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Castillo-Aleman YM, Villegas-Valverde CA, Bencomo-Hernandez AA, Ventura-Carmenate Y, Lumame S, Castelo C, Al-Saadawi NA, Abu-Haleeqa MI, El-Najjar I, Al-Kaabi FM. Cell throughput and performance ratio as quality indicators on hematopoietic stem cell apheresis: A single-center experience. Transfus Apher Sci 2024; 63:104003. [PMID: 39265224 DOI: 10.1016/j.transci.2024.104003] [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: 08/01/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Benchmarking in CD34+ cell apheresis is crucial for optimizing resources, ensuring consistent collection performance, and ultimately, decision-making algorithms to improve donor safety. Key performance indicators such as the "performance ratio" (PR) are applied routinely in some apheresis centers, whereas this report identifies the "cell throughput" (CT) as another quality indicator in apheresis. MATERIAL AND METHODS This single-center study includes retrospective data from 117 aphereses. CT and PR were calculated based on the mononuclear cell collection (MNC) or continuous mononuclear cell collection (cMNC) protocols of the Spectra Optia® apheresis system, types of venous access, transplant settings, and mobilization regimens. RESULTS CTs (× 106 CD34+ cells/min) were found to be greater in cMNC compared to MNC protocols (1.4 vs. 1.0, p = 0.0037), in allogeneic versus autologous (1.3 vs. 1.1, p = 0.0274), and in the mobilization regimen of G-CSF alone versus the G-CSF combined (1.3 vs. 1.0, p = 0.0249). In contrast, PR (%) was only statistically significant in favor of the cMNC protocol (213.0 vs. 186.8 for MNC). CONCLUSIONS CT and PR are feasible quality indicators on CD34+ cell apheresis, are easy to calculate and implement, and have clinical and administrative implications. Analyzing CT and PR may strengthen the institutional criteria for selecting cMNC or MNC protocols; they may also be used to evaluate the performance of new personnel or cell separator devices or, eventually, trigger investigations for those aphereses under-collected by specific thresholds.
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Affiliation(s)
- Yandy Marx Castillo-Aleman
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates.
| | | | | | - Yendry Ventura-Carmenate
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Shinnette Lumame
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Charisma Castelo
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Nameer Abdul Al-Saadawi
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Mohamed Ibrahim Abu-Haleeqa
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Inas El-Najjar
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - Fatema Mohammed Al-Kaabi
- Abu Dhabi Stem Cells Center (ADSCC), 25, Mahdar Qutouf St, Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
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2
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Maitta RW. Apheresis collection of mononuclear cells for chimeric-antigen receptor therapies. Eur J Haematol 2024; 112:36-40. [PMID: 37525900 DOI: 10.1111/ejh.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
Collections of lymphocytes to be genetically modified to treat hematologic malignancies have seen a dramatic increase over the last few years as commercial products have been approved. Reports of new products in development that can possibly treat solid organ malignancies represent a massive change in the field. Apheresis is at the center of the collection of cells for the manufacture of these chimeric-antigen receptor therapy products. The expansion of these collections represents one of the areas of apheresis procedures growth. This review will summarize concepts important to this type of collection and variables that need to be optimized to obtain desired cell yields while increasing patients' safety.
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Affiliation(s)
- Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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3
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Sauer S, Hieke L, Brandt J, Müller-Tidow C, Schmitt A, Kauer J, Kriegsmann K. Impact of Clinical Parameters and Induction Regimens on Peripheral Blood Stem-Cell Mobilization and Collection in Multiple Myeloma Patients. Transfus Med Hemother 2023; 50:382-395. [PMID: 37899996 PMCID: PMC10601599 DOI: 10.1159/000530056] [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: 12/30/2022] [Accepted: 03/06/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction High-dose chemotherapy (HDCT) followed by autologous blood stem-cell transplantation (ABSCT) remains the standard consolidation therapy for newly diagnosed eligible multiple myeloma (MM) patients. As a prerequisite, peripheral blood stem cells (PBSCs) must be mobilized and collected by leukapheresis (LP). Many factors can hamper PBSC mobilization/collection. Here, we provide a comprehensive multiparametric assessment of PBSC mobilization/collection outcome parameters in a large cohort. Methods In total, 790 MM patients (471 [60%] male, 319 [40%] female) who underwent PBSC mobilization/collection during first-line treatment were included. Evaluated PBSC mobilization/collection outcome parameters included the prolongation of PBSC mobilization, plerixafor administration, number of LP sessions, and overall PBSC collection goal/result. Results 741 (94%) patients received cyclophosphamide/adriamycin/dexamethasone (CAD) and granulocyte-colony-stimulating factor (G-CSF) mobilization. Plerixafor was administered in 80 (10%) patients. 489 (62%) patients started LP without delay. 530 (67%) patients reached the PBSC collection goal at the first LP session. The mean overall PBSC collection result was 10.3 (standard deviation [SD] 4.4) × 106 CD34+ cells/kg. In a multiparametric analysis, variables negatively associated with PBSC mobilization/collection outcomes were female gender, age >60 years, an advanced ISS stage, and local radiation pre-/during induction, but not remission status postinduction. Notably, the identified risk factors contributed differently to each PBSC mobilization/collection outcome parameter. In this context, compared to all other induction regimens, lenalidomide-based induction with/without antibodies negatively affected only the number of LP sessions required to reach the collection goal, but no other PBSC mobilization/collection outcome parameters. In contrast, the probability of reaching a high collection goal of ≥6 × 106 CD34+ cells/kg body weight was higher after lenalidomide-based induction compared to VCD/PAD or VAD - taking into account - that a higher G-SCF dosage was given in approximately one-third of patients receiving lenalidomide-based induction with/without antibodies. Conclusion Considering the identified risk factors in the clinical setting can contribute to optimized PBSC mobilization/collection. Moreover, our study demonstrates the necessity for a differentiated evaluation of PBSC mobilization/collection outcome parameters.
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Affiliation(s)
- Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lennart Hieke
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Juliane Brandt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anita Schmitt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Joseph Kauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kriegsmann
- Laborarztpraxis Rhein-Main MVZ GbR, Limbach Gruppe SE, Frankfurt am Main, Germany
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Kayser S, Schlenk RF, Steiner M, Klüter H, Wuchter P. Predicting Successful Hematopoietic Stem Cell Collection in Healthy Allogeneic Donors. Transfus Med Hemother 2023; 50:396-402. [PMID: 37899994 PMCID: PMC10601602 DOI: 10.1159/000531236] [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: 02/24/2023] [Accepted: 05/18/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Collection of peripheral blood stem cells (PBSCs) from healthy donors is a well-established process. We aimed to identify factors predictive of successful CD34+ PBSC collection and established a formula capable of predicting CD34+ cell yield. Methods We retrospectively evaluated 588 healthy adult donors (median age 29 years, range 18-69 years) at our institution from 2017 to 2022. The predicted minimal number of CD34+ cells was calculated as follows: (peripheral CD34+ cells/µL × adjusted collection efficiency of 30%) × total liters processed. This formula was further modified according to donor and recipient body weight (BW). Results Median total collection was 8.0 × 106 CD34+ cells/kg BW (range 1.0-47.1 × 106 cells/kg BW) with 522 donors (89%) collecting ≥5.0 × 106 cells/kg of recipient BW. A second leukapheresis (LP) was performed in 49 donors. Need for two LPs was more common in female donors (OR 6.68, 95% CI, 2.62-17.05; p < 0.001), donors with higher age (OR for 10 years difference 1.53, 95% CI, 1.15-2.03, p = 0.003), donors with WBC count <30 × 109/L after 5 days of granulocyte-colony stimulating factor (G-CSF) stimulation (OR, 4.33; 95% CI, 1.59-11.83; p = 0.004), and a donor/recipient weight ratio <1 (OR 6.21, 95% CI, 2.69-14.34; p < 0.001). Predictive factors for optimal LP (i.e., ≥5.0 × 106 CD34+ cells/kg of recipient BW) were peripheral blood (PB) CD34+ cell count >50/µL (OR 12.82, range 6.34-25.92, p < 0.001), male donor (OR 2.77, range 1.06-7.23, p = 0.04), and a donor/recipient weight ratio >1 (OR 3.12, range 1.57-6.24, p = 0.001). WBC, platelets, hemoglobin, and age had no significant predictive value. Predicted versus observed number of CD34+ cells/kg BW collected demonstrated a very strong linear correlation (r = 0.925, 95% CI, 0.912-0.936, p < 0.0001). Conclusions Of the routinely monitored indicators in PBSC donors, CD34+ cell count in PB is the most important factor in predicting G-CSF-induced PBSC yields. Higher age, female sex, WBC <30 × 109/L, and a donor/recipient weight ratio <1 are useful indicators for identifying suboptimal mobilizers. The modified formula has shown successful and consistent performance in the prediction of key outcome measures including the minimum CD34+ cell collection, determination of the required length of apheresis, and whether a second day of PBSC collection was necessary to achieve the respective collection goal.
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Affiliation(s)
- Sabine Kayser
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University; German Red Cross Blood Service Baden-Württemberg – Hessen, Mannheim, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Richard F. Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcus Steiner
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University; German Red Cross Blood Service Baden-Württemberg – Hessen, Mannheim, Germany
| | - Harald Klüter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University; German Red Cross Blood Service Baden-Württemberg – Hessen, Mannheim, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University; German Red Cross Blood Service Baden-Württemberg – Hessen, Mannheim, Germany
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Castillo-Aleman YM, Ventura-Carmenate Y, Ann-Martinez M. Collection efficiency in apheresis. Transfus Apher Sci 2023; 62:103758. [PMID: 37438245 DOI: 10.1016/j.transci.2023.103758] [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: 05/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
Significant advances in procedural information displayed by current apheresis machines have been made, but analyses of cell collection efficiency (CE) still rely on calculations done by apheresis professionals. Accordingly, understanding CE equations can support the optimization of apheresis techniques and identification of incidents that could impact the procedure's effectiveness. This report summarizes classical and novel CE analyses applied to apheresis exemplified by an actual case of hematopoietic progenitor cell collection. In addition to the apheresis yield and most common CE1 and CE2 formulas, we present the instantaneous and corrected CE, fold enrichment, collection throughput, collection rate and its variants, average inlet rate, classical and adjusted captured cells, recruitment pool, recruitment factor, recruitment coefficient, blood component loss, predictive apheresis yield, and performance ratio calculations. Moreover, the mathematical relationship between these CE equations is also shown, which can be helpful in many apheresis procedures.
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Affiliation(s)
- Yandy Marx Castillo-Aleman
- Abu Dhabi Stem Cells Center (ADSCC), Villa 25, Al Misahah St., Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates.
| | - Yendry Ventura-Carmenate
- Abu Dhabi Stem Cells Center (ADSCC), Villa 25, Al Misahah St., Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
| | - May Ann-Martinez
- Abu Dhabi Stem Cells Center (ADSCC), Villa 25, Al Misahah St., Rowdhat, PO Box 4600, Abu Dhabi, United Arab Emirates
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Impact of Mobilization Strategies on Peripheral Blood Stem Cell Collection Efficiency and Product Quality: A Retrospective Single-Center Study. Cancers (Basel) 2022; 14:cancers14246259. [PMID: 36551743 PMCID: PMC9777066 DOI: 10.3390/cancers14246259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Autologous stem cell transplantation is routinely used in the management of several hematological diseases, solid tumors, and immune disorders. Peripheral blood stem cell (PBSC) collection performed by apheresis is the preferred source of stem cells. In this study, the potential impact of mobilization regimens on the performance of the Spectra Optia® continuous mononuclear cell collection system was evaluated. We performed a retrospective data analysis for patients undergoing autologous PBSC collection at the Medical University Vienna, Vienna General Hospital between September 2016 and June 2018. Collections were divided into two main groups according to the mobilization regimen received: without (210 collections) or with (99 collections) plerixafor. Assessed variables included product characteristics and collection efficiency (CE). Overall, product characteristics were similar between the groups. Median CD34+ CE2 was 50.1% versus 53.0%, and CE1 was 66.9% versus 69.9% following mobilization without and with plerixafor, respectively; the difference was not statistically significant. Simple linear regression showed a very weak positive correlation between the mobilization method and CE1 or CE2 (mobilization with plerixafor increased CE2 by 4.106%). In conclusion, the Spectra Optia® apheresis system led to high CE and a good quality of PBSC products when mobilization regimens with or without plerixafor were used.
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7
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Sauer S, Erdmann K, Jensen AD, Wennmann M, Pavel P, Jordan K, Schmitt A, Kriegsmann M, Wuchter P, Goldschmidt H, Müller-Tidow C, Kriegsmann K. Local Radiation Therapy Before and During Induction Delays Stem Cell Mobilization and Collection in Multiple Myeloma Patients. Transplant Cell Ther 2021; 27:876.e1-876.e11. [PMID: 34214737 DOI: 10.1016/j.jtct.2021.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
In multiple myeloma, local radiation therapy (RT) of osseous lesions before peripheral blood stem cell (PBSC) mobilization is assumed to impair the PBSC mobilization and collection. However, the results of previously published studies are inconsistent and do not evaluate detailed metrics of RT and PBSC outcome parameters. In total, 352 patients undergoing PBSC mobilizations and RT in first-line treatment were evaluated. Patients were grouped into RT (n = 283) and no RT (n = 69) before PBSC mobilization. Except for the International Staging System score, both groups were homogeneous regarding the first diagnosis characteristics, first-line treatments, and response parameters. RT metrics (RT yes versus no, volume of irradiated hematopoietic bone marrow [BM], biologically equivalent doses in 2 Gy fractions [EQD2]) were analyzed for the following PBSC outcome parameters: achievement of the PBSC collection goal, CD34+ cell collection yield, duration of the mobilization phase, and number of leukapheresis (LP) sessions to reach the collection goal. No statistically significant differences in the percentage of collection failures to reach at least 3 sufficient PBSC transplants were identified comparing patients with (n = 32 [11%]) and without RT (n = 4 [6%]) before PBSC mobilization (P = .265). However, patients with RT before PBSC mobilization showed a significant prolongation of the PBSC mobilization (median 1 day, P =.026) and required a higher number of LP sessions to reach the collection goal (median 1 LP, P < .001) compared with patients who received RT after PBSC mobilization. Moreover, patients with RT before PBSC mobilization reached a significantly lower CD34+ cell collection result (mean 8.94 versus 9.81 × 106/kg body weight [bw], P = .002). No correlation was identified between the overall CD34+ cell yield and the volume of irradiated hematopoietic BM or EQD2, respectively. In the RT before PBSC mobilization group, patients who required more than 1 LP session to reach the PBSC collection goal after RT had a significantly higher percentage of radiated hematopoietic BM compared to those who required only 1 LP session (mean 9.7% versus 7.2%, P = .002). Overall, our study indicates a negative impact of RT on PBSC mobilization and collection. Apart from emergency settings, it might be beneficial to postpone RT to a post-PBSC collection time point. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- Sandra Sauer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Erdmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospitals Gießen and Marburg (UKGM), Gießen, Germany; FB20 Medicine, Philipps-University Marburg, Marburg, Germany
| | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Petra Pavel
- Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany
| | - Karin Jordan
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anita Schmitt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
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Kriegsmann K, Wack M, Pavel P, Schmitt A, Kriegsmann M, Bruckner T, Müller-Tidow C, Wuchter P. Collection, Cryostorage, Transplantation, and Disposal of Hematopoietic Stem Cell Products. Biol Blood Marrow Transplant 2019; 25:382-390. [DOI: 10.1016/j.bbmt.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022]
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9
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Kriegsmann K, Wuchter P. Mobilization and Collection of Peripheral Blood Stem Cells in Adults: Focus on Timing and Benchmarking. Methods Mol Biol 2019; 2017:41-58. [PMID: 31197767 DOI: 10.1007/978-1-4939-9574-5_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral blood stem cells (PBSCs) are preferentially used as a hematopoietic stem cell source for autologous blood stem cell transplantation (ABSCT) upon high-dose chemotherapy (HDT) in a variety of hemato-oncologic diseases. As a prerequisite, hematopoietic stem cells have to be mobilized into the peripheral blood (PB) and collected by leukapheresis (LP). Despite continuous improvements, e.g., the introduction of plerixafor, current challenges are the further optimization regarding the leukapheresis procedure, preventing collection failures, as well as benchmarking and harmonization of mobilization approaches between institutions.This chapter summarizes the current PBSC mobilization and collection approaches and is focusing on timely orchestration of mobilization therapy, granulocyte colony-stimulating factor (G-CSF) application, and peripheral blood (PB) CD34+ cell assessment. Moreover, strategies for prediction and performance assessment of the PBSC collection yield are discussed.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Medicine V (Hematology, Oncology, Rheumatology), Heidelberg University, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany.
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11
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Anyanwu A, Sitzmann N, Hetjens S, Klüter H, Wuchter P. Low-Volume Leukapheresis in Non-Cytokine-Stimulated Donors for the Collection of Mononuclear Cells. Transfus Med Hemother 2018; 45:323-330. [PMID: 30498410 DOI: 10.1159/000490859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background There is an increasing demand for products containing mononuclear cells (MNCs) for cellular immune therapy. Hence, leukapheresis is increasingly performed in healthy volunteer donors. Methods We evaluated 147 low-volume leukapheresis procedures from 77 healthy non-cytokine-stimulated donors. Complete blood counts (CBCs) of the donors were measured before and directly after the procedures as well as from the MNC products. Follow-up CBCs were collected from donors within 21 days. Results The product hematocrit within a range from 1.2 to 6.0% did not correlate with the collection efficiency of any cell population or the granulocyte and platelet yield. There was a strong correlation between the CBC values before leukapheresis and the cell yield of lymphocytes and monocytes as well as a perfect negative correlation between cell recruitment and cell loss in all cell populations. Furthermore, we observed a significant decrease in the CBC values in all cell populations directly after leukapheresis, which recovered within a mean of 16.1 days (SD ± 2.1 days) and even showed a significant increase in granulocytes and platelets. Conclusion Low-volume leukapheresis is feasible for the collection of MNCs in which the product hematocrit is negligible for the collection efficiency, cell yield, or contamination of residual cells under operational settings recommended by the manufacturer. Our data suggests that cell recruitment is regulated by the number of cells removed, which may also be the stimulus to induce granulo- and thrombopoiesis within the first days after leukapheresis.
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Affiliation(s)
- Adamma Anyanwu
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | - Nicole Sitzmann
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of Medical Statistics, Biomathematics and Informatics, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Harald Klüter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen, Mannheim, Germany
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12
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Pandey S, Cottler-Fox M. Optia® continuous mononuclear collection (CMNC) system is a safe and efficient system for hematopoietic progenitor cells-apheresis (HPC-a) collection and yields a lower product hematocrit (HCT%) than the COBE® spectra system: A retrospective study. J Clin Apher 2018; 33:505-513. [DOI: 10.1002/jca.21629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Soumya Pandey
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock Arkansas 72205
| | - Michele Cottler-Fox
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock Arkansas 72205
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13
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Kriegsmann K, Schmitt A, Kriegsmann M, Bruckner T, Anyanwu A, Witzens-Harig M, Müller-Tidow C, Klein S, Wuchter P. Orchestration of Chemomobilization and G-CSF Administration for Successful Hematopoietic Stem Cell Collection. Biol Blood Marrow Transplant 2018; 24:1281-1288. [PMID: 29353110 DOI: 10.1016/j.bbmt.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
Successful collection of peripheral blood stem cells (PBSCs) depends on the optimal orchestration of mobilization chemotherapy, granulocyte colony stimulating factor (G-CSF) application, and CD34+ cell number assessment in the peripheral blood (PB). However, determining the optimal timing in accordance to the applied chemomobilization regimen can be challenging. Although most centers apply their own local timing schedules, a reliable timetable including the currently most often used mobilization regimens is lacking. We present a comprehensive analysis of the timing modalities for 11 of the most commonly used chemomobilization regimens. A retrospective analysis was performed on the clinical and PBSC collection parameters (including duration of G-CSF application, time point of CD34+ assessment, PB CD34+ cell count, number of leukapheresis [LP] sessions, processed blood volume, and CD34+ collection results) of 91 representatively selected patients who had undergone stem cell mobilization at 2 collection centers. Six to 10 patients were analyzed per regimen with a variety of diagnoses, including multiple myeloma, malignant lymphoma, and sarcoma. No collection failures (<2 × 106 CD34+ cells/kg body weight) were observed. All analyzed patients successfully reached their individual collection goal in adherence to the given schedule of chemotherapy, application of G-CSF, measurement of CD34+ cells, and subsequent LP. The presented data on the timing of chemomobilization, G-CSF application, and stem cell collection may be helpful in clinical decision making and contribute to a more transparent and predictable treatment process.
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Affiliation(s)
| | - Anita Schmitt
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics, Heidelberg University, Heidelberg, Germany
| | - Adamma Anyanwu
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | | | | | - Stefan Klein
- Department of Medicine III, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.
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14
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Baertsch MA, Kriegsmann K, Pavel P, Bruckner T, Hundemer M, Kriegsmann M, Ho AD, Goldschmidt H, Wuchter P. Platelet Count before Peripheral Blood Stem Cell Mobilization Is Associated with the Need for Plerixafor But Not with the Collection Result. Transfus Med Hemother 2018; 45:24-31. [PMID: 29593457 PMCID: PMC5836245 DOI: 10.1159/000478911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A low platelet count before mobilization has recurrently been identified as risk factor for poor mobilization. METHODS To determine the relevance of this finding for peripheral blood stem cell (PBSC) mobilization, including pre-emptive or rescue plerixafor in the case of poor mobilization, we retrospectively analyzed all patients undergoing PBSC collection at our institution between January 2014 and December 2015 (n = 380). RESULTS In total, 99% of the patients (377/380) successfully collected a minimum of 2 × 106 CD34+ cells/kg body weight sufficient for a single transplant. Rescue or pre-emptive plerixafor was administered to 11% of the patients (42/380). No correlations between the platelet count before mobilization and the number of peripheral blood CD34+ cells or the CD34+ cell collection result were detected in the entire population or the subgroups according to diagnosis (newly diagnosed multiple myeloma, relapsed multiple myeloma, lymphoma, amyloid light-chain amyloidosis, sarcoma, or germ cell tumor). However, patients requiring pre-emptive or rescue plerixafor had a significantly lower platelet count before mobilization (217/nl vs. 245/nl; p = 0.004). CONCLUSION With the current state of the art PBSC mobilization strategies, the platelet count before mobilization was not associated with the CD34+ cell collection result but was associated with the need for pre-emptive or rescue application of plerixafor.
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Affiliation(s)
- Marc-Andrea Baertsch
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Petra Pavel
- Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics, Heidelberg University, Heidelberg, Germany
| | - Michael Hundemer
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Anthony D. Ho
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V (Hematology, Oncology and Rheumatology), University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg – Hesse, Mannheim, Germany
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15
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Kriegsmann K, Heilig C, Cremer M, Novotny P, Kriegsmann M, Bruckner T, Müller-Tidow C, Egerer G, Wuchter P. Successful collection of peripheral blood stem cells upon VIDE chemomobilization in sarcoma patients. Eur J Haematol 2017; 99:459-464. [DOI: 10.1111/ejh.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 02/05/2023]
Affiliation(s)
| | - Christoph Heilig
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Martin Cremer
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Philipp Novotny
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Mark Kriegsmann
- Institute of Pathology; Heidelberg University; Heidelberg Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics; Heidelberg University; Heidelberg Germany
| | | | - Gerlinde Egerer
- Department of Medicine V; Heidelberg University; Heidelberg Germany
| | - Patrick Wuchter
- Department of Medicine V; Heidelberg University; Heidelberg Germany
- Institute of Transfusion Medicine and Immunology; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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16
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Lisenko K, Pavel P, Kriegsmann M, Bruckner T, Hillengass J, Goldschmidt H, Witzens-Harig M, Ho AD, Wuchter P. Storage Duration of Autologous Stem Cell Preparations Has No Impact on Hematopoietic Recovery after Transplantation. Biol Blood Marrow Transplant 2016; 23:684-690. [PMID: 28013016 DOI: 10.1016/j.bbmt.2016.12.631] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/19/2016] [Indexed: 12/16/2022]
Abstract
Peripheral blood stem cells (PBSCs) are widely used for autologous blood stem cell transplantation (ABSCT). These cells must be stored for months or even years, usually at temperatures ≤-140°C, until their use. Although several in vitro studies on CD34+ viability and clonogenic assays of PBSCs after long-term storage have been reported, only a few publications have investigated the influence of long-term storage on in vivo hematopoietic reconstitution. In this study, we retrospectively analyzed hematopoietic recovery after storage of PBSCs via controlled-rate freezing (CRF) and cryostorage in 10% DMSO at ≤-140°C in 105 patients with multiple myeloma who received high-dose melphalan before ABSCT. Three groups of PBSC transplantation (n = 247) were delineated based on the storage period: short-term (≤12 months, n = 143), medium-term (>12 and ≤60 months, n = 75), and long-term storage (>60 months, n = 29). A neutrophil increase of ≥.5 × 109/L in medium-term or long-term PBSC cryopreservation groups was observed at day 14 after ABSCT; this increase was comparable to patients who received briefly stored PBSCs (day 15). No negative effect of PBSC storage duration was observed on leucocyte or neutrophil reconstitution. Platelet reconstitutions of ≥20 × 109/L and 50 × 109/L were observed after median times of 10 to 11 and 13 to 14 days after ABSCT, respectively. No influence of PBSC storage duration on platelet recovery of ≥20 × 109/L and ≥50 × 109/L was observed in the 3 storage groups (P = .07, P = .32). The number of previous ABSCTs also had no significant impact upon hematopoietic reconstitution. In conclusion, these results indicate that long-term cryopreservation of PBSC products at vapor nitrogen temperature after CRF does not have a negative effect on hematopoietic recovery even after prolonged storage.
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Affiliation(s)
- Katharina Lisenko
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - Petra Pavel
- Stem Cell Laboratory, IKTZ Heidelberg GmbH, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry und Informatics, Heidelberg University, Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | | | | | - Anthony D Ho
- Department of Medicine V, Heidelberg University, Heidelberg, Germany
| | - Patrick Wuchter
- Department of Medicine V, Heidelberg University, Heidelberg, Germany; Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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