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Imoto N, Kondo Y, Uchida K, Kurahashi S. Hematopoietic Progenitor Cell Counts of the Leukapheresis Product Determined Using Sysmex XN Analyzers Predict a Sufficient Number of CD34 + Stem Cells in a Peripheral Blood Stem Cell Harvest for Autologous Transplantation. Intern Med 2024; 63:189-195. [PMID: 37225486 PMCID: PMC10864077 DOI: 10.2169/internalmedicine.1697-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/06/2023] [Indexed: 05/26/2023] Open
Abstract
Objective Several institutions outsource CD34+ cell counting of leukapheresis products, limiting rapid measurements, as results are obtained the next day. This problem is compounded with plerixafor use, a stem cell-mobilizing drug that increases leukapheresis efficiency but requires administration the day before leukapheresis. Use of this drug for a second leukapheresis procedure before the first-day leukapheresis CD34+ count results are confirmed causes unnecessary leukapheresis and expensive plerixafor administration. We investigated whether or not measuring hematopoietic progenitor cells in leukapheresis products (AP-HPCs) using a Sysmex XN-series analyzer could resolve this problem. Methods We retrospectively compared the absolute AP-HPC value per body weight with the CD34+ (AP-CD34+) count in 96 first-day leukapheresis product samples obtained between September 2013 and January 2021. Comparisons were also conducted according to regimen: granulocyte colony-stimulating factor (G-CSF) monotherapy, chemotherapy plus G-CSF, or plerixafor mobilization. Results AP-CD34+ and AP-HPC counts correlated strongly (rs=0.846) overall and, in particular, under chemotherapy plus G-CSF (rs=0.92) but correlated mildly under G-CSF monotherapy (rs=0.655). AP-HPCs could not completely be dichotomized based on an AP-CD34+ threshold of 2×106/kg for any stimulation procedure. In most cases with AP-HPCs >6×106/kg, the AP-CD34+ count exceeded 2.0×106/kg, but in 5.7% of these cases, the AP-CD34+ count was <2.0×106/kg. A cut-off of AP-HPCs >4.843×106/kg yielded a sensitivity of 71% and specificity of 96% for predicting AP-CD34+≥2×106/kg. Conclusion AP-HPCs can identify cases in which sufficient stem cells have been collected.
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Affiliation(s)
- Naoto Imoto
- Division of Hematology and Oncology, Toyohashi Municipal Hospital, Japan
| | - Yuka Kondo
- Division of Clinical Laboratory, Toyohashi Municipal Hospital, Japan
| | - Kazuho Uchida
- Division of Clinical Laboratory, Toyohashi Municipal Hospital, Japan
| | - Shingo Kurahashi
- Division of Hematology and Oncology, Toyohashi Municipal Hospital, Japan
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2
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Rogers KJ, Mott SL, Parsons MG, Schlueter AJ. Use of subgroup-specific hematopoietic stem cell collection efficiencies to improve truncation calculations for large-volume leukapheresis procedures. J Clin Apher 2023; 38:664-676. [PMID: 37526046 DOI: 10.1002/jca.22077] [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: 03/25/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE A critical component of optimizing peripheral blood (PB) hematopoietic stem cell (HSC) collections is accurately determining the processed blood volume required to collect the targeted number of HSCs. Fundamental to most truncation equations employed to determine this volume is the procedure's estimated collection efficiency (CE), which is typically applied uniformly across all HSC collections. Few studies have explored the utility of using different CEs in subpopulations of donors that have substantially different CEs than the institutional average. METHODS Initial procedures from 343 autologous and 179 allogeneic HSC collections performed from 2018 to 2021 were retrospectively analyzed. Predictive equations were developed to determine theoretical truncation rates in various donor subgroups. RESULTS Quantitative variables (pre-procedure cell counts) and qualitative variables (relatedness to recipient, gender, method of venous access, and mobilization strategy) were found to significantly impact CE. However, much of the variability in CE between donors could not be explained by the variables assessed. Analyses of procedures with high pre-collection PB cell counts identified lower CE values for these donors' truncation equations which still allow truncation but minimize risk of collecting less CD34+ cells than requested. CONCLUSIONS Individualized CE does not substantially improve truncation volume calculations over use of a fixed CE and adds complexity to these calculations. The optimal fixed CE varies between autologous and allogeneic donors, and donors with high pre-collection PB cell counts in either of these groups. This model will be clinically validated and continuously refined through analysis of future HSC collections.
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Affiliation(s)
- Kai J Rogers
- Department of Pathology, University of Iowa, Iowa City, Iowa, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
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3
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Rahim MQ, Goebel WS, Delph J, Soundar E. Primed for change: The effect of a blood prime on peripheral blood stem cell collection and accuracy of a prediction tool in pediatric patients. J Clin Apher 2023; 38:540-547. [PMID: 37243380 DOI: 10.1002/jca.22057] [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: 09/09/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Pediatric apheresis collection of peripheral blood stem cells for autologous transplantation often requires use of a blood prime. We evaluated the relationship between pre-apheresis blood CD34+ counts and final CD34+ yield with use of a blood prime. Forty patients underwent apheresis stem cell collection in a 5 year period in our hospital, of which 27 required blood priming of the apheresis machine. Despite the blood prime group having significantly higher pre-apheresis CD34+ cell counts, this group processed a relatively higher volume of blood due to a higher dilutional effect and collected significantly less than predicted CD34+ cell yield. Use of weight-specific collection efficiencies and dilution-adjusted pre-apheresis CD34+ counts will help in accurately estimating the whole blood volume to process for PBSC collection and therefore increase efficiency and decrease the overall cost of collection.
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Affiliation(s)
- Mahvish Q Rahim
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Indianapolis, Indiana, USA
| | - W Scott Goebel
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Indianapolis, Indiana, USA
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
| | - John Delph
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
| | - Esther Soundar
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana University Health Apheresis Program, Indianapolis, Indiana, USA
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4
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Huang L, Zhu G, Mu Y, Xia Y. The Sysmex XN series hematopoietic progenitor cell (XN-HPC) as a predictive marker of stem cell enumeration and products: a systemic review and meta-analysis. Hematology 2022; 27:1230-1236. [DOI: 10.1080/16078454.2022.2143747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lunhui Huang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
| | - Guoqing Zhu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
| | - Yueyi Mu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
| | - Yonghui Xia
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People’s Republic of China
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5
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Jamal A, Khan T, Zaidi U, Rizvi QA, Jahanzeb S, Salim A, Imam M, Shamsi T. Highly specific functional equivalence of XN-HPC for optimum CD34+ cell count in harvested allogeneic bone marrow stem cell products. Hematology 2022; 27:232-238. [DOI: 10.1080/16078454.2022.2030884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aisha Jamal
- Department of Clinical Haematology, NIBD & BMT, Karachi, Pakistan
| | - Tahir Khan
- School of Public Health, DUHS, Karachi, Pakistan
| | - Uzma Zaidi
- Department of Bone Marrow Transplantation, NIBD & BMT, Karachi, Pakistan
| | | | - Shafaq Jahanzeb
- Department of Bone Marrow Transplantation, NIBD & BMT, Karachi, Pakistan
| | - Ali Salim
- Department of Clinical Haematology, NIBD & BMT, Karachi, Pakistan
| | - Mehjabeen Imam
- Department of Transplant Immunology, NIBD & BMT, Karachi, Pakistan
| | - Tahir Shamsi
- Department of Clinical Haematology, NIBD & BMT, Karachi, Pakistan
- Department of Bone Marrow Transplantation, NIBD & BMT, Karachi, Pakistan
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6
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Kim SM, Kim HY, Kim SJ, Jang JH, Kim K, Kim WS, Jung CW, Cho D, Kang ES. Correlation between peripheral blood automated hematopoietic progenitor cell counts and flow cytometric CD34 + cell counts differs according to diagnosis in patients undergoing autologous peripheral blood stem cell transplantation. J Clin Apher 2021; 36:737-749. [PMID: 34283414 DOI: 10.1002/jca.21924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 05/21/2021] [Accepted: 06/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND An automated hematopoietic progenitor cell count measurement in Sysmex XN analyzer (XN-HPC) has been developed to assist flow cytometry CD34+ cell count measurement, which requires technical expertise and a long turnaround time. Here, we evaluated the correlation between XN-HPC count and flow cytometric CD34+ cell count in pre-harvest peripheral blood (PB) samples from patients undergoing autologous peripheral blood stem cell (PBSC) transplantation according to diagnosis and investigated the possible cause of the decreased correlation in plasma cell neoplasm patients. MATERIALS AND METHODS We retrospectively included 399 patient data that had matched PB XN-HPC count and CD34+ cell count of PB and apheresis product from Samsung Medical Center (SMC) and the Hematopoietic Stem Cell (HSC) registry. We assessed the diagnostic accuracy and the potential cutoff values of XN-HPC count for predicting adequate PBSC collection. RESULTS The PB XN-HPC count was 1.6 and 1.3-fold higher than the CD34+ cell count in SMC (25.0 vs 15.9/μl) and the HSC registry (20.0 vs 15.2/μl), respectively. Overall the correlation between the PB XN-HPC and CD34+ cell count was moderate (SMC, r = 0.71; HSC registry, r = 0.66). A significant proportional and systemic bias with overestimation of XN-HPC count were noted in the plasma cell neoplasm patients in both SMC and the HSC registry. However, no significant difference in correlation was observed according to myeloma-related laboratory parameters in plasma cell neoplasm patients. CONCLUSION Our results suggest that XN-HPC count should be interpreted cautiously in cancer patients undergoing autologous PBSC transplantation, especially in those with plasma cell neoplasm.
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Affiliation(s)
- Sang-Mi Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Young Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jun Ho Jang
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kihyun Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Chul Won Jung
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, South Korea
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7
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Successful autologous peripheral blood stem cell collection using large volume leukapheresis in patients with very low or undetectable peripheral blood CD34+ progenitor cells. Transfus Apher Sci 2021; 60:103170. [PMID: 34090813 DOI: 10.1016/j.transci.2021.103170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
Autologous stem cell transplantation provides some patients with hematolymphoid and solid organ malignancies an opportunity for cure. Management of peripheral hematopoietic stem cell (HSC) collections differs among institutions, especially if a very low pre-procedure peripheral blood CD34+ cell count (PBCD34) is demonstrated. This study retrospectively analyzed results of large-volume peripheral HSC collections in 91 patients over approximately two years. Fifteen patients with PBCD34 < 10 × 10e6/l (eleven with undetectable PBCD34) were compared to 76 patients with higher counts on the first collection day (adequate mobilizers). The poor mobilizer group had significantly lower pre-collection WBC and platelet counts as well as collection yields. However, most patients with PBCD34 < 10 × 10e6/l (80 %) collected the minimum target for HSC transplant (2.0 × 10e6 CD34+ cells/kg) in <5 consecutive days of collection, and those who did collect the minimum successfully underwent autologous transplantation, with hematopoietic engraftment and long-term survival comparable to the adequate mobilizers. Successful HSC collection may often be achieved regardless of d 1 PBCD34 counts.
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8
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Jamal A, Khan MT, Parveen S, Rizvi Q, Farzana T, Zaidi U, Borhany M, Siddiqui S, Ansari SH, Shamsi TS. Peripheral Blood Stem Cell Harvest HPC Count Is an Effective Surrogate Marker for CD34+ Cell Count in Allogeneic Stem Cell Transplant Setting. Transl Oncol 2020; 13:100788. [PMID: 32408157 PMCID: PMC7218209 DOI: 10.1016/j.tranon.2020.100788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: We assessed the predictive potential of XN-HPC for CD34+ cell count as obtained through Sysmex automated hematology analyzers (XN-1000). METHODS: This study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation in 84 donors between December 2012 and December 2017 in the first phase and later validated in 112 donors between December 2017 and December 2018. Sysmex XN-1000 and BD FACS Calibur estimated XN-HPC and CD34+ cells of peripheral blood apheresis product, respectively. Spearman's correlation was assessed between XN-HPC and CD34+ cell count followed by receiver operating characteristic curve calculation to determine the XN-HPC cutoff for a CD34+ count of ≥2 million cells/kg of recipient's body weight RESULTS: There is a moderately positive correlation (P value = .003) between XN-HPC and CD34+ count. Receiver operating characteristic curve analyses demonstrated that a cutoff value for XN-HPC of ≥1·845×106cells/kg of recipient's body weight has a specificity and sensitivity of 100% and 78·2%, respectively, for predicting the CD34+ count of ≥2 million cells/kg of recipient's body weight. This cutoff value of XN-HPC was prospectively validated in 112 donors. The positive predictive value was found to be 100%, while negative predictive value was 17%. CONCLUSION: XN-HPC has a highly promising potential to serve as a cost-effective and time-saving surrogate for CD34+ cell count.
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Affiliation(s)
- Aisha Jamal
- Clinical Haematology, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Mohammad Tahir Khan
- School of Public Health, Dow University of Health Sciences, 111 Suparco Rd, Gulzar-e-Hijri Gulzar E Hijri Scheme 33, Karachi, Karachi, City, Sindh, Pakistan.
| | - Sadia Parveen
- Research, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Qurratulain Rizvi
- Clinical Haematology, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Tasneem Farzana
- Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Uzma Zaidi
- Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Munira Borhany
- Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Saima Siddiqui
- Transplant Immunology, National Institute of Blood Disease & Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Saqib Hussain Ansari
- Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
| | - Tahir Sultan Shamsi
- Clinical Haematology, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan; Bone Marrow Transplantation, National Institute of Blood Disease and Bone Marrow Transplantation, ST, 2/A Block 17 Gulshan-e-Iqbal KDA Scheme 24, Karachi, 75300, Pakistan.
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9
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Söderström A, Møller BK, Sørensen BS. Evaluation of the Sysmex XN automated hematopoietic progenitor cell enumeration for timing of peripheral blood stem cell harvest. Transfus Apher Sci 2020; 59:102683. [DOI: 10.1016/j.transci.2019.102683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
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10
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Furundarena JR, Uranga A, Alkorta A, González C, Javier Ferreiro J, Rey M, Aragón L, Urreta I, Emparanza JI, Redín H, Garrido A, Araiz M. Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield. Int J Lab Hematol 2019; 42:170-179. [DOI: 10.1111/ijlh.13142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/16/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Alasne Uranga
- Hematology Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - Aitziber Alkorta
- Hematopoietic Stem Cell Transplantation Unit Hematology Department Donostia University Hospital (DUH) Donostia Spain
| | - Carmen González
- Hematology Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - José Javier Ferreiro
- Hematopoietic Stem Cell Transplantation Unit Hematology Department Donostia University Hospital (DUH) Donostia Spain
| | - Mercedes Rey
- Immunology Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - Larraitz Aragón
- Immunology Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - Iratxe Urreta
- Clinical Epidemiology Unit Donostia University Hospital (DUH) Donostia Spain
| | | | - Helena Redín
- Core Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - Adolfo Garrido
- Core Laboratory Donostia University Hospital (DUH) Donostia Spain
| | - María Araiz
- Hematopoietic Stem Cell Transplantation Unit Hematology Department Donostia University Hospital (DUH) Donostia Spain
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11
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Assessment of haematopoietic progenitor cell counting with the Sysmex ® XN-1000 to guide timing of apheresis of peripheral blood stem cells. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:67-76. [PMID: 31403932 DOI: 10.2450/2019.0086-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Successful peripheral blood stem cell (PBSC) collection depends on optimal timing of apheresis, as usually determined by flow cytometry CD34-positive (+) cell count in peripheral blood (PB). Since this method is costly and labour-intensive, we evaluated the use of the Hematopoietic Progenitor Cell count programme on a Sysmex® XN haematologic analyser (XN-HPC) as a rapid and inexpensive alternative for predicting CD34+ cell count in PB samples. MATERIALS AND METHODS Haematopoietic progenitor cell and CD34+ cell counts were compared using 273 PB samples collected from 78 healthy donors and 72 patients who underwent PBSC transplantation. We assessed the effectiveness of the XN-HPC in safely predicting pre-harvest CD34+ counts. The most efficient cut-off values of XNHPC were identified. We also evaluated the imprecision (coefficient of variation, CV) and functional sensitivity. RESULTS Imprecision of the XN-HPC count was <6.3% on daily measurement of three levels of quality control material. Functional sensitivity was 8.9×106/L. A cut-off value of ≥62×106/L XN-HPC for multiple myeloma (MM) patients and ≥30×106/L for all other subjects had both 100% specificity and 100% positive predictive value for identifying samples with CD34+ cells ≥20×106/L. An XN-HPC threshold of <13×106/L identified preharvest CD34+ cell count <10×106/L with 100% sensitivity and 100% negative predictive value. DISCUSSION The XN-HPC is a fast, easy and inexpensive test that can safely improve apheresis workflow thus possibly replacing other more expensive CD34 counts currently performed and promoting optimal timing of PBSC collection.
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12
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Mathur G, Bell SL, Collins L, Nelson GA, Knudson CM, Schlueter AJ. Factors influencing platelet clumping during peripheral blood hematopoietic stem cell collection. Transfusion 2017; 57:1142-1151. [PMID: 28150319 PMCID: PMC5769924 DOI: 10.1111/trf.14022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Platelet clumping is a common occurrence during peripheral blood hematopoietic stem cell (HSC) collection using the Spectra Optia mononuclear cell (MNC) protocol. If clumping persists, it may prevent continuation of the collection and interfere with proper MNC separation. This study is the first to report the incidence of clumping, identify precollection factors associated with platelet clumping, and describe the degree to which platelet clumping interferes with HSC product yield. STUDY DESIGN AND METHODS In total, 258 HSC collections performed on 116 patients using the Optia MNC protocol were reviewed. Collections utilized heparin in anticoagulant citrate dextrose to facilitate large-volume leukapheresis. Linear and logistic regression models were utilized to determine which precollection factors were predictive of platelet clumping and whether clumping was associated with product yield or collection efficiency. RESULTS Platelet clumping was observed in 63% of collections. Multivariable analysis revealed that a lower white blood cell count was an independent predictor of clumping occurrence. Chemotherapy mobilization and a lower peripheral blood CD34+ cell count were predictors of the degree of clumping. Procedures with clumping had higher collection efficiency but lower blood volume processed on average, resulting in no difference in collection yields. Citrate toxicity did not correlate with clumping. CONCLUSION Although platelet clumping is a common technical problem seen during HSC collection, the total CD34+ cell-collection yields were not affected by clumping. WBC count, mobilization approach, and peripheral blood CD34+ cell count can help predict clumping and potentially drive interventions to proactively manage clumping.
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Affiliation(s)
- Gagan Mathur
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Sarah L. Bell
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Laura Collins
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Gail A. Nelson
- Department of Pathology, University of Iowa, Iowa City, Iowa
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13
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Krasowski MD, Ford BA, Klutts JS, Jensen CS, Briggs AS, Robinson RA, Bruch LA, Karandikar NJ. Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship. Acad Pathol 2017; 4:2374289517722152. [PMID: 28913416 PMCID: PMC5590695 DOI: 10.1177/2374289517722152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/22/2022] Open
Abstract
Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.
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Affiliation(s)
- Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bradley A. Ford
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - J. Stacey Klutts
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Pathology and Laboratory Medicine, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Chris S. Jensen
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Angela S. Briggs
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Robert A. Robinson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Leslie A. Bruch
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nitin J. Karandikar
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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