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Lehmann M, Bonig H. Predicting chimeric antigen receptor apheresis process volume. Cytotherapy 2023; 25:900-901. [PMID: 37149798 DOI: 10.1016/j.jcyt.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Maximilian Lehmann
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt am Main, Germany; German Red Cross Blood Service, Baden-Württemberg-Hesse, Frankfurt am Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt am Main, Germany; German Red Cross Blood Service, Baden-Württemberg-Hesse, Frankfurt am Main, Germany.
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2
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Worel N, Holbro A, Vrielink H, Ootjers C, Le Poole K, Beer-Wekking I, Rintala T, Lozano M, Bonig H. A guide to the collection of T-cells by apheresis for ATMP manufacturing-recommendations of the GoCART coalition apheresis working group. Bone Marrow Transplant 2023; 58:742-748. [PMID: 37024570 DOI: 10.1038/s41409-023-01957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
Autologous chimeric antigen receptor-modified T-cells (CAR-T) provide meaningful benefit for otherwise refractory malignancies. As clinical indications for CAR-T cells are expanding, hospitals hitherto not active in the field of immune effector cell therapy will need to build capacity and expertise. The GoCART Coalition seeks to disseminate knowledge and skills to facilitate the introduction of CAR-T cells and to standardize management and documentation of CAR-T cell recipients, in order to optimize outcomes and to be able to benchmark clinical results against other centers. Apheresis generates the starting material for CAR-T cell manufacturing. This guide provides some initial suggestions for patient's apheresis readiness and performance to collect starting material and should thus facilitate the implementation of a CAR-T-starting material apheresis facility. It cannot replace, of course, the extensive training needed to perform qualitative apheresis collections in compliance with national and international regulations and assess their cellular composition and biological safety.
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Affiliation(s)
- Nina Worel
- Department for Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria.
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
- Division of Hematology, University Hospital Basel and University Basel, Basel, Switzerland
- Innovation Focus Cell Therapies, University Hospital Basel, Basel, Switzerland
| | - Hans Vrielink
- Department for Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Claudia Ootjers
- Department of Hematology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kaatje Le Poole
- Department for Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Ingrid Beer-Wekking
- Department of Hematology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Miquel Lozano
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, University Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt a.M., Germany
- Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
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3
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Zhang D, Zhu Y, Jin Y, Kaweme NM, Dong Y. Leukapheresis and Hyperleukocytosis, Past and Future. Int J Gen Med 2021; 14:3457-3467. [PMID: 34285568 PMCID: PMC8286901 DOI: 10.2147/ijgm.s321787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023] Open
Abstract
Hyperleukocytosis is a hematologic crisis caused by excessive proliferation of leukemic cells and has a relatively high early mortality due to a series of severe complications. Therefore, prompt and effective intervention is required. Leukapheresis performed using apheresis equipment to separate leukocytes from peripheral blood, at the same time returns autologous plasma, platelets and erythrocytes to the patient, is applied clinically for the treatment of hyperleukocytosis. Leukapheresis not only removes excessive leukocytes rapidly and corrects metabolic abnormalities but also alleviates the symptoms of leukostasis. In addition, the procedure of leukapheresis is generally well tolerated. Leukapheresis has become one of the most imperative adjuvant therapies to treat hyperleukocytosis, especially in the patient who was not inappropriate to cytoreduce with Ara-C or hydroxyurea. In this review, we present the background of leukapheresis development and highlight its clinical application in hyperleukocytic leukemia patients.
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Affiliation(s)
- Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
| | - Yufan Zhu
- Orthopedics department, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Yanxia Jin
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Natasha Mupeta Kaweme
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Youhong Dong
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People's Republic of China
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4
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Jarisch A, Rettinger E, Sörensen J, Klingebiel T, Schäfer R, Seifried E, Bader P, Bonig H. Unstimulated apheresis for chimeric antigen receptor manufacturing in pediatric/adolescent acute lymphoblastic leukemia patients. J Clin Apher 2020; 35:398-405. [PMID: 32750197 DOI: 10.1002/jca.21812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Autologous unstimulated leukapheresis product serves as starting material for a variety of innovative cell therapy products, including chimeric antigen receptor (CAR)-modified T-cells. Although it may be reasonable to assume feasibility and efficiency of apheresis for CAR-T cell manufacture, several idiosyncrasies of these patients warrant their separate analysis: target cells (mononuclear cells [MNC] and T-cells) are relatively few which may instruct the selection of apheresis technology, low body weight, and, hence, low total blood volume (TBV) can restrict process and product volume, and patients may be in compromised health. We here report outcome data from 46 consecutive leukaphereses in 33 unique pediatric patients performed for the purpose of CD19-CAR-T-cell manufacturing. Apheresis targets of 2×109 MNC/1×109 T-cells were defined by marketing authorization holder specification. Patient weight was 8 to 84 kg; TBV was 0.6 to 5.1 L. Spectra Optia apheresis technology was used. For 23 patients, a single apheresis sufficed to generate enough cells and manufacture CAR-T-cells, the remainder required two aphereses to meet target dose and/or two apheresis series because of production failure. Aphereses were technically feasible and clinically tolerable without serious adverse effects. The median collection efficiencies for MNC and T-cells were 53% and 56%, respectively. In summary, CAR apheresis in pediatric patients, including the very young, is feasible, safe and efficient, but the specified cell dose targets can be challenging in smaller children. Continuous monitoring of apheresis outcomes is advocated in order to maintain quality.
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Affiliation(s)
- Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Eva Rettinger
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Jan Sörensen
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Richard Schäfer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Department for Children and Adolescents, Goethe University, Frankfurt/Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt/Main, Frankfurt/Main, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt/Main, Germany.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
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5
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Current Challenges in Providing Good Leukapheresis Products for Manufacturing of CAR-T Cells for Patients with Relapsed/Refractory NHL or ALL. Cells 2020; 9:cells9051225. [PMID: 32429189 PMCID: PMC7290830 DOI: 10.3390/cells9051225] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background: T lymphocyte collection through leukapheresis is an essential step for chimeric antigen receptor T (CAR-T) cell therapy. Timing of apheresis is challenging in heavily pretreated patients who suffer from rapid progressive disease and receive T cell impairing medication. Methods: A total of 75 unstimulated leukaphereses were analyzed including 45 aphereses in patients and 30 in healthy donors. Thereof, 41 adult patients with Non-Hodgkin’s lymphoma (85%) or acute lymphoblastic leukemia (15%) underwent leukapheresis for CAR-T cell production. Results: Sufficient lymphocytes were harvested from all patients even from those with low peripheral lymphocyte counts of 0.18/nL. Only four patients required a second leukapheresis session. Leukapheresis products contained a median of 98 × 108 (9 - 341 × 108) total nucleated cells (TNC) with 38 × 108 (4 - 232 × 108) CD3+ T cells. Leukapheresis products from healthy donors as well as from patients in complete remission were characterized by high TNC and CD3+ T lymphocyte counts. CAR-T cell products could be manufactured for all but one patient. Conclusions: Sufficient yield of lymphocytes for CAR-T cell production is feasible also for patients with low peripheral blood counts. Up to 12–15 L blood volume should be processed in patients with absolute lymphocyte counts ≤ 1.0/nL.
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6
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Steinhardt MJ, Wiercinska E, Pham M, Grigoleit GU, Mazzoni A, Da-Via M, Zhou X, Meckel K, Nickel K, Duell J, Krummenast FC, Kraus S, Hopkinson C, Weissbrich B, Müllges W, Stoll G, Kortüm KM, Einsele H, Bonig H, Rasche L. Progressive multifocal leukoencephalopathy in a patient post allo-HCT successfully treated with JC virus specific donor lymphocytes. J Transl Med 2020; 18:177. [PMID: 32316991 PMCID: PMC7175555 DOI: 10.1186/s12967-020-02337-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy is a demyelinating CNS disorder. Reactivation of John Cunningham virus leads to oligodendrocyte infection with lysis and consequent axonal loss due to demyelination. Patients usually present with confusion and seizures. Late diagnosis and lack of adequate therapy options persistently result in permanent impairment of brain functions. Due to profound T cell depletion, impairment of T-cell function and potent immunosuppressive factors, allogeneic hematopoietic cell transplantation recipients are at high risk for JCV reactivation. To date, PML is almost universally fatal when occurring after allo-HCT. METHODS To optimize therapy specificity, we enriched JCV specific T-cells out of the donor T-cell repertoire from the HLA-identical, anti-JCV-antibody positive family stem cell donor by unstimulated peripheral apheresis [1]. For this, we selected T cells responsive to five JCV peptide libraries via the Cytokine Capture System technology. It enables the enrichment of JCV specific T cells via identification of stimulus-induced interferon gamma secretion. RESULTS Despite low frequencies of responsive T cells, we succeeded in generating a product containing 20 000 JCV reactive T cells ready for patient infusion. The adoptive cell transfer was performed without complication. Consequently, the clinical course stabilized and the patient slowly went into remission of PML with JCV negative CSF and containment of PML lesion expansion. CONCLUSION We report for the first time feasibility of generating T cells with possible anti-JCV activity from a seropositive family donor, a variation of virus specific T-cell therapies suitable for the post allo transplant setting. We also present the unusual case for successful treatment of PML after allo-HCT via virus specific T-cell therapy.
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Affiliation(s)
- M J Steinhardt
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - E Wiercinska
- Department of Cellular Therapeutics (GMP), German Red Cross Blood Service BaWüHe, Institute Frankfurt, Frankfurt, Germany
| | - M Pham
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
| | - G U Grigoleit
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - A Mazzoni
- Immunohematology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - M Da-Via
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - X Zhou
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - K Meckel
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - K Nickel
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - J Duell
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - F C Krummenast
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - S Kraus
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - C Hopkinson
- Northeastern Oklahoma Community Health Center, Afton, OK, USA
| | - B Weissbrich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - W Müllges
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - G Stoll
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - K M Kortüm
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - H Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany
| | - H Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - L Rasche
- Department of Internal Medicine II, University Hospital Würzburg, Oberdürrbacher Street 6, 97080, Würzburg, Germany. .,Mildred Scheel Early Career Center, University Hospital of Würzburg, Würzburg, Germany.
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7
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Nguyen TH, Bach KQ, Vu HQ, Nguyen NQ, Duong TD, De Reys S, Wheeler J. Pre‐chemotherapy white blood cell depletion by therapeutic leukocytapheresis in leukemia patients: A single‐institution experience. J Clin Apher 2019; 35:117-124. [DOI: 10.1002/jca.21766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/03/2019] [Accepted: 11/20/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Thanh H. Nguyen
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Khanh Q. Bach
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Hung Q. Vu
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Nhat Q. Nguyen
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
| | - Thien D. Duong
- National Institute of Hematology and Blood Transfusion Hanoi Vietnam
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8
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Paroder M, Le N, Pham HP, Thibodeaux SR. Important aspects of T‐cell collection by apheresis for manufacturing chimeric antigen receptor T cells. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/acg2.75] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Monika Paroder
- Department of Pathology Montefiore Medical Center of the Albert Einstein College of Medicine Bronx NY USA
| | - Nguyet Le
- Department of Pathology Indiana University School of Medicine Indianapolis IN USA
| | - Huy P. Pham
- Department of Pathology Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Suzanne R. Thibodeaux
- Department of Pathology and Immunology Washington University in St. Louis School of Medicine St. Louis MO USA
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9
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Del Fante C, Scudeller L, Mortellaro C, Viarengo G, Martinasso A, Perotti C. Automated mononuclear cell collection: a feasibility study employing a new software for extracorporeal photopheresis. Vox Sang 2019; 114:884-889. [PMID: 31463961 DOI: 10.1111/vox.12841] [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] [Received: 04/18/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Very recently, Fresenius Kabi, improved the software (autoMNC lymphocytes, SW 04.03.08) for mononuclear cells (MNCs) collection with the aim to ameliorate the quality of harvest, employing the automated autoMNC lymphocytes software SW 04.03.09. Herein, we report the results of an observational study evaluating the feasibility of MNCs collection in patients undergoing extracorporeal photopheresis (ECP) at our centre, using the new COM.TEC software 04.03.08c for MNC collection, afterwards integrated in the software 04.03.09, available on the market since November 2018. MATERIALS AND METHODS Thirty adult patients (21 males and 9 females) with GvHD, Chronic Lung Allograft Dysfunction or renal rejection, were consecutively enrolled to undergo 1 ECP procedure by the offline technique, according to our internal protocol, processing 1·5 blood volumes. Feasibility of collection was defined as: Hct in collection bag ≤5%, MNCs purity (percentage of MNCs/bag) ≥80%, MNCs collection efficiency (CE2) ≥60%, patient's platelet depletion ≤50%. RESULTS Thirty ECP procedures were evaluated. Feasibility (defined by the four parameters previously described) of MNCs collection was observed in 1 out of the 30 harvests analysed. Median Hct in the product was 3·45% (IQR: 2·6-5·0), and median MNCs purity was 97·2% (IQR 89·1-98·6). Median CE2 for MNCs was 21·4% (IQR: 11·9-41·2), and median patient's platelet depletion was 36·2% (IQR 21·9-51·4). CONCLUSION The autoMNC lymphocytes software SW 04.03.08c for MNCs collection in ECP setting demonstrated to collect a good quality product in terms of purity and RBC contamination even if the collection efficiency and platelet contamination must be improved.
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Affiliation(s)
- Claudia Del Fante
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigia Scudeller
- Scientific Direction, Clinical Epidemiology and Biostatistics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Mortellaro
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianluca Viarengo
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alberto Martinasso
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Perotti
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Tuazon SA, Li A, Gooley T, Eunson TW, Maloney DG, Turtle CJ, Linenberger ML, Connelly-Smith LS. Factors affecting lymphocyte collection efficiency for the manufacture of chimeric antigen receptor T cells in adults with B-cell malignancies. Transfusion 2019; 59:1773-1780. [PMID: 30729531 DOI: 10.1111/trf.15178] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical and procedural parameters that affect the optimal collection of lymphocytes for the production of chimeric antigen receptor (CAR) T cells remain undefined but are increasingly important, as commercial products are now available. We evaluated determinants of low lymphocyte collection efficiency (CE) and the rate of successful CAR T-cell manufacture in middle-aged and older adults with advanced B-cell malignancies. STUDY DESIGNS AND METHODS Mononuclear cell collections using two apheresis platforms (COBE Spectra and Spectra Optia, Terumo BCT) from patients participating in a CD19-directed CAR T-cell therapy trial were reviewed. Patient- and disease-specific factors, peripheral blood counts, apheresis parameters, and product cell counts were analyzed to determine effects on lymphocyte CE. RESULTS Ninety-two apheresis events from patients with acute lymphocytic leukemia (ALL) (n = 28), chronic lymphocytic leukemia (n = 18), and non-Hodgkin lymphoma (n = 46) were available for analysis. Forty-one collections (45%) had a lymphocyte CE of <40%. On multivariable analysis, age (every 10-year increase, odds ratio [OR] = 1.51; p = 0.034), disease type (chronic lymphocytic leukemia vs. ALL, OR = 0.24; p = 0.052; non-Hodgkin lymphoma vs. ALL, OR = 0.20; p = 0.009) and precollection platelets (every 10 × 103 /μL increase, OR = 1.07; p = 0.005) were appreciably associated with a lymphocyte CE of <40%. No major apheresis complications occurred. CONCLUSIONS Lymphocyte collection at our center was well tolerated and 100% successful in manufacturing CD19-directed CAR T cells from adult patients with B-cell malignancies despite low CE in some patients. A diagnosis of ALL, advancing age, and higher preapheresis platelet counts were observed to be associated with low CE.
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Affiliation(s)
- Sherilyn A Tuazon
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Ang Li
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
| | - Theodore Gooley
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Thomas W Eunson
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - David G Maloney
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Cameron J Turtle
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,University of Washington, Department of Medicine, Division of Oncology, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael L Linenberger
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
| | - Laura S Connelly-Smith
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington.,University of Washington, Department of Medicine, Division of Hematology, Seattle, Washington
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11
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Roddie C, O'Reilly M, Dias Alves Pinto J, Vispute K, Lowdell M. Manufacturing chimeric antigen receptor T cells: issues and challenges. Cytotherapy 2019; 21:327-340. [PMID: 30685216 DOI: 10.1016/j.jcyt.2018.11.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
Clinical trials of adoptively transferred CD19 chimeric antigen receptor (CAR) T cells have delivered unprecedented responses in patients with relapsed refractory B-cell malignancy. These results have prompted Food and Drug Administration (FDA) approval of two CAR T-cell products in this high-risk patient population. The widening range of indications for CAR T-cell therapy and increasing patient numbers present a significant logistical challenge to manufacturers aiming for reproducible delivery systems for high-quality clinical CAR T-cell products. This review discusses current and novel CAR T-cell processing methodologies and the quality control systems needed to meet the increasing clinical demand for these exciting new therapies.
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Affiliation(s)
- Claire Roddie
- Research Department of Haematology, University College London, London, UK; Department of Haematology, University College London Hospitals National Health Service (NHS) Foundation Trust, London.
| | - Maeve O'Reilly
- Research Department of Haematology, University College London, London, UK; Department of Haematology, University College London Hospitals National Health Service (NHS) Foundation Trust, London
| | | | - Ketki Vispute
- Research Department of Haematology, University College London, London, UK
| | - Mark Lowdell
- Research Department of Haematology, University College London, London, UK
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12
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Pascual C, González‐Arias E, Pérez‐Corral AM, Bailén R, Gayoso J, Besson N, Serrano D, Kwon M, Anguita J, Díez‐Martín JL. Mononuclear cell collection for extracorporeal photopheresis by using the
“
off‐line
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system: A comparative study between COBE Spectra and Spectra Optia devices. J Clin Apher 2018; 34:359-366. [DOI: 10.1002/jca.21679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Cristina Pascual
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Elena González‐Arias
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
| | - Ana María Pérez‐Corral
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Rebeca Bailén
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Jorge Gayoso
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Nelly Besson
- Medical Affairs Department TerumoBCT Zaventem Belgium
| | - David Serrano
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Mi Kwon
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
| | - Javier Anguita
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
- Universidad Complutense de Madrid Madrid Spain
| | - José Luis Díez‐Martín
- Hemathology and Hemotherapy DepartmentHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain
- Universidad Complutense de Madrid Madrid Spain
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14
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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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15
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Putensen D, Smith R, Pilcher L, Trandafir G. Comparison of the CMNC and MNC apheresis protocol for the collection of T-cells showed comparable outcome: An observational study in a single centre. J Clin Apher 2018; 33:349-356. [DOI: 10.1002/jca.21618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/05/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Daniel Putensen
- University College London Hospitals, Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London, WC1E 6AG 02034471804 United Kingdom
| | - Richard Smith
- University College London Hospitals, Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London, WC1E 6AG 02034471804 United Kingdom
| | - Linda Pilcher
- University College London Hospitals, Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London, WC1E 6AG 02034471804 United Kingdom
| | - George Trandafir
- University College London Hospitals, Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London, WC1E 6AG 02034471804 United Kingdom
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16
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Piccirillo N, Putzulu R, Massini G, Fiore AG, Chiusolo P, Sica S, Zini G. Mononuclear cell collection for extracorporeal photopheresis: Concentrate characteristics for off-line UV-A irradiation procedure. J Clin Apher 2017; 33:217-221. [DOI: 10.1002/jca.21574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/23/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Nicola Piccirillo
- Transfusion Medicine Department; Catholic University of Rome; Rome Italy
| | - Rossana Putzulu
- Transfusion Medicine Department; Catholic University of Rome; Rome Italy
| | - Giuseppina Massini
- Transfusion Medicine Department; Catholic University of Rome; Rome Italy
| | | | | | - Simona Sica
- Haematology Department; Catholic University of Rome; Rome Italy
| | - Gina Zini
- Transfusion Medicine Department; Catholic University of Rome; Rome Italy
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17
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Punzel M, Kozlova A, Quade A, Schmidt AH, Smith R. Evolution of MNC and lymphocyte collection settings employing different Spectra Optia ® Leukapheresis systems. Vox Sang 2017; 112:586-594. [PMID: 28809049 DOI: 10.1111/vox.12540] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 04/02/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The Spectra Optia® continuous mononuclear cell (CMNC apheresis) system has emerged as the preferred device in peripheral blood stem cell collections over the original two-step Spectra Optia® mononuclear cell (MNC apheresis) system. Until now, no comparative data were available for non-stimulated MNC collections that are required for immunotherapy. MATERIALS AND METHODS We compared collection parameters and product composition for Spectra Optia MNC- as well as CMNC-apheresis systems in non-stimulated MNC collections from 35 registry donors intended for donor lymphocyte infusions. In a subsequent analysis, different centrifugation forces (determined as packing factor or PF) were investigated regarding target cell yield and contamination in 61 collections using the CMNC device only. RESULTS Comparable collection efficiencies as well as target cell yields could be achieved with the Spectra Optia MNC- versus CMNC program. Similar numbers of MNC, T, B and NK cells could be collected with both devices. This led to a more than twofold lymphocyte recruitment from lymphatic tissue into the blood during apheresis. However, significantly more blood had to be processed with longer procedure time using the MNC program resulting in larger product volumes compared to the CMNC setting. Red blood cell and platelet (PLT) contamination were similar. Lowering the centrifugation force from PF4·5 to PF4·0 significantly reduced PLT contamination without affecting target cell yield in the product. CONCLUSION The Spectra Optia® CMNC device using lower centrifugal force (PF4·0) showed similar target cell yield and composition as well as collection efficiencies with superior performance parameters and lower PLT contamination compared to the MNC setting.
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Affiliation(s)
- M Punzel
- MediaPark Klinik Koeln, Cellex Collection Center, Koeln, Germany.,Praxis Dr. Punzel, Straelen, Germany
| | - A Kozlova
- MediaPark Klinik Koeln, Cellex Collection Center, Koeln, Germany
| | - A Quade
- Labor MVZ Quade, Koeln, Germany
| | - A H Schmidt
- DKMS, German Bone Marrow Donor Center, Tübingen, Germany
| | - R Smith
- Terumo BCT, Lakewood, CO, USA
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18
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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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19
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Mohammadi S, Norooznezhad AH, Mohammadi AM, Nasiri H, Nikbakht M, Saki N, Vaezi M, Alimoghaddam K, Ghavamzadeh A. Optimizing peripheral blood stem cells transplantation outcome through amend relapse and graft failure: a review of current literature. Exp Hematol Oncol 2017; 6:24. [PMID: 28808609 PMCID: PMC5550945 DOI: 10.1186/s40164-017-0082-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been considered as a valuable approach in treatment of numerous malignant and none malignant hematologic disorders. However, relapse and poor graft function (PGF) after allo-SCT remain to be controversial issues which may affect the transplantation outcome. Relevant articles were searched in MEDLINE database (2000–2016) using keywords and phrases: donor lymphocyte infusions, allogeneic stem cells transplantation, relapsed hematologic malignancies, booster schedules, cell dose, laboratory monitoring protocols and technical aspects of apheresis. Relapse of disease and PGF could be reduced via noting some main points such as choosing the suitable time and patient for donor lymphocyte infusion (DLI) and also determination of patients who ought to candidate for second allogeneic HSCT or for the use of stem cell boost. DLI and stem cell booster are promising treatment strategies noted in this review. Finally, this paper discusses indications and technical aspects of DLI and stem cell booster in hematological malignancies and emphasizes their therapeutic or pre-emptive potentials.
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Affiliation(s)
- Saeed Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | | | - Ashraf Malek Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Hajar Nasiri
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Mohsen Nikbakht
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Najmaldin Saki
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Kamran Alimoghaddam
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, North Kargar Avenue, Tehran, 14117-13131 Iran
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20
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Even-Or E, Di Mola M, Ali M, Courtney S, McDougall E, Alexander S, Schechter T, Whitlock JA, Licht C, Krueger J. Optimizing autologous nonmobilized mononuclear cell collections for cellular therapy in pediatric patients with high-risk leukemia. Transfusion 2017; 57:1536-1542. [DOI: 10.1111/trf.14094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Ehud Even-Or
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - Maria Di Mola
- Division of Nephrology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Muhammad Ali
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - Sarah Courtney
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - Elizabeth McDougall
- Department of Paediatric Laboratory Medicine; The Hospital for Sick Children; Toronto Ontario Canada
| | - Sarah Alexander
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - Tal Schechter
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - James A. Whitlock
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
| | - Christoph Licht
- Division of Nephrology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Joerg Krueger
- Division of Haematology/Oncology/Bone Marrow Transplantation; The Hospital for Sick Children; Toronto Ontario Canada
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21
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Hähnel V, Dormann F, Nitsopoulos A, Friedle A, Ahrens N. A method for the quantification of 8-methoxypsoralen by mass spectrometry for offline extracorporeal photopheresis. Photochem Photobiol Sci 2017; 16:193-200. [DOI: 10.1039/c6pp00327c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An LC-MS/MS assay for analysis of 8-methoxypsoralene was developed as assay to monitor extracorporeal photopheresis. This allows quantification of 8-MOP adhering to plastic surface and of the UV light-dependent decay constant.
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Affiliation(s)
- Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine
- Transfusion Medicine
- University Hospital Regensburg
- 93053 Regensburg
- Germany
| | - Frauke Dormann
- Institute for Clinical Chemistry and Laboratory Medicine
- Transfusion Medicine
- University Hospital Regensburg
- 93053 Regensburg
- Germany
| | | | | | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine
- Transfusion Medicine
- University Hospital Regensburg
- 93053 Regensburg
- Germany
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22
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Brosig A, Hähnel V, Orsó E, Wolff D, Holler E, Ahrens N. Technical comparison of four different extracorporeal photopheresis systems. Transfusion 2016; 56:2510-2519. [DOI: 10.1111/trf.13728] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Andreas Brosig
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg; Regensburg Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg; Regensburg Germany
| | - Evelyn Orsó
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg; Regensburg Germany
| | - Daniel Wolff
- Department of Hematology and Oncology; University Hospital Regensburg; Regensburg Germany
| | - Ernst Holler
- Department of Hematology and Oncology; University Hospital Regensburg; Regensburg Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg; Regensburg Germany
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23
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Castagna L, Sarina B, Bramanti S, Perseghin P, Mariotti J, Morabito L. Donor lymphocyte infusion after allogeneic stem cell transplantation. Transfus Apher Sci 2016; 54:345-55. [PMID: 27216544 DOI: 10.1016/j.transci.2016.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Allogeneic stem cell transplantation (allo-SCT) is considered the cornerstone in the treatment of several malignant and not malignant hematological diseases. However, relapse of hematological disease after allo-SCT is considered the most challenging point in the field. The risk can be reduced through optimal patients, donor and disease selection before allo-SCT, but harnessing donor immune system is an appealing way to treat or avoid disease relapse. Donor lymphocyte infusion (DLI) is a simple and effective therapy after allo-SCT. In this paper, the efficacy of DLI will be analyzed in different hematological diseases, focusing also on their therapeutic or pre-emptive use.
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Affiliation(s)
- Luca Castagna
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy.
| | - Barbara Sarina
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | | | - Jacopo Mariotti
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lucio Morabito
- Programma Trapianto Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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24
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Fesnak A, Lin C, Siegel DL, Maus MV. CAR-T Cell Therapies From the Transfusion Medicine Perspective. Transfus Med Rev 2016; 30:139-45. [PMID: 27067907 DOI: 10.1016/j.tmrv.2016.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/21/2016] [Indexed: 02/06/2023]
Abstract
The use of chimeric antigen receptor (CAR)-T cell therapy for the treatment of hematologic malignancies has generated significant excitement over the last several years. From a transfusion medicine perspective, the implementation of CAR-T therapy as a potential mainstay treatment for not only hematologic but also solid-organ malignancies represents a significant opportunity for growth and expansion. In this review, we will describe the rationale for the development of genetically redirected T cells as a cancer therapeutic, the different elements that are required to engineer these cells, as well as an overview of the process by which patient cells are harvested and processed to create and subsequently validate CAR-T cells. Finally, we will briefly describe some of the toxicities and clinical efficacy of CAR-T cells in the setting of patients with advanced malignancy.
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Affiliation(s)
- Andrew Fesnak
- Division of Transfusion Medicine & Therapeutic Pathology, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - ChieYu Lin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Don L Siegel
- Division of Transfusion Medicine & Therapeutic Pathology, Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marcela V Maus
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA.
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25
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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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26
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Grabmer C, Schlager S, Mayer G, Streif D, Lener T, Schallmoser K, Rohde E. An alternative mini buffy coat preparation method for adult patients with extracorporeal photopheresis contraindications. J Clin Apher 2016; 32:12-15. [PMID: 26939709 DOI: 10.1002/jca.21455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is an important cell-based therapy for various diseases but is limited to patients eligible for apheresis. We developed an alternative mini buffy coat (BC) preparation method using the Spectra Optia® apheresis system and compared its efficacy of white blood cell (WBC) recovery with the standard mini BC preparation method already established for pediatric patients. METHODS Whole blood (450 ± 45 mL) samples were collected from 30 randomly selected healthy volunteer blood donors and divided into two groups. In the first group, WBCs were separated with a fully automated separator device (Compomat G4® ). In the second group, BCs were separated with the bone marrow processing program of the Spectra Optia apheresis system. RESULTS There were no significant differences in total leukocyte counts per product between the two groups. In contrast, lymphocyte counts per product were significantly higher (P < 0.001) in BCs separated from apheresis. CONCLUSION Our novel technique resulted in similar WBC yields but higher lymphocyte yields than the standard mini BC preparation method. This method can serve as an alternative to WBC collection in conventional ECP for adult patients with apheresis contraindications. J. Clin. Apheresis 32:12-15, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Christoph Grabmer
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria
| | - Sandra Schlager
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria
| | - Georg Mayer
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria
| | - Doris Streif
- Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Thomas Lener
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria
| | - Katharina Schallmoser
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Eva Rohde
- Department for Blood Group Serology and Transfusion Medicine, SALK - Paracelsus Medical University (PMU), Salzburg, Austria.,Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University (PMU), Salzburg, Austria
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27
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Bacher P, Jochheim-Richter A, Mockel-Tenbrink N, Kniemeyer O, Wingenfeld E, Alex R, Ortigao A, Karpova D, Lehrnbecher T, Ullmann AJ, Hamprecht A, Cornely O, Brakhage AA, Assenmacher M, Bonig H, Scheffold A. Clinical-scale isolation of the total Aspergillus fumigatus-reactive T-helper cell repertoire for adoptive transfer. Cytotherapy 2015; 17:1396-405. [PMID: 26188965 DOI: 10.1016/j.jcyt.2015.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AIMS Evidence of the criticality of the adaptive immune response for controlling invasive aspergillosis has been provided. This observation is supported by the fact that invasive aspergillosis, a grave complication of allogeneic stem cell transplantation, occurs long after myeloid reconstitution in patients with low T-cell engraftment and/or on immunosuppressants. Adoptive T-cell transfer might be beneficial, but idiosyncrasies of Aspergillus fumigatus and the anti-Aspergillus immune response render established selection technologies ineffective. METHODS We developed a Good Manufacturing Practice (GMP)-compliant protocol for preparation of A. fumigatus-specific CD4+ cells by sequentially depleting regulatory and cytotoxic T cells, activating A. fumigatus-specific T-helper cells with GMP-grade A. fumigatus lysate, and immuno-magnetically isolating them via the transiently up-regulated activation marker, CD137. RESULTS In 13 full-scale runs, we demonstrate robustness and feasibility of the approach. From 2 × 10(9) peripheral blood mononuclear cells, we isolated 27 × 10(3)-318 × 10(3)Aspergillus-specific T-helper cells. Frequency among total T cells was increased, on average, by 200-fold. Specific studies indicate specificity and functionality: After non-specific in vitro expansion and re-stimulation with different antigens, we observed strong cytokine responses to A. fumigatus and some other fungi including Candida albicans, but none to unrelated antigens. DISCUSSION Our technology isolates naturally occurring Aspergillus-specific T-helper cells within 2 days of identifying the clinical indication. Rapid adoptive transfer of Aspergillus-specific T cells may be quite feasible; the clinical benefit remains to be demonstrated. A manufacturing license as an advanced-therapy medicinal product was received and a clinical trial in post-transplantation invasive aspergillosis patients approved. The product is dosed at 5 × 10E3/kg T cells (single intravenous injection), of which at least 10% must be A. fumigatus-specific.
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Affiliation(s)
- Petra Bacher
- Department of Cellular Immunology, Clinic for Rheumatology and Clinical Immunology, Charité, University Medicine Berlin, Germany
| | - Andrea Jochheim-Richter
- Institute for Transfusion Medicine and Immunohematology, Department of Translational Development of Cellular Therapeutics (GMP), Goethe University, Frankfurt, Germany
| | | | - Olaf Kniemeyer
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), University Hospital, Jena, Germany
| | - Eva Wingenfeld
- Institute for Transfusion Medicine and Immunohematology, Department of Translational Development of Cellular Therapeutics (GMP), Goethe University, Frankfurt, Germany
| | | | - Alice Ortigao
- Institute for Transfusion Medicine and Immunohematology, Department of Translational Development of Cellular Therapeutics (GMP), Goethe University, Frankfurt, Germany
| | - Darja Karpova
- Institute for Transfusion Medicine and Immunohematology, Department of Translational Development of Cellular Therapeutics (GMP), Goethe University, Frankfurt, Germany
| | - Thomas Lehrnbecher
- Pediatric Hematology and Oncology, Children's Hospital III, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Andrew J Ullmann
- Division of Infectious Diseases, Department of Internal Medicine II, University Medical Center, Würzburg, Germany
| | - Axel Hamprecht
- Department I of Internal Medicine, University Hospital of Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver Cornely
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Axel A Brakhage
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute (HKI) Jena and Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | | | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Department of Translational Development of Cellular Therapeutics (GMP), Goethe University, Frankfurt, Germany; German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt, Germany; Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Alexander Scheffold
- Department of Cellular Immunology, Clinic for Rheumatology and Clinical Immunology, Charité, University Medicine Berlin, Germany; German Rheumatism Research Center, Berlin, Germany
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Bunos M, Hümmer C, Wingenfeld E, Sorg N, Pfirrmann V, Bader P, Seifried E, Bönig H. Automated isolation of primary antigen-specific T cells from donor lymphocyte concentrates: results of a feasibility exercise. Vox Sang 2015; 109:387-93. [PMID: 25951789 DOI: 10.1111/vox.12291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/30/2015] [Accepted: 03/30/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The safety and clinical efficacy of adoptive transfer of prospectively isolated antigen-specific T cells are well established. Several competing selection methods are available, one of which is based on immunomagnetic enrichment of T cells secreting IFNγ after incubation with the relevant antigen. The proprietary, GMP-conforming selection technology, called 'cytokine capture system' (CCS) is established in many laboratories for the CliniMACS Plus system. It is robust and efficient, but labour-intensive and incompatible with a single-shift working schedule. An automatic immunomagnetic cell processing system, CliniMACS Prodigy ('Prodigy'), including a protocol for fully automatic CCS execution was recently released. MATERIAL AND METHODS Feasibility of clinical-scale CMV-specific T-cell selection using Prodigy was evaluated using leukoapheresis products from five healthy CMV sero-positive volunteers. Clinical reagents and consumables were used throughout. RESULTS The process required no operator input beyond set-up and QC-sample collection, that is, feasibility was given. An IFNγ-secreting target T-cell population was detectable after stimulation, and >2 log-scale relative depletion of not CMV-reactive T cells in the target population was achieved. Purity, that is the frequency of CMV-reactive T cells among all CD3(+) cells ranged between 64 and 93%. CONCLUSION The CCS protocol on Prodigy is unrestrictedly functional. It runs fully automatically beyond set-up and thus markedly reduces labour. The quality of the products generated is similar to products generated with CliniMACS Plus. The automatic system is thus suitable for routine clinical application.
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Affiliation(s)
- M Bunos
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - C Hümmer
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - E Wingenfeld
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - N Sorg
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany
| | - V Pfirrmann
- Center of Child and Adolescent Health, Department for Stem Cell Transplantation and Immunology, Goethe University Medical Center, Frankfurt, Germany
| | - P Bader
- Center of Child and Adolescent Health, Department for Stem Cell Transplantation and Immunology, Goethe University Medical Center, Frankfurt, Germany
| | - E Seifried
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), Institute Frankfurt, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University Medical Center, Frankfurt, Germany
| | - H Bönig
- German Red Cross Blood Service Baden-Württemberg-Hesse, Department of Cellular Therapeutics (GMP), 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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Sorg N, Poppe C, Bunos M, Wingenfeld E, Hümmer C, Krämer A, Stock B, Seifried E, Bonig H. Red blood cell depletion from bone marrow and peripheral blood buffy coat: a comparison of two new and three established technologies. Transfusion 2015; 55:1275-82. [PMID: 25647556 DOI: 10.1111/trf.13001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Red blood cell (RBC) depletion is a standard technique for preparation of ABO-incompatible bone marrow transplants (BMTs). Density centrifugation or apheresis are used successfully at clinical scale. The advent of a bone marrow (BM) processing module for the Spectra Optia (Terumo BCT) provided the initiative to formally compare our standard technology, the COBE2991 (Ficoll, manual, "C") with the Spectra Optia BMP (apheresis, semiautomatic, "O"), the Sepax II NeatCell (Ficoll, automatic, "S"), the Miltenyi CliniMACS Prodigy density gradient separation system (Ficoll, automatic, "P"), and manual Ficoll ("M"). C and O handle larger product volumes than S, P, and M. STUDY DESIGN AND METHODS Technologies were assessed for RBC depletion, target cell (mononuclear cells [MNCs] for buffy coats [BCs], CD34+ cells for BM) recovery, and cost/labor. BC pools were simultaneously purged with C, O, S, and P; five to 18 BM samples were sequentially processed with C, O, S, and M. RESULTS Mean RBC removal with C was 97% (BCs) or 92% (BM). From both products, O removed 97%, and P, S, and M removed 99% of RBCs. MNC recovery from BC (98% C, 97% O, 65% P, 74% S) or CD34+ cell recovery from BM (92% C, 90% O, 67% S, 70% M) were best with C and O. Polymorphonuclear cells (PMNs) were depleted from BCs by P, S, and C, while O recovered 50% of PMNs. Time savings compared to C or M for all tested technologies are considerable. CONCLUSION All methods are in principle suitable and can be selected based on sample volume, available technology, and desired product specifications beyond RBC depletion and MNC and/or CD34+ cell recovery.
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Affiliation(s)
- Nadine Sorg
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Carolin Poppe
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Milica Bunos
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Eva Wingenfeld
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Christiane Hümmer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Ariane Krämer
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt
| | - Belinda Stock
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Frankfurt.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany.,Department of Medicine/Hematology, University of Washington, Seattle, Washington
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Abstract
Abstract
Patients presenting with new or recurrent acute leukemia, particularly of the myeloid lineage, with WBC counts exceeding 100 × 109/L are often considered for leukocytapheresis, especially if they are experiencing symptoms of leukostasis. These symptoms are thought to occur because of blast aggregates and WBC thrombi in the circulation, which reduce blood flow. Leukostasis may cause various complications, including hyperviscosity syndrome, vascular occlusion resulting in intracranial hemorrhages and respiratory failure, and perivascular leukemic infiltrates. Leukostasis occurs more commonly with a high WBC count and with leukemias of monocytoid lineage such as acute myelomonocytic leukemia, which is a reflection of the nature of the leukemic blasts. Leukocytapheresis is used in an effort to quickly decrease a patient's circulating blast count, which can both prevent the development of leukostasis and provide symptomatic relief of leukostasis. However, the impact of leukocytapheresis on early- and long-term mortality is controversial, with several studies producing conflicting results. In this chapter, the pathophysiology of leukostasis, performance of leukocytapheresis, and efficacy of this treatment are reviewed.
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31
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Leitner GC, Kolovratova V, Horvath M, Worel N. Granulocyte collection using a novel apheresis system eases the procedure and provides concentrates of high quality. Transfusion 2014; 55:991-5. [DOI: 10.1111/trf.12928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Gerda C. Leitner
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| | - Vera Kolovratova
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| | - Michaela Horvath
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| | - Nina Worel
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
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32
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Steininger P, Zimmermann R, Eckstein R, Strasser E. Possible reasons for variable leukapheresis collection outcomes with automated apheresis systems. Transfusion 2014; 54:2584-5. [DOI: 10.1111/trf.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Steininger
- Transfusion Medicine and Haemostaseology Department; University Hospital Erlangen; Erlangen Germany
| | - Robert Zimmermann
- Transfusion Medicine and Haemostaseology Department; University Hospital Erlangen; Erlangen Germany
| | - Reinhold Eckstein
- Transfusion Medicine and Haemostaseology Department; University Hospital Erlangen; Erlangen Germany
| | - Erwin Strasser
- Transfusion Medicine and Haemostaseology Department; University Hospital Erlangen; Erlangen Germany
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33
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Schulz M, Bönig H. In reply. Transfusion 2014; 54:2585-6. [DOI: 10.1111/trf.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Miriam Schulz
- German Red Cross Blood Service Baden-Württemberg-Hesse; Frankfurt Germany
| | - Halvard Bönig
- German Red Cross Blood Service Baden-Württemberg-Hesse; Frankfurt Germany
- Institute for Transfusion Medicine and Immunohematology; Goethe University; Frankfurt Germany
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34
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Long G, Waller EK, Gregurek S, Tricot G, Marschner S, Bill J. Evaluation of the spectra Optia® mononuclear cell collection procedure in multiple myeloma patients. J Clin Apher 2014; 30:1-7. [DOI: 10.1002/jca.21341] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Gwynn Long
- Department of Medicine; Division of Cellular Therapy; Duke University School of Medicine; Durham North Carolina
| | - Edmund K. Waller
- Department of Hematology and Medical Oncology; Division of Stem Cell and Bone Marrow Transplantation; Winship Cancer Institute; Emory University School of Medicine; Atlanta Georgia
| | - Steven Gregurek
- Department of Pathology and Laboratory Medicine; University of Indiana School of Medicine; Indianapolis Indiana
| | - Guido Tricot
- Division of Hematology/BMT/Myeloma Program; University of Utah School of Medicine; Salt Lake City Utah
| | | | - Jerry Bill
- Scientific Affairs; Terumo BCT; Lakewood Colorado
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