bologna, Italia
| |
Collapse
|
6
|
Yuan S, Zhuang L, Stinson S, Barton P, Noeller J, Garcia A, Wang S. Red cell clumping in stem cell collection bag. Transfusion 2020; 60:673-674. [PMID: 32064611 DOI: 10.1111/trf.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Lefan Zhuang
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Sherri Stinson
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Pat Barton
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Jessica Noeller
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Alexander Garcia
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Shirong Wang
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California
| |
Collapse
|
7
|
Badami KG, Smith MP, Murton D, Rodger S, Atkinson G. Autologous peripheral blood stem cell harvest and transplant in a patient with cold agglutinin disease secondary to lymphoma. Transfus Med 2017; 27:222-224. [DOI: 10.1111/tme.12393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- K. G. Badami
- New Zealand Blood Service; Christchurch New Zealand
| | - M. P. Smith
- Haematology Department; Canterbury District Health Board; Christchurch New Zealand
| | - D. Murton
- New Zealand Blood Service; Christchurch New Zealand
| | - S. Rodger
- New Zealand Blood Service; Christchurch New Zealand
| | - G. Atkinson
- New Zealand Blood Service; Christchurch New Zealand
| |
Collapse
|
8
|
Sartor MM, Garvin F, Antonenas V, Bradstock KF, Gottlieb DJ. Failure to achieve a threshold dose of CD34+CD110+ progenitor cells in the graft predicts delayed platelet engraftment after autologous stem cell transplantation. Bone Marrow Transplant 2007; 40:851-7. [PMID: 17704793 DOI: 10.1038/sj.bmt.1705818] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, we retrospectively analysed the utility of CD110 expression on CD34(+) cells as a predictor of delayed platelet transfusion independence in 39 patients who underwent autologous peripheral blood stem cell transplantation. Absolute CD34(+) cells and CD34(+) subsets expressing CD110 were enumerated using flow cytometry. Of the 39 patients, 7 required 21 days or more to achieve platelet transfusion independence. Six of the seven patients received a dose of CD34(+)CD110(+) cells below 6.0 x 10(4)/kg while 30 of 32 patients who achieved platelet transfusion independence in <21 days received a dose of CD34(+)CD110(+) cells >6.0 x 10(4)/kg (P<0.001). Patients with delayed platelet engraftment received a median dose of 5.2 x 10(4) CD34(+)CD110(+) cells/kg compared with a median dose of 16.4 x 10(4) cells/kg for those engrafting within 21 days (P=0.003). Further analysis showed that >6.0 x 10(4) CD34(+)CD110(+) cells/kg was highly sensitive (93.8%) and highly specific (85.7%) for achieving platelet transfusion independence within 21 days. Delay in platelet transfusion independence translated into an increased requirement for platelet transfusion (median 6 vs 2 transfusions, P<0.0001). The dose of CD34(+)/CD110(+) cells/kg infused at time of transplantation appears to be an important factor identifying patients at risk of delayed platelet engraftment.
Collapse
Affiliation(s)
- M M Sartor
- Flow Cytometry Unit, Haematology Department, Leukaemia Research Laboratory, Westmead Hospital, University of Sydney, Sydney, NSW, Australia.
| | | | | | | | | |
Collapse
|