1
|
Kim BK, Hong KT, Choi JY, Kim H, Park HJ, Kang HJ. Comparable outcomes of allogeneic peripheral blood versus bone marrow hematopoietic stem cell transplantation from a sibling donor for pediatric patients. Ann Hematol 2024; 103:2051-2058. [PMID: 38594416 DOI: 10.1007/s00277-024-05737-5] [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: 08/29/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
Traditionally, bone marrow (BM) has been preferred as a source of stem cells (SCs) in pediatric hematopoietic SC transplantation (HSCT); however, the use of peripheral blood SCs (PBSC) has recently increased. With advancing graft-versus-host disease (GVHD) prophylaxis, whether the BM is still a better SC source than PB in sibling donor HSCT remains controversial. Here, we compared the results of BM transplantation (BMT) and PBSC transplantation (PBSCT) in pediatric patients with malignant or non-malignant diseases receiving sibling HSCT using a total of 7.5 mg/kg of anti-thymocyte globulin (ATG). We retrospectively reviewed children who received HSCT from a sibling donor between 2005 and 2020 at Seoul National University Children's Hospital. Of the 86 patients, 40 underwent BMT, and 46 underwent PBSCT. Fifty- six patients had malignant diseases, whereas thirty patients had non-malignant diseases. All conditioning regimens comprised ATG. Busulfan-based myeloablative conditioning regimens were administered to patients with malignant diseases and approximately half of those with non-malignant diseases. The remaining half of the patients with non-malignant diseases were administered cyclophosphamide-based reduced- intensity conditioning regimens. According to studies conducted at our center, all BM donors received G-CSF before harvest to achieve early engraftment. In all 86 patients (47 males and 39 females), the median age at the time of HSCT was 11.4 (range, 0.7 - 24.6) years. The median follow-up period was 57.9 (range, 0.9-228.6) months, and the corresponding values for those with BM and PBSC were 77 (range, 2.4-228.6) months and 48.7 (range, 0.9-213.2) months, respectively. Engraftment failure occurred in one patient with BM and no patient with PBSC. The cumulative incidence of acute GVHD with grades II-IV was higher in PBSC (BM 2.5%, PBSC 26.1%, p = 0.002), but there was no significant difference in those with grades III-IV acute GVHD (BM 0%, PBSC 6.5%, p = 0.3703) and extensive chronic GVHD (BM 2.5%, PBSC 11.6%, p = 0.1004). There were no significant differences in treatment-related mortality (TRM) (BM 14.2%, PBSC 6.8%, p = 0.453), 5-year event-free survival (EFS) (BM 71.5%, PBSC 76.2%, p = 0.874), and overall survival (OS) rates (BM 80.8%, PBSC 80.3%, p = 0.867) between BM and PBSC in the univariate analysis. In the multivariate analysis, which included all factors with p < 0.50 in the univariate analysis, there was no significant prognostic factor for EFS or OS. There was no significant difference in the relapse incidence between BM and PBSC among patients with malignant diseases (BM 14.2%, PBSC 6.8%, p = 0.453). Additionally, there were no significant differences in the TRM, 5-year EFS, and OS rates between malignant and non-malignant diseases nor between the busulfan-based myeloablative regimen and reduced-intensity chemotherapy using cyclophosphamide. In this study, we showed no significant differences in EFS, OS, TRM, and GVHD, except for acute GVHD grades II-IV, between BMT and PBSCT from sibling donors, using ATG (a total of 7.5 mg/kg). Therefore, PB collection, which is less invasive for donors and less labor-intensive for doctors, could also be considered an acceptable SC source for sibling donor HSCT in children.
Collapse
Affiliation(s)
- Bo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul, 03722, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul, 03722, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul, 03722, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hyery Kim
- Divison of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul, 03722, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 101 Daehak-ro, Jongno-gu, Seoul, 03722, Korea.
- Seoul National University Cancer Research Institute, Seoul, Korea.
| |
Collapse
|
2
|
Lejeune M, Menard B, Servais S, Andrianne C, Capelle L, De Maistre S, Fabaron C, Cornier MF, Goutagny MP, Pereira M, Tardy C, Turquet E, Benakli M, Baudoux E, Evard S, Faucher C, Herrero G, Magro L, Geurten C. [Haematopoietic stem cell donation from minor donor: Respecting laws, assessing fitness, delivering information and good care (SFGM-TC)]. Bull Cancer 2024:S0007-4551(24)00152-8. [PMID: 38755034 DOI: 10.1016/j.bulcan.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024]
Abstract
Haematopoietic stem cell collection from paediatric donors is a common and life-saving practice, as evidenced by the fact that there is a growing annual number of cases of transplants from minor donors among SFGM-TC centers over the last decade. Still, medical use of human tissue from a healthy and underage donor requires proper regulations and medical management. The guidelines below aim at underlining the importance of pondering the legal, medical and ethical aspects of using stem cells from healthy paediatric donors and stress out the importance of obtaining informed consent at the time of assessing HLA compatibility. Combined medical and psychological assessments are required before the donation, as well as one month later and one year later to ensure of the child's physical and mental wellbeing. Bone marrow harvest under general anaesthetics remains the preferred method of collection for children. Peripheral blood stem cell collection should only be considered for children who will not require a central venous access for collection. We aim at offering guidelines centered on the healthy child donating stem cells and his/her wellbeing, and these should be regularly reviewed as medical practices evolve.
Collapse
Affiliation(s)
- Marie Lejeune
- Service d'hématologie, CHU de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Bertille Menard
- Service d'hématologie pédiatrique, hôpital de la Timone Enfants, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Sophie Servais
- Service d'hématologie, CHU de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Christelle Andrianne
- Service d'hématologie, CHU de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Lucie Capelle
- Service d'hématologie pédiatrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - Ségolène De Maistre
- Service d'hématologie pédiatrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Catherine Fabaron
- Service d'onco-hematologie pédiatrique, CHU Purpan Toulouse, 1, place du Dr Baylac, 31300 Toulouse, France
| | - Marie Flata Cornier
- Service d'hémato-oncologie pédiatrique, hôpitaux universitaires de Genève, rue Willy-Donzé, 1203 Genève, Suisse
| | - Marie-Pierre Goutagny
- Service d'hématologie pédiatrique, IHOPe, 1, place Joseph-Renaut, 69008 Lyon, France
| | - Maguy Pereira
- Service d'hématologie, CHU de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Clea Tardy
- Service de pharmacie, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - Eric Turquet
- Service d'onco-hematologie pédiatrique, CHU de Rennes, Hôpital Sud, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Malek Benakli
- Coordinateur national du groupe algérien de travail sur la Greffe de cellules souches hématopoïétiques (GATGCSH), Centre Pierre et Marie Curie, rue Tebessi Larbi, Sidi M'Hamed, 16000 Alger, Algérie
| | - Etienne Baudoux
- Laboratoire de thérapie cellulaire et génique, centre hospitalier universitaire de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique
| | - Solène Evard
- Centre hospitalier universitaire de Rennes-Inserm, CIC-1414, centre d'investigation clinique de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes, France
| | - Catherine Faucher
- Agence de la biomédecine, 1, avenue du stade de France, 93212 Saint-Denis La Plaine cedex, France
| | - Gwenaelle Herrero
- Association de patients, rue de la Fontenette 23, 1227 Carouge,, Suisse
| | - Léonardo Magro
- LIRIC, Inserm U995, CHU de Lille, université de Lille, 59000 Lille, France
| | - Claire Geurten
- Service de pédiatrie, département d'hématologie pédiatrique, CHU de Liège, 1, avenue de l'Hôpital, 4000 Liège, Belgique.
| |
Collapse
|
3
|
Chen L, Wen J, Xu X, Du J, Ruan Y, Feng X, Li J, He Y, Wu X. Safety and efficacy of peripheral blood stem cells collection in healthy children and pediatric patients with thalassemia major weighing 20 kg or less. J Clin Apher 2024; 39:e22102. [PMID: 38186371 DOI: 10.1002/jca.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Peripheral blood stem cell (PBSC) collection in children poses challenges due to their small size, low body weight (BW), and unique pediatric physiology, especially among children weighing 20 kg (kg) or less. METHODS PBSC collection data of both healthy children and patients with thalassemia major (TM) weighing 20 kg or less between January 2013 and December 2020 were reviewed. Moreover, PBSCs characteristics along with various aspects of efficiency and safety between healthy donors and patients with TM were compared. RESULTS A total of 262 PBSC procedures were performed on 255 children. Of these, 91 procedures were carried out on 85 allogeneic healthy donors, and 171 auto-backup collections were performed on 170 patients with TM to ensure PBSC availability and prevent transplantation failure. A minimum pre-apheresis hemoglobin (HGB) level of 60 g/L was discovered to be safe and feasible in patients with TM. The median CD34+ cell dose in the PBSC product during the initial apheresis procedure was higher in healthy donors compared to patients with TM (7.29 ± 5.28 × 106 cells/kg vs5.88 ± 4.23 × 106 cells/kg, P = .043). The total CD34+ cells/kg recipient weight exhibited a positive correlation with pre-apheresis monocyte counts, but a negative correlation with donor weight. Apheresis significantly reduced hematocrit and platelet counts in the allogeneic group compared to the autologous group. Patients with TM experienced a higher occurrence of bone pain related to granulocyte colony-stimulating factor treatment. Notably, no serious complications related to PBSCs mobilization, central venous catheter placement, or the apheresis procedure were observed in either group. CONCLUSIONS PBSCs collection was both safe and effective in healthy children and pediatric patients with TM weighing 20 kg or less.
Collapse
Affiliation(s)
- Libai Chen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jianyun Wen
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoxiao Xu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jing Du
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yongsheng Ruan
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xiaoqin Feng
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Juan Li
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yuelin He
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Xuedong Wu
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| |
Collapse
|
4
|
Ross LF. The Philosophical Underpinning of the Family for Pediatric Decision-Making. Pediatr Clin North Am 2024; 71:27-37. [PMID: 37973304 DOI: 10.1016/j.pcl.2023.08.007] [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] [Indexed: 11/19/2023]
Abstract
Although traditional medical ethics focuses on the dyadic doctor-patient relationship, when the patient is a child, the relationship is triadic, meaning it involves the patient, the parent(s), and the clinician. A brief examination of the family, the rights and responsibilities of parents, the rights of children, and the moral basis of the parent-child relationship provide a philosophic underpinning for understanding the family in pediatric decision-making. Although biological parents have presumptive authority to make health-care decisions for their children, and are given wide discretion, parental autonomy is not absolute.
Collapse
Affiliation(s)
- Lainie Friedman Ross
- Department of Health Humanities and Bioethics, University of Rochester School of Medicine and Dentistry; Department of Pediatrics, University of Rochester School of Medicine and Dentistry; Paul M Schyve Center for Bioethics, University of Rochester; Department of Philosophy, University of Rochester.
| |
Collapse
|
5
|
Ros-Soto J, Pryce A, Zoubek E, Burlton C, Szydlo R, Anthias C. Favorable recovery profiles and good reliability among youngest unrelated stem cell donors supports lowering the minimum donor registration age. J Clin Apher 2023; 38:562-572. [PMID: 37309733 DOI: 10.1002/jca.22066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Younger donor age in hematopoietic cell transplantation has been associated with improved overall and disease-free survival. Safety data on peripheral blood stem cell (PBSC) and bone marrow (BM) donation is well established, including in the <18-year old age group in the related setting. In response, Anthony Nolan became the first stem cell donor registry to lower the minimum age for unrelated donors to 16-years. MATERIALS AND METHODS This retrospective study reviewed unrelated donors donating PBSC or BM for the first time between April 2015 and October 2017 since adoption of the lowered recruitment age. Data were collected from registry electronic database and structured follow-up questionnaires. Primary outcomes were turnaround time from VT to donation, optimal cell yield achievement, and physical and emotional recovery. RESULTS Out of a total of 1013 donors, there were no differences between the different age groups in proportion of donors achieving optimal CD34+ or TNC (PBSC and BM, respectively). There was no increased central line requirement for younger donors or increased emergency telephone support. Youngest donors were more likely to report physical recovery 2 and 7 days post-PBSC (P = .024 and P = .015, respectively) as well as an earlier emotional recovery (P = .001) and fewer physical symptoms 1 week BM donation (P = .04). CONCLUSION This study shows that younger donors are as reliable as older donors, and have favorable recovery profiles without need for increased support at any stage of the donation, supporting Anthony Nolan recruitment strategy and offering reassurance to donor registries considering the same.
Collapse
Affiliation(s)
- Jose Ros-Soto
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Angharad Pryce
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | | | | | - Richard Szydlo
- Anthony Nolan, London, UK
- Imperial College Healthcare Trust, London, UK
| | - Chloe Anthias
- Anthony Nolan, London, UK
- The Royal Marsden Healthcare Trust, London, UK
- Institute of Cancer Research London, London, UK
| |
Collapse
|
6
|
Epah J, Spohn G, Preiß K, Müller MM, Dörr J, Bauer R, Daqiq-Mirdad S, Schwäble J, Bernas SN, Schmidt AH, Seifried E, Schäfer R. Small volume bone marrow aspirates with high progenitor cell concentrations maximize cell therapy dose manufacture and substantially reduce donor hemoglobin loss. BMC Med 2023; 21:360. [PMID: 37726769 PMCID: PMC10510270 DOI: 10.1186/s12916-023-03059-3] [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: 05/11/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bone marrow (BM) transplantation is a life-saving therapy for hematological diseases, and the BM harbors also highly useful (progenitor) cell types for novel cell therapies manufacture. Yet, the BM collection technique is not standardized. METHODS Benchmarking our collection efficiency to BM collections worldwide (N = 1248), we noted a great variability of total nucleated cell (TNC) yields in BM products (HPC-M) with superior performance of our center, where we have implemented a small volume aspirate policy. Thus, we next prospectively aimed to assess the impact of BM collection technique on HPC-M quality. For each BM collection (N = 20 donors), small volume (3 mL) and large volume (10 mL) BM aspirates were sampled at 3 time points and analyzed for cell composition. RESULTS Compared to large volume aspirates, small volume aspirates concentrated more TNCs, immune cells, platelets, hematopoietic stem/progenitor cells, mesenchymal stromal cells (MSCs), and endothelial progenitors. Inversely, the hemoglobin concentration was higher in large volume aspirates indicating more hemoglobin loss. Manufacturing and dosing scenarios showed that small volume aspirates save up to 42% BM volume and 44% hemoglobin for HPC-M donors. Moreover, MSC production efficiency can be increased by more than 150%. CONCLUSIONS We propose to consider small volume BM aspiration as standard technique for BM collection.
Collapse
Affiliation(s)
- Jeremy Epah
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Gabriele Spohn
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Kathrin Preiß
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Markus M Müller
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Johanna Dörr
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Rainer Bauer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Shabnam Daqiq-Mirdad
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Joachim Schwäble
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | | | | | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen gGmbH, Goethe University Hospital, Frankfurt Am Main, Germany.
- Institute for Transfusion Medicine and Gene Therapy, Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| |
Collapse
|
7
|
Zubicaray J, Martin-Consuegra S, Nieto M, Albi G, Iriondo J, Sebastian E, Gálvez E, Molina B, González-Vicent M, de Pablo JG, Castillo A, Ramírez M, Madero L, Díaz MA, Sevilla J. Adverse events related to central venous catheters (CVC) and the influence of CVC characteristics on peripheral blood hematopoietic progenitor cell collection in children. Front Pediatr 2023; 11:1131905. [PMID: 37152327 PMCID: PMC10160364 DOI: 10.3389/fped.2023.1131905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The use of peripheral blood progenitor cells (PBPCs) as a source for hematopoietic stem cell transplantation (HSCT) in pediatric healthy donors is still under debate. The risk of a central venous catheter (CVC) placement and catheter-related complications continue to be the main arguments to discourage its use. Methods we present a retrospective analysis of 140 PBPC collections in pediatric patients and donors, describing adverse events (AE) related to CVCs as well as the influence of catheterrelated variables on the efficiency of the leukapheresis. Results 14 CVC-related AEs were recorded (10%). The most common was fever in 5 patients, 4 of which had a catheter-related bacteriemia. Thrombotic events were only observed in 3 patients with active malignancy. A healthy donor presented a moderate bleeding after catheter withdrawal that resolved with local measures, and none of the rest presented any AE. Regarding variables related to the development of AEs, the subject group (patient or donor) was the only one significantly associated (p < 0.0001). Of interest, efficiency was also related to catheter location, being worse in those located in the femoral vein than in into the jugular or the subclavian veins (p < 0.05). In a multivariate analysis, the only variable significantly associated was catheter size (beta 0.238, p < 0.01). Discussion Placing a CVC for PBPC collection in pediatric subjects is overall safe; CVC-related complications in pediatric healthy donors are very rare. Furthermore, we should try to place catheters of the largest caliber possible, since the efficiency of the collection is related to this variable.
Collapse
Affiliation(s)
- Josune Zubicaray
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sofía Martin-Consuegra
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Monserrat Nieto
- Pediatric Intensive Care Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Gustavo Albi
- Radiology Department, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - June Iriondo
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena Sebastian
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva Gálvez
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Blanca Molina
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jesus Gonzalez de Pablo
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Castillo
- Hematology and Oncology Laboratory, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramírez
- Hematology and Oncology Laboratory, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Hematology and Oncology Laboratory, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Miguel Angel Díaz
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julián Sevilla
- Hematology and Hemotherapy Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Correspondence: Julián Sevilla
| |
Collapse
|
8
|
Worel N, Aljurf M, Anthias C, Buser AS, Cody M, Fechter M, Galeano S, Greinix HT, Kisch AM, Koh MBC, Mengling T, Nicoloso G, Niederwieser D, Pulsipher MA, Seber A, Shaw BE, Stefanski HE, Switzer GE, Szer J, van Walraven SM, Yang H, Halter JP. Suitability of haematopoietic cell donors: updated consensus recommendations from the WBMT standing committee on donor issues. Lancet Haematol 2022; 9:e605-e614. [PMID: 35901845 DOI: 10.1016/s2352-3026(22)00184-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
The contribution of related donors to the globally rising number of allogeneic haematopoietic stem cell transplantations (HSCT) remains increasingly important, particularly because of the growing use of haploidentical HSCT. Compared with the strict recommendations on the suitability for unrelated donors, criteria for related donors allow for more discretion and vary between centres. In 2015, the donor outcome committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) proposed consensus recommendations of suitability criteria for paediatric and adult related donors. This Review provides updates and additions to these recommendations from a panel of experts with global representation, including the WBMT, the European Society for Blood and Marrow Transplantation donor outcome committee, the Center for International Blood and Marrow Transplant Research donor health and safety committee, the US National Marrow Donor Program, and the World Marrow Donor Association, after review of the current literature and guidelines. Sections on the suitability of related donors who would not qualify as unrelated donors have been updated. Sections on communicable diseases, clonal haematopoiesis of indeterminate potential, paediatric aspects including psychological issues, and reporting on serious adverse events have been added. The intention of this Review is to support decision making, with the goal of minimising the medical risk to the donor and protecting the recipient from transmissible diseases.
Collapse
Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, 1090, Austria.
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Riyadh Province, Saudi Arabia
| | - Chloe Anthias
- Anthony Nolan, London UK; Royal Marsden Hospital, London, UK
| | - Andreas S Buser
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland; Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Meghann Cody
- National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mirjam Fechter
- Matchis Foundation (the Dutch Centre for Stem Cell Donors), Leiden, the Netherlands
| | | | | | - Annika M Kisch
- Department of Haematology, Oncology, Radiation Physics, Skane University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Sweden
| | - Mickey B C Koh
- Infection and Immunity Institute, St George's, University of London, London, UK; Department of Haematology, St George's Hospital, London, UK; Cell Therapy Programme, Health Sciences Authority, Singapore, Singapore
| | | | - Grazia Nicoloso
- Swiss Transfusion Swiss Red Cross, Swiss Blood Stem Cells, Bern, Switzerland
| | - Dietger Niederwieser
- Medical Clinic and Policlinic 1, Haematology, Cellular Therapy and Hemostaseology, Leipzig Medical Centre, University Leipzig, Leipzig, Germany
| | - Michael A Pulsipher
- Division of Pediatric Haematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute at the Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Adriana Seber
- Hospital Samaritano and Insituto de Oncologia Pediatrica - Graacc-Unifesp, São Paulo, Brazil
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Galen E Switzer
- Departments of Medicine, Psychiatry, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suzanna M van Walraven
- Department for Quality and Release Management, Sanquin Blood Bank, Amsterdam, Netherlands
| | - Hung Yang
- Australian Bone Marrow Donor Registry, Sydney, NSW, Australia
| | - Jörg P Halter
- Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
9
|
Manson L, Barry J, Fong C, Potok D, Sweeny D, Reeks D, Watson D, Hope D, Piccinini E, Cui H, Keane H, Armstrong J, Sinclair J, Guest J, Chuku J, Kerr M, Francis N, Bell N, Smith R, Angelica R, Shingler W, Shingleton W, Turner M. Recommendations for procurement of starting materials by apheresis for advanced therapy medicinal products. Cytotherapy 2022; 24:861-868. [PMID: 35710768 DOI: 10.1016/j.jcyt.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022]
Abstract
Activities involved in the production of certain advanced therapy medicinal products (ATMPs) require standardized approaches to mononuclear cell procurement to ensure the highest product quality, safety and process efficiency. These aims must be achieved while meeting regulatory and accreditation requirements for the procurement of mononuclear cells as starting materials. Mononuclear cells constitute the starting materials for many ATMPs, and this article sets out recommendations for procurement by clinical apheresis, addressing the variation among existing working practices and different manufacturers' requirements that currently poses a challenge when managing multiple different protocols.
Collapse
Affiliation(s)
- Lynn Manson
- Jack Copland Centre, Scottish National Blood Transfusion Service, Edinburgh, UK
| | | | | | - Davina Potok
- National Health Service Blood and Transplant, Filton, UK
| | - Di Sweeny
- Christie National Health Service Foundation Trust, Manchester, UK
| | | | - Douglas Watson
- Cell and Gene Therapy, Novartis Pharmaceuticals UK Limited, London, UK
| | - Drew Hope
- eXmoor Pharma Concepts Ltd, Stoke Gifford, UK
| | | | - Haili Cui
- King's College Hospital National Health Service Foundation Trust, London, UK
| | - Helen Keane
- University College London Hospital National Health Service Foundation Trust, London, UK
| | | | | | - Julie Guest
- Great Northern Children's Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Justina Chuku
- Cell and Gene Therapy Catapult, Guy's Hospital, London, UK
| | - Maria Kerr
- National Health Service Blood and Transplant, Filton, UK
| | | | - Neil Bell
- Autolus Therapeutics plc, London, UK
| | - Richard Smith
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota, USA
| | - Rita Angelica
- Christie National Health Service Foundation Trust, Manchester, UK
| | | | | | - Marc Turner
- Jack Copland Centre, Scottish National Blood Transfusion Service, Edinburgh, UK.
| |
Collapse
|
10
|
Lederer CW, Koniali L, Buerki-Thurnherr T, Papasavva PL, La Grutta S, Licari A, Staud F, Bonifazi D, Kleanthous M. Catching Them Early: Framework Parameters and Progress for Prenatal and Childhood Application of Advanced Therapies. Pharmaceutics 2022; 14:pharmaceutics14040793. [PMID: 35456627 PMCID: PMC9031205 DOI: 10.3390/pharmaceutics14040793] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 01/19/2023] Open
Abstract
Advanced therapy medicinal products (ATMPs) are medicines for human use based on genes, cells or tissue engineering. After clear successes in adults, the nascent technology now sees increasing pediatric application. For many still untreatable disorders with pre- or perinatal onset, timely intervention is simply indispensable; thus, prenatal and pediatric applications of ATMPs hold great promise for curative treatments. Moreover, for most inherited disorders, early ATMP application may substantially improve efficiency, economy and accessibility compared with application in adults. Vindicating this notion, initial data for cell-based ATMPs show better cell yields, success rates and corrections of disease parameters for younger patients, in addition to reduced overall cell and vector requirements, illustrating that early application may resolve key obstacles to the widespread application of ATMPs for inherited disorders. Here, we provide a selective review of the latest ATMP developments for prenatal, perinatal and pediatric use, with special emphasis on its comparison with ATMPs for adults. Taken together, we provide a perspective on the enormous potential and key framework parameters of clinical prenatal and pediatric ATMP application.
Collapse
Affiliation(s)
- Carsten W. Lederer
- The Molecular Genetics Thalassemia Department, The Cyprus Institute of Neurology & Genetics, Nicosia 2371, Cyprus; (L.K.); (P.L.P.); (M.K.)
- Correspondence: ; Tel.: +357-22-392764
| | - Lola Koniali
- The Molecular Genetics Thalassemia Department, The Cyprus Institute of Neurology & Genetics, Nicosia 2371, Cyprus; (L.K.); (P.L.P.); (M.K.)
| | - Tina Buerki-Thurnherr
- Empa, Swiss Federal Laboratories for Materials Science and Technology, 9014 St. Gallen, Switzerland;
| | - Panayiota L. Papasavva
- The Molecular Genetics Thalassemia Department, The Cyprus Institute of Neurology & Genetics, Nicosia 2371, Cyprus; (L.K.); (P.L.P.); (M.K.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology, IFT National Research Council, 90146 Palermo, Italy;
| | - Amelia Licari
- Pediatric Clinic, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Frantisek Staud
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec Králové, Charles University, 50005 Hradec Králové, Czech Republic;
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche (CVBF) and European Paediatric Translational Research Infrastructure (EPTRI), 70122 Bari, Italy;
| | - Marina Kleanthous
- The Molecular Genetics Thalassemia Department, The Cyprus Institute of Neurology & Genetics, Nicosia 2371, Cyprus; (L.K.); (P.L.P.); (M.K.)
| |
Collapse
|
11
|
Basic characteristics and safety of donation in related and unrelated haematopoietic progenitor cell donors - first 10 years of prospective donor follow-up of Swiss donors. Bone Marrow Transplant 2022; 57:918-924. [PMID: 35379914 DOI: 10.1038/s41409-022-01656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Since July 2007 prospective life-long follow-up (FU) for unrelated (URD) and related donors (RD) is mandatory in Switzerland and data on every allogeneic haematopoietic progenitor cell (HPC) donation are collected prospectively. We report the real-world experience of HPC donation during a 10-year study period (01.07.2007-30.06.2017) with basic characteristics and FU data. 1105 donors underwent 1155 HPC donation procedures. Eighty percent of first donations performed by 802 (73%) RDs and 303 (27%) URDs were peripheral blood stem cells (PBSC), 20% bone marrow (BM). Male donors were over-represented as URD (60% male vs 40% female). Main differences between RDs and URDs concerned age and pre-existing health disorders. RDs were significantly older at first donation (median age 48 years) compared to URD (34 years, p < 0.0001) and had more pre-existing health problems: 25% vs 9% in URD (p < 0.0001). No fatal complications occurred, collection related severe adverse events (SAE) after first donation were not significantly different between groups (RD 1.2%, URD 0.99%), incidence rates for neoplastic and autoimmune diseases did not exceed the rates of the general population. RDs are a more heterogeneous and potentially more vulnerable group, but if donor evaluation is performed appropriately, HPC donation is still safe.
Collapse
|
12
|
Is there a choice when a sibling is ill? Experiences of children and adolescents who donated stem cells to a sibling. Eur J Oncol Nurs 2022; 58:102147. [DOI: 10.1016/j.ejon.2022.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/04/2022] [Accepted: 04/23/2022] [Indexed: 11/21/2022]
|
13
|
Bougar S, Atouf O, Ouadghiri S, Bourhanbour AD, Brick C, Essakalli M. Collection, cryopreservation and thawing of stem cells for children weighing less than 25 Kg with high-risk neuroblastoma: A single center results in Morocco. Hematol Transfus Cell Ther 2022; 44:535-541. [PMID: 35216961 PMCID: PMC9605889 DOI: 10.1016/j.htct.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/07/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction An important component of the advances made in neuroblastoma treatment has been the use of peripheral blood stem cells to support high-dose chemotherapy. In this study, we report our experience on a series of small children who have undergone standard and large volume leukaphersis (LVL) procedures, provide an update on a single institution's experience with cryopreservation of autologous peripheral blood stem cells (PBSCs), using 10% dimethyl sulfoxide (DMSO) and applying post-thaw DMSO depletion and analyze a number of variables that may affect viability. Methods A total of 36 aphereses were performed on 29 children weighing less than 25 kg between July 2016 and October 2019 at the Ibn Sina university hospital. Results Seven females and twenty-two males, median bodyweight 14 kg (9 - 22). A single apheresis was sufficient to obtain at least 3 × 10⁶/kg body weight (BW) of CD34+ cells in 82.8% of the cases. The LVL was performed in 22 aphereses. A median number of 5.9 × 10⁶/kg CD34 cells were collected per apheresis. A total of 60 PBSC samples were cryopreserved and 46 samples were infused. The mean cell viability percentage decreased from 94.75 ± 1.14% before freezing to 70.84 ± 8.6% after thawing (p < 0.001). No correlation was found between post-thaw viability and storage time (r = -0.233; p = 0.234) or number of total nucleated cells (r = 0.344; p = 0.073). Conclusion Leukapheresis is safe and feasible in small pediatric patients if the appropriate measures are used. Cryopreservation poses numerous challenges, especially a decrease in cell viability after thawing.
Collapse
Affiliation(s)
- Sara Bougar
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco.
| | - Ouafa Atouf
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | - Sanae Ouadghiri
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| | | | - Chehrazade Brick
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco
| | - Malika Essakalli
- Ibn Sina University Hospital, Tissue and Stem cell Bank, Rabat, Morocco; University Mohamed V, Faculty of Medicine and Pharmacy, UPR of Immunology, Rabat, Morocco
| |
Collapse
|
14
|
Livingston J, Di-Mola M, Lowry J, Ruse N, Chiang KY, Chopra Y, Schechter T, Ali M, Licht C, Wall D, Krueger J. Peripheral venous catheter collection of immune effector cells and hematopoietic stem cells is feasible and safe in older pediatric patients. Transfusion 2021; 61:3413-3419. [PMID: 34751944 DOI: 10.1111/trf.16717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Collection of hematopoietic stem cells (HSC) and immune effector cells (IEC) has unique challenges in children. To maintain adequate blood flow, central venous catheters (CVCs) remain the standard of care in many centers, but are associated with procedural risks and increased resource utilization. The goal of this study was to determine feasibility and safety of peripheral venous catheter (PVC) cell collection in older children. METHODS Patients and donors requiring venous access with weight >25 kg, age >8 years were screened for PVC collection via 18G PVCs. Those with poor venous access (on history/exam/pre-screening ultrasound) or unable to maintain suitable procedural position were excluded. Comparison was made to CVC collections in a matched patient cohort. RESULTS Thirty-eight individuals were screened and met age/weight criteria for PVC collection. Five did not have PVC collection attempted due to poor access (n = 4) or behavioral concerns (n = 1). Thirty-three had PVC collection attempt (HSC = 22; IEC = 11) with median age 15.3 year (range 9.7-18.0) and weight 58.5 kg (range 27.9-115.4). Thirty-two of 33 (97%) patients were collected successfully by PVC without adverse events. Comparing PVC to matched CVC collection cohort (n = 18), there was no significant difference in flow rate (48.2 mL/h vs 53.9 mL/h, p = 0.12), collection time (266 min vs 262 min, p = 0.85) or collection efficiency (IEC/CD3 60.9% vs 60.8% p = 0.99; HSC/CD34 53.6% vs 41.3% p = 0.05). CONCLUSION PVC collection of HSC and IEC is feasible and safe in older children with comparable collection efficiency to CVC collections. Ultrasound screening may reduce failure rates. PVC collections can reduce the risk of CVC insertions and associated healthcare costs.
Collapse
Affiliation(s)
- Joel Livingston
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Maria Di-Mola
- Dialysis and Apheresis Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Lowry
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nigel Ruse
- Vascular Access Service, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kuang-Yueh Chiang
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Yogi Chopra
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Ali
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Christoph Licht
- Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada.,Dialysis and Apheresis Program, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donna Wall
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Joerg Krueger
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Canarutto D, Tucci F, Gattillo S, Zambelli M, Calbi V, Gentner B, Ferrua F, Marktel S, Migliavacca M, Barzaghi F, Consiglieri G, Gallo V, Fumagalli F, Massariello P, Parisi C, Viarengo G, Albertazzi E, Silvani P, Milani R, Santoleri L, Ciceri F, Cicalese MP, Bernardo ME, Aiuti A. Peripheral blood stem and progenitor cell collection in pediatric candidates for ex vivo gene therapy: a 10-year series. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2021; 22:76-83. [PMID: 34485596 PMCID: PMC8390560 DOI: 10.1016/j.omtm.2021.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 01/09/2023]
Abstract
Hematopoietic stem and progenitor cell (HSPC)-based gene therapy (GT) requires the collection of a large number of cells. While bone marrow (BM) is the most common source of HSPCs in pediatric donors, the collection of autologous peripheral blood stem cells (PBSCs) is an attractive alternative for GT. We present safety and efficacy data of a 10-year cohort of 45 pediatric patients who underwent PBSC collection for backup and/or purification of CD34+ cells for ex vivo gene transfer. Median age was 3.7 years and median weight 15.8 kg. After mobilization with lenograstim/plerixafor (n = 41) or lenograstim alone (n = 4) and 1−3 cycles of leukapheresis, median collection was 37 × 106 CD34+ cells/kg. The procedures were well tolerated. Patients who collected ≥7 and ≥13 × 106 CD34+ cells/kg in the first cycle had pre-apheresis circulating counts of at ≥42 and ≥86 CD34+ cells/μL, respectively. Weight-adjusted CD34+ cell yield was positively correlated with peripheral CD34+ cell counts and influenced by female gender, disease, and drug dosage. All patients received a GT product above the minimum target, ranging from 4 to 30.9 × 106 CD34+ cells/kg. Pediatric PBSC collection compares well to BM harvest in terms of CD34+ cell yields for the purpose of GT, with a favorable safety profile.
Collapse
Affiliation(s)
- Daniele Canarutto
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Salvatore Gattillo
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Matilde Zambelli
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Giulia Consiglieri
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Vera Gallo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | | | - Cristina Parisi
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Gianluca Viarengo
- Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico S. Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Elena Albertazzi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Luca Santoleri
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maria Ester Bernardo
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Alessandro Aiuti
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.,Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| |
Collapse
|
16
|
Peripheral Blood Stem Cell Mobilization and Collection in Pediatric Healthy Sibling Donors Weighing 20 Kilograms or Less; Algerian Experience. Transfus Apher Sci 2020; 59:102987. [DOI: 10.1016/j.transci.2020.102987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
17
|
Zubicaray J, Galvez E, Sebastian E, Molina B, González-Vicent M, Castillo A, Ramírez M, Madero L, Díaz MA, Sevilla J. Plerixafor-based mobilization in pediatric healthy donors with unfavorable donor/recipient body weight ratio resulted in a better CD34 + collection yield: A retrospective analysis. J Clin Apher 2020; 36:78-86. [PMID: 33079424 DOI: 10.1002/jca.21844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In order to propose risk-adapted mobilization algorithms, several authors have tried to look for predictive factors of the CD34+ yield in healthy pediatric donors. Donor recipient body weight ratio (D/R ratio) was identified as one of the main variables related with the success to achieve the target cell dose for transplantation. According to this variable we modified the mobilization schedule. MATERIAL AND METHODS We report the results of 46 mobilizations and apheresis procedures performed in our center with unfavorable D/R ratio. Mobilization was attempted by the standard regime of G-CSF (10 mcg/kg/24 hours) in 28 cases (60.9%), with high dose G-CSF (10 mcg/kg/12 hours) in 9 cases (19.6%), and with plerixafor and G-CSF single dose regime in 9 cases (19.6%). RESULTS CD34+ cell quantification before apheresis is closely related to CD34+ yield, being the only factor related to collected CD34+ cells (beta .71; P < .0001). The mobilization efficiency was higher in plerixafor group compared to the other two schedules (P < .0001). By using plerixafor for mobilization, we achieved the target CD34+ cell dose of ≥2 × 106 /kg per recipient body weight in all cases with unfavorable D/R ratio. It was observed that 17.4% of cases that not reached the established target cell dose were located in the standard or high-dose mobilization regimes. This difference is even greater for optimal collections (≥5 × 106 /kg), since of the 54.3% cases that did not reach this goal none was mobilized by plerixafor. CONCLUSION Tailoring the mobilization regime we can reach the target cell dose, even in those cases with the worst D/R ratio.
Collapse
Affiliation(s)
- Josune Zubicaray
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Eva Galvez
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena Sebastian
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Blanca Molina
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta González-Vicent
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ana Castillo
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Manuel Ramírez
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Luis Madero
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Laboratorio Hematología y Oncología, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Miguel Angel Díaz
- Hematopoietic Transplant Unit, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Julian Sevilla
- Hematology y Hemotherapy Unit, Hematología y Oncología Pediátricas, Fundación para la Investigación Biomédica Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| |
Collapse
|
18
|
Devasia AJ, Abraham MA, Sagadevan C, Korula A, Kulkarni U, Fouzia NA, Abraham A, Srivastava A, Mathews V, George SP, George B. Safety of peripheral blood stem cell harvest in children under anaesthesia in the day care setting - A single centre experience. Transfus Apher Sci 2020; 60:102962. [PMID: 33051092 DOI: 10.1016/j.transci.2020.102962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
The use of cytokine mobilized peripheral blood stem cells (PBSC) for stem cell transplantation offers early engraftment, and less early transplant related mortality and morbidity. This can be done easily in the out-patient setting in an adult donor, but is difficult in children. The safety and efficacy of general anaesthesia outside the controlled operation room setting is quite challenging and demanding. We present our experience with paediatric PBSC harvest done under anaesthesia in the out-patient setting between January 2009 to June 2017. A total of 158 children underwent 164 PBSC harvests during the study period. Donors were predominantly females with a median age of 5 years (1-12) and a median weight of 17.5 kg (9.4-51). In 50% of the cases, induction of anaesthesia was by sevoflurane followed by total intravenous anaesthesia (TIVA) while in 32% it was sevoflurane induction followed by sedation. Hudson mask (48.5%) and laryngeal mask airway (50%) were the most common modes of airway and all patients were ventilated in the spontaneous mode. Propofol was the most commonly used maintenance agent (67%). There were no major complications except for acute pulmonary edema secondary to infusion of blood products requiring a short stay in ICU for one donor. All donors were discharged on the next day of harvest. No long term complications have been reported in any of these donors. Paediatric PBSC harvest can be safely done under anaesthesia with due precautions in the day care setting.
Collapse
Affiliation(s)
- Anup J Devasia
- Department of Haematology, Christian Medical College, Vellore, India.
| | | | | | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Uday Kulkarni
- Department of Haematology, Christian Medical College, Vellore, India
| | - N A Fouzia
- Department of Haematology, Christian Medical College, Vellore, India
| | - Aby Abraham
- Department of Haematology, Christian Medical College, Vellore, India
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | | | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| |
Collapse
|
19
|
Farhadfar N, Murthy HS, Logan BR, Sees JA, Ayas M, Battiwalla M, Beitinjaneh AM, Chhabra S, Diaz MA, Engles K, Frangoul H, Ganguly S, Gergis U, Kamani NR, Kamble RT, Kasow KA, Lazarus HM, Liesveld JL, Norkin M, O' Donnell PV, Olsson RF, Rossmann S, Savani BN, Schears R, Seo S, Solh MM, Spitzer T, Sugrue M, Yared JA, Linenberger M, Schwartz J, Pulsipher MA, Shah NN, Switzer GE, Confer DL, Shaw BE, Wingard JR. Impact of autologous blood transfusion after bone marrow harvest on unrelated donor's health and outcome: a CIBMTR analysis. Bone Marrow Transplant 2020; 55:2121-2131. [PMID: 32355289 DOI: 10.1038/s41409-020-0911-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/03/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Abstract
Pre-harvest autologous blood collection from bone marrow (BM) donors is performed to meet potential post-operative transfusion needs. This study examines the impact of autologous blood transfusion on BM donor's health and safety. The study included first-time unrelated BM donors from the United States whose BM harvest was facilitated by the National Marrow Donor Program (NMDP) centers between 2006 and 2017. Examination of 7024 BM donors revealed that 60% received at least one unit of autologous blood. The donors who received autologous blood were older, had lower hemoglobin pre-harvest, underwent longer duration of anesthesia, and higher volume BM harvest. Only donors who underwent high-volume BM harvest, defined as a BM harvest volume >27% of donor's blood volume, benefited from autologous transfusion. After a high-volume BM harvest, autologous blood transfusion was shown to decrease grade 2 to 4 collection-associated toxicities within 48 h of BM donation (p = 0.010) and shorten the time to donor-reported "complete" recovery from donation-associated symptoms (p < 0.001). Therefore, autologous transfusion could be avoided as support of marrow donation in the majority of unrelated BM donors and should be limited to cases where the planned BM harvest volume is expected to exceed 27% of donor's blood volume.
Collapse
Affiliation(s)
- Nosha Farhadfar
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Brent R Logan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Sees
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Mouhab Ayas
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Saurabh Chhabra
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | - Katie Engles
- CW Bill Young Marrow Donor Program, Kensington, MD, USA
| | - Haydar Frangoul
- The Children's Hospital at TriStar Centennial and Sarah Cannon Research Institute, Nashville, TN, USA
| | - Siddhartha Ganguly
- Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, KS, USA
| | - Usama Gergis
- Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Rammurti T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jane L Liesveld
- Strong Memorial Hospital-University of Rochester Medical Center, Rochester, NY, USA
| | - Maxim Norkin
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| | | | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Raquel Schears
- Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA
| | | | - Melhem M Solh
- The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | | | | | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA
| | | | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Dennis L Confer
- CIBMTR® (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.,National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Bronwen E Shaw
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - John R Wingard
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, FL, USA
| |
Collapse
|
20
|
Connelly-Smith LS. Donor Evaluation for Hematopoietic Stem and Progenitor Cell Collection. ADVANCES AND CONTROVERSIES IN HEMATOPOIETIC TRANSPLANTATION AND CELL THERAPY 2020. [PMCID: PMC7123736 DOI: 10.1007/978-3-319-55131-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
With the increasing incidence of hematopoietic allogeneic cell transplantation (allo-HCT), the importance of securing a cellular product, safely from a donor, and ensuring that the product is without additional risk to the recipient, continues to be of paramount importance. The evaluation of the donor’s medical eligibility and suitability is designed to identify and limit the risk of transmitting infectious, genetic, or neoplastic diseases to the recipient through the product. It also aims to ensure a maximum level of safety for the donor and informs them of the risks of donation. Several regulatory agencies, national and international registries, and accreditation bodies have facilitated the availability and safe provision of human cells, tissues, and cellular- and tissue-based products not only at local institutions but also through international exchange.
Collapse
|
21
|
Balduzzi A, Dalle JH, Wachowiak J, Yaniv I, Yesilipek A, Sedlacek P, Bierings M, Ifversen M, Sufliarska S, Kalwak K, Lankester A, Toporski J, Di Maio L, Glogova E, Poetschger U, Peters C. Transplantation in Children and Adolescents with Acute Lymphoblastic Leukemia from a Matched Donor versus an HLA-Identical Sibling: Is the Outcome Comparable? Results from the International BFM ALL SCT 2007 Study. Biol Blood Marrow Transplant 2019; 25:2197-2210. [PMID: 31319153 DOI: 10.1016/j.bbmt.2019.07.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
Eligibility criteria for hematopoietic stem cell transplantation (HSCT) in acute lymphoblastic leukemia (ALL) vary according to disease characteristics, response to treatment, and type of available donor. As the risk profile of the patient worsens, a wider degree of HLA mismatching is considered acceptable. A total of 138 children and adolescents who underwent HSCT from HLA-identical sibling donors (MSDs) and 210 who underwent HSCT from matched donors (MDs) (median age, 9 years; 68% male) in 10 countries were enrolled in the International-BFM ALL SCT 2007 prospective study to assess the impact of donor type in HSCT for pediatric ALL. The 4-year event-free survival (65 ± 5% vs 61 ± 4%; P = .287), overall survival (72 ± 4% versus 68 ± 4%; P = .235), cumulative incidence of relapse (24 ± 4% versus 25 ± 3%; P = .658) and nonrelapse mortality (10 ± 3% versus 14 ± 3%; P = .212) were not significantly different between MSD and MD graft recipients. The risk of extensive chronic (cGVHD) was lower in MD graft recipients than in MSD graft recipients (hazard ratio [HR], .38; P = .002), and the risks of severe acute GVHD (aGVHD) and cGVHD were higher in peripheral blood stem cell graft recipients than in bone marrow graft recipients (HR, 2.06; P = .026). Compared with the absence of aGVHD, grade I-II aGVHD was associated with a lower risk of graft failure (HR, .63; P = .042) and grade III-IV aGVHD was associated with a higher risk of graft failure (HR, 1.85; P = .020) and nonleukemic death (HR, 8.76; P < .0001), despite a lower risk of relapse (HR, .32; P = .021). Compared with the absence of cGVHD, extensive cGVHD was associated with a higher risk of nonleukemic death (HR, 8.12; P < .0001). Because the outcomes of transplantation from a matched donor were not inferior to those of transplantation from an HLA-identical sibling, eligibility criteria for transplantation might be reviewed in pediatric ALL and possibly in other malignancies as well. Bone marrow should be the preferred stem cell source, and the addition of MTX should be considered in MSD graft recipients.
Collapse
Affiliation(s)
- Adriana Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy.
| | - Jean-Hugues Dalle
- Hemato-Immunology Department, Robert-Debre Hospital, APHP and Paris-Diderot University, Paris, France
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Isaac Yaniv
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Akif Yesilipek
- Antalya Medicalpark Hospital, Pediatric Stem Cell Transplantation Unit, Antalya, Turkey
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Marc Bierings
- Princess Maxima Centre for Pediatric Oncology and Utrecht University Children's Hospital, Utrecht, The Netherlands
| | - Marianne Ifversen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sabina Sufliarska
- Bone Marrow Transplantation Unit, Comenius University Children's Hospital, Bratislava, Slovakia, Bratislava, Slovakia
| | - Krzysztof Kalwak
- Department of Pediatric Hematology/Oncology and BMT, Wroclaw Medical University, Wroclaw, Poland
| | - Arjan Lankester
- Department of Pediatrics, University Medical Centre, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Jacek Toporski
- Children's Hospital, Skåne University Hospital, Lund, Sweden
| | - Lucia Di Maio
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | | | | | | |
Collapse
|
22
|
Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Ball ED, Bolwell BJ, Bunin NJ, Cheerva A, Delgado DC, Dvorak CC, Gillio AP, Hahn TE, Hale GA, Haight AE, Hayes-Lattin BM, Kasow KA, Linenberger M, Magalhaes-Silverman M, Mori S, Prasad VK, Quigg TC, Sahdev I, Schriber JR, Shenoy S, Tse WT, Yanik GA, Navarro WH, Horowitz MM, Confer DL, Shaw BE, Switzer GE. Higher Risks of Toxicity and Incomplete Recovery in 13- to 17-Year-Old Females after Marrow Donation: RDSafe Peds Results. Biol Blood Marrow Transplant 2019; 25:955-964. [PMID: 30605731 PMCID: PMC6511296 DOI: 10.1016/j.bbmt.2018.12.765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
Although donation of bone marrow (BM) or peripheral blood stem cells (PBSCs) from children to family members undergoing allogeneic transplantation are well-established procedures, studies detailing levels of pain, symptoms, and long-term recovery are lacking. To address this lack, we prospectively enrolled 294 donors age <18 years at 25 pediatric transplantation centers in North America, assessing them predonation, peridonation, and at 1 month, 6 months, and 1 year postdonation. We noted that 71% of children reported pain and 59% reported other symptoms peridonation, with resolution to 14% and 12% at 1 month postdonation. Both older age (age 13 to 17 years versus younger) and female sex were associated with higher levels of pain peridonation, with the highest rates in older females (57% with grade 2-4 pain and 17% with grade 3-4 pain). Multivariate analyses showed a 4-fold increase in risk for older females compared with males age <13 years (P <.001). At 1 year, 11% of 13- to 17-year-old females reported grade 2-4 pain, compared with 3% of males age 13 to 17 years, 0% of females age <13 years, and 1% of males age <13 years (P = .01). Males and females age 13 to 17 years failed to return to predonation pain levels at 1 year 22% and 23% of the time, respectively, compared with 3% and 10% in males and females age <13 years (P = .002). Our data show that females age 13 to 17 years are at increased risk of grade 2-4 pain at 1 year and >20% of females and males age 13 to 17 years do not return to baseline pain levels by 1 year after BM donation. Studies aimed at decreasing symptoms and improving recovery in older children are warranted.
Collapse
Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Center for Children's Cancer and Blood Diseases, USC Keck School of Medicine, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Chapel Hill, North Carolina, Division of Hematology and Oncology
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine. M.D. Anderson Cancer Center, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Department of Landscape Architecture & Urban Planning, Center for Health Systems & Design, Texas A&M University, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | - Brian J Bolwell
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nancy J Bunin
- Blood and Marrow Transplant Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexandra Cheerva
- Blood and Marrow Transplant Program, Kosair Children's Hospital, Louisville, Kentucky
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - Alfred P Gillio
- Pediatric Hematology-Oncology, Hackensack Meridian University Medical Center, Hackensack, New Jersey
| | - Theresa E Hahn
- Department of Medicine. Cancer Prevention and Population Sciences CCSG Program. Roswell Park Cancer Institute, Buffalo, New York
| | - Gregory A Hale
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Michael Linenberger
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Shalini Shenoy
- Hematology and Oncology, St. Louis Children's Hospital, St. Louis, Missouri
| | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
23
|
Donor assessment and follow-up: not a minor issue. Bone Marrow Transplant 2019; 54:1728-1729. [PMID: 30971778 DOI: 10.1038/s41409-019-0529-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/08/2022]
|
24
|
Parikh SH, Pentz RD, Haight A, Adeli M, Martin PL, Driscoll TA, Page K, Kurtzberg J, Prasad VK, Barfield RC. Ethical considerations of using a single minor donor for three bone marrow harvests for three HLA-matched siblings with primary immunodeficiency. Pediatr Blood Cancer 2019; 66:e27602. [PMID: 30609294 DOI: 10.1002/pbc.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 11/07/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation is curative for primary immunodeficiencies. Bone marrow from an unaffected human leukocyte antigen (HLA)-identical sibling donor is the ideal graft source. For minor donors, meaningful consent or assent may not be feasible, and permission from parents or legal guardians is considered acceptable. Adverse events, albeit extremely small, can be associated with bone marrow harvest in pediatric donors. Donor safety concerns potentially increase with multiple bone marrow harvests. Very little is known about multiple bone marrow harvests from pediatric donors. We describe the ethical considerations and clinical decision-making in an unusual clinical situation where three patients with the same primary immunodeficiency were HLA identical to one another and their younger sibling, who underwent bone marrow harvests three times between 1.3 and 4 years of age, resulting in successful transplantation for all three patients. We hope that this experience will provide guidance to providers and families in a similar situation.
Collapse
Affiliation(s)
| | | | - Ann Haight
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, Georgia
| | | | - Paul L Martin
- Duke University Medical Center, Durham, North Carolina
| | | | - Kristin Page
- Duke University Medical Center, Durham, North Carolina
| | | | | | | |
Collapse
|
25
|
One single bone marrow harvesting from donors under 3 years of age: assessing safety and efficacy of the procedure. Bone Marrow Transplant 2018; 54:1121-1123. [DOI: 10.1038/s41409-018-0415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 11/09/2022]
|
26
|
Hoag J, Igler E, Karst J, Bingen K, Kupst MJ. Decision-making, knowledge, and psychosocial outcomes in pediatric siblings identified to donate hematopoietic stem cells. J Psychosoc Oncol 2018; 37:367-382. [PMID: 30372379 DOI: 10.1080/07347332.2018.1489443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To (a) describe the decision-making experience and psychosocial outcome of sibling hematopoietic stem cell (HSC) donors, and (b) to determine the feasibility of completing a prospective and longitudinal assessment of HSC sibling donors at a single institution. DESIGN A mixed-methods approach was utilized. SAMPLE AND METHODS 12 potential siblings HSC donors aged 10-21 years completed various psychological measures and participated in semi-structured interviews at three time points in the donation experience: pre-donation, within 1 week after the harvest procedure, and six months post-donation. Caregivers also completed parent-proxy measures. FINDINGS Qualitative analysis indicated donors want to make their own decision about donation but may not be given the option or may feel that there is no choice given their limited awareness of alternative options. Donors felt well prepared for the donation procedure but demonstrated a poor understanding of possible recipient outcomes. A minority of donors endorsed emotional distress prior to and after donation; however, this was not linked to recipient health. Forty percent of donors felt that they had inadequate support following their donation. Small sample size restricted quantitative data analysis. CONCLUSIONS AND IMPLICATIONS Utilizing a donor advocate offers opportunity to work with donors to encourage decision-making tied to ideals rather obligation, increase education about possible recipient outcomes, and offer support at key times, such as when a recipient dies. Future research should include prospective multi-site studies.
Collapse
Affiliation(s)
- Jennifer Hoag
- a Department of Pediatrics , Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - Eva Igler
- a Department of Pediatrics , Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - Jeffrey Karst
- a Department of Pediatrics , Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - Kristin Bingen
- a Department of Pediatrics , Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - Mary Jo Kupst
- a Department of Pediatrics , Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| |
Collapse
|
27
|
Abstract
Apheresis procedures are standard of care for a wide range of indications in children, collection of hematopoietic stem cells being the most frequent one. With increasing numbers of hematopoietic stem cell transplants, advances in graft manipulation techniques and the development of innovative therapies using immune effector cells and gene therapy, apheresis within the pediatric population is growing in demand. While young children have higher circulating white blood cell counts and robustly mobilize hematopoietic stem cells, apheresis machines were designed for use within the adult population and apheresis procedures in children, particularly small children, can be more challenging as vascular access, collection techniques and impact of extracorporeal volumes increase the rate of adverse events. In this article we review topics of particular relevance to hematopoietic stem cell and immune effector cell collections in small children.
Collapse
|
28
|
|
29
|
Styczynski J. Young child as a donor of cells for transplantation and lymphocyte based therapies. Transfus Apher Sci 2018; 57:323-330. [DOI: 10.1016/j.transci.2018.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Del Fante C, Seghatchian J, Perotti C. Reflections on methodical approaches to hematopoietic stem cell collection in children. Transfus Apher Sci 2018; 57:425-427. [DOI: 10.1016/j.transci.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
31
|
Perotti C, Seghatchian J, Del Fante C. Pediatric apheresis emergencies and urgencies: An update. Transfus Apher Sci 2018; 57:339-341. [PMID: 29784538 DOI: 10.1016/j.transci.2018.05.016] [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] [Indexed: 11/18/2022]
Abstract
Urgency and emergency in general, and even more in the pediatric setting, remain a thematic debate not yet fully resolved. The decision to undergo a pediatric patient to an invasive treatment not free from potentially serious side effects like an apheresis procedure should be weighted with great attention. At the moment there is no unanimous consensus about the clinical pictures in which an urgency procedure in pediatrics is indicated. Each center acts according to its own experience and not infrequently to its own fears. Consequently the difficult to draw up an unequivocal shared list of pathologies needing an intervention in urgency/emergency it is confirmed as problematic. We report the experience of a big multidisciplinary hospital that has selected and shared with the specialists of different medical disciplines during the years the pediatric clinical conditions in which an urgent intervention with apheresis technology is indicated.
Collapse
Affiliation(s)
- Cesare Perotti
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico S. Matteo, Pavia Italy.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection, and DDR Strategies, London, UK
| | - Claudia Del Fante
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico S. Matteo, Pavia Italy
| |
Collapse
|
32
|
Pruszczyk K, Skwierawska K, Król M, Moskowicz A, Jabłoński D, Torosian T, Piotrowska I, Urbanowska E, Wiktor-Jędrzejczak W, Snarski E. Bone marrow harvest from unrelated donors-up-to-date methodology. Eur J Haematol 2018; 99:357-365. [PMID: 28719093 DOI: 10.1111/ejh.12929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Bone marrow harvesting is one of the essential sources of stem cells for hematopoietic stem cell transplantation. We describe here the current "up-to-date" standard of the bone marrow harvest in unrelated stem cell donors. METHODS We analyzed medical data of 187 unrelated hematopoietic stem cell donors who underwent bone marrow harvest without previous peripheral blood stem collection at the center between 2011 and 2015. The methodology of marrow collection includes multiple cells aimed at safety of the procedure, for example, educational movie, modified skin disinfection protocol, cell enumeration during the procedure, reduction of the contamination surfaces, and ongoing monitoring of the quality of work of the doctors. RESULTS The total nucleated cell count over 2×108 per kg of recipient has been reached in 93.6% of harvests. All of the donors harvested more than 1×108 per kg of the recipient. There were no donors who required transfusions or had serious adverse events during and after the harvest. CONCLUSION We describe here the current up-to-date standard of bone marrow harvest, which leads to excellent results in majority of donors without causing significant complications during the donation.
Collapse
Affiliation(s)
- Katarzyna Pruszczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kamila Skwierawska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Król
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Albert Moskowicz
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Elżbieta Urbanowska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Emilian Snarski
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
33
|
Then SN, Kerridge IH, Marks M. Children as haematopoietic stem cell donors: ethically challenging and legally complex. Med J Aust 2018; 208:334-337. [PMID: 29716509 DOI: 10.5694/mja17.00758] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/05/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Shih-Ning Then
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW
| | | |
Collapse
|
34
|
Furey A, Rastogi S, Prince R, Jin Z, Smilow E, Briamonte C, Kahn JM, Tanhehco Y, Patel N, George D, Garvin J, Bhatia M, Satwani P. Bone Marrow Harvest in Pediatric Sibling Donors: Role of Granulocyte Colony-Stimulating Factor Priming and CD34+ Cell Dose. Biol Blood Marrow Transplant 2018; 24:324-329. [DOI: 10.1016/j.bbmt.2017.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
|
35
|
Karasu G, Uygun V, Yesilipek A. Factors associated with peripheral blood stem cell yield in healthy pediatric donors. Transfus Apher Sci 2017; 56:819-824. [DOI: 10.1016/j.transci.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
36
|
Ghosh S, Indracanti N, Joshi J, Indraganti PK. Rescuing Self: Transient Isolation and Autologous Transplantation of Bone Marrow Mitigates Radiation-Induced Hematopoietic Syndrome and Mortality in Mice. Front Immunol 2017; 8:1180. [PMID: 28993772 PMCID: PMC5622201 DOI: 10.3389/fimmu.2017.01180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/06/2017] [Indexed: 01/19/2023] Open
Abstract
The inflamed bone marrow niche shortly after total body irradiation (TBI) is known to contribute to loss of hematopoietic stem cells in terms of their number and function. In this study, autologous bone marrow transfer (AL-BMT) was evaluated as a strategy for mitigating hematopoietic form of the acute radiation syndrome by timing the collection phase (2 h after irradiation) and reinfusion (24 h after irradiation) using mice as a model system. Collection of bone marrow (BM) cells (0.5 × 106 total marrow cells) 2 h after lethal TBI rescued different subclasses of hematopoietic stem and progenitor cells (HSPCs) from the detrimental inflammatory and damaging milieu in vivo. Cryopreservation of collected graft and its reinfusion 24 h after TBI significantly rescued mice from lethal effects of irradiation (65% survival against 0% in TBI group on day 30th) and hematopoietic depression. Transient hypometabolic state (HMS) induced 2 h after TBI effectively preserved the functional status of HSPCs and improved hematopoietic recovery even when BM was collected 8 h after TBI. Homing studies suggested that AL-BMT yielded similar percentages for different subsets of HSPCs when compared to syngeneic bone marrow transfer. The results suggest that the timing of collection, and reinfusion of graft is crucial for the success of AL-BMT.
Collapse
Affiliation(s)
- Subhajit Ghosh
- Division of Radiation Biosciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.,S.N. Pradhan Centre for Neuroscience-University of Calcutta, Kolkata, India
| | - Namita Indracanti
- Division of Radiation Biosciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Jayadev Joshi
- Division of Radiation Biosciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.,S.N. Pradhan Centre for Neuroscience-University of Calcutta, Kolkata, India
| | - Prem Kumar Indraganti
- Division of Radiation Biosciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| |
Collapse
|
37
|
Pahnke S, Larfors G, Axdorph-Nygell U, Fischer-Nielsen A, Haastrup E, Heldal D, Itälä-Remes M, Johansson JE, Kauppila M, Lenhoff S, Ljungman P, Niittyvuopio R, Sandstedt A, Hägglund H. Short-term side effects and attitudes towards second donation: A comparison of related and unrelated haematopoietic stem cell donors. J Clin Apher 2017; 33:226-235. [PMID: 28833474 DOI: 10.1002/jca.21576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/02/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022]
Abstract
The Nordic Register of Haematopoietic Stem Cell Donors (NRHSD) has registered related and unrelated donors from 10 transplant centres in Sweden, Norway, Finland and Denmark since 1998. We present a prospective, observational study of 1,957 donors, focusing mainly on the differences between related and unrelated donors. Related donors are reported to have more comorbidities, but similar side effects compared with unrelated donors. Side effects after BM or PBSC donation are generally of short duration and in this study no deaths, myocardial infarctions, splenic ruptures, or thromboembolic events are reported. Interestingly, related donors express more hesitancy towards donating again when asked 1 month after donation.
Collapse
Affiliation(s)
- Simon Pahnke
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Axdorph-Nygell
- Centre for Apheresis and Stem Cell Processing (CASH), Clinical Immunology/Transfusion Medicine, and Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Haastrup
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dag Heldal
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Maija Itälä-Remes
- Stem Cell Transplantation Unit, Turku University Hospital, Turku, Finland
| | - Jan-Erik Johansson
- Department of Haematology and Coagulation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marjut Kauppila
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Stig Lenhoff
- Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Per Ljungman
- Department of Haematology, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska University Hospital, Division of Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Riita Niittyvuopio
- Stem Cell Transplantation Unit, Helsinki University Hospital, Helsinki, Finland
| | - Anna Sandstedt
- Department of Haematology, Linköping University Hospital, Linköping, Sweden
| | - Hans Hägglund
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
38
|
Riezzo I, Pascale N, La Russa R, Liso A, Salerno M, Turillazzi E. Donor Selection for Allogenic Hemopoietic Stem Cell Transplantation: Clinical and Ethical Considerations. Stem Cells Int 2017; 2017:5250790. [PMID: 28680446 PMCID: PMC5478865 DOI: 10.1155/2017/5250790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
Allogenic hematopoietic progenitor cell transplantation (allo-HSCT) is an established treatment for many diseases. Stem cells may be obtained from different sources: mobilized peripheral blood stem cells, bone marrow, and umbilical cord blood. The progress in transplantation procedures, the establishment of experienced transplant centres, and the creation of unrelated adult donor registries and cord blood banks gave those without an human leucocyte antigen- (HLA-) identical sibling donor the opportunity to find a donor and cord blood units worldwide. HSCT imposes operative cautions so that the entire donation/transplantation procedure is safe for both donors and recipients; it carries with it significant clinical, moral, and ethical concerns, mostly when donors are minors. The following points have been stressed: the donation should be excluded when excessive risks for the donor are reasonable, donors must receive an accurate information regarding eventual adverse events and health burden for the donors themselves, a valid consent is required, and the recipient's risks must be outweighed by the expected benefits. The issue of conflict of interest, when the same physician has the responsibility for both donor selection and recipient care, is highlighted as well as the need of an adequate insurance protection for all the parties involved.
Collapse
Affiliation(s)
- Irene Riezzo
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Natascha Pascale
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Raffaele La Russa
- Istituto Clinico-Scientifico Malzoni, 83100 Avellino, Italy
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00185 Rome, Italy
| | - Arcangelo Liso
- Institute of Hematology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
| | - Monica Salerno
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| | - Emanuela Turillazzi
- Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale “Colonnello D'Avanzo”, Viale Degli Aviatori, 1, 71122 Foggia, Italy
| |
Collapse
|
39
|
Ohara Y, Ohto H, Tasaki T, Sano H, Mochizuki K, Akaihata M, Kobayashi S, Waragai T, Ito M, Hosoya M, Nollet KE, Ikeda K, Ogawa C, Kanno T, Shikama Y, Kikuta A. Comprehensive technical and patient-care optimization in the management of pediatric apheresis for peripheral blood stem cell harvesting. Transfus Apher Sci 2016; 55:338-343. [PMID: 27765663 DOI: 10.1016/j.transci.2016.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. STUDY DESIGN AND METHODS We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg. RESULTS The median CD34+ cell yield per apheresis procedure was 2.3 × 106 CD34+ cells/kg (0.2-77.9 × 106 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990-1997 versus 5.8% during 1998-2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration. CONCLUSION By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg.
Collapse
Affiliation(s)
- Yoshihiro Ohara
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
| | - Tetsunori Tasaki
- Department of Transfusion Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuko Akaihata
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Tomoko Waragai
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| | - Masaki Ito
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan
| | - Chitose Ogawa
- Division of Pediatric Oncology, The National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Kanno
- Japanese Red Cross Fukushima Blood Center, Fukushima, Japan
| | - Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
40
|
Procedure-related complications and adverse events associated with pediatric autologous peripheral blood stem cell collection. J Clin Apher 2016; 32:35-48. [DOI: 10.1002/jca.21465] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/21/2016] [Accepted: 03/28/2016] [Indexed: 02/06/2023]
|
41
|
Successful tandem transplant in a young aplastic anemia patient from a small-weight 11-month-old sibling donor. Transfus Apher Sci 2016; 54:144-6. [DOI: 10.1016/j.transci.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 09/30/2015] [Accepted: 12/29/2015] [Indexed: 02/08/2023]
|
42
|
Weaver MS, Diekema DS, Carr A, Triplett B. Matched Marrow, Sibling Shadow: The Epidemiology, Experience, and Ethics of Sibling Donors of Stem Cells. J Adolesc Young Adult Oncol 2016; 4:100-4. [PMID: 26812663 DOI: 10.1089/jayao.2014.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meaghann S Weaver
- 1 Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Douglas S Diekema
- 2 Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute , Seattle, Washington
| | - Ashley Carr
- 3 Child Life Program, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Brandon Triplett
- 4 Department of Bone Marrow Transplant, St. Jude Children's Research Hospital , Memphis, Tennessee
| |
Collapse
|
43
|
Bitan M, van Walraven SM, Worel N, Ball LM, Styczynski J, Torrabadella M, Witt V, Shaw BE, Seber A, Yabe H, Greinix HT, Peters C, Gluckman E, Rocha V, Halter J, Pulsipher MA. Determination of Eligibility in Related Pediatric Hematopoietic Cell Donors: Ethical and Clinical Considerations. Recommendations from a Working Group of the Worldwide Network for Blood and Marrow Transplantation Association. Biol Blood Marrow Transplant 2016; 22:96-103. [DOI: 10.1016/j.bbmt.2015.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/12/2015] [Indexed: 11/27/2022]
|
44
|
Then SN. Pressure placed on paediatric haematopoietic stem cell donors: Views from health professionals. J Paediatr Child Health 2015; 51:1182-7. [PMID: 26059420 DOI: 10.1111/jpc.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 12/01/2022]
Abstract
AIM Paediatric haematopoietic stem cell donors undergo non-therapeutic procedures and endure known and unknown physical and psychosocial risks for the benefit of a family member. One ethical concern is the risk that they may be pressured by parents or health professionals to act as a donor. This paper adds to what is known about this topic by presenting the views of health professionals. METHODS This qualitative study involved semi-structured interviews with 14 health professionals in Australasia experienced in dealing with paediatric donors. Transcripts were analysed using established qualitative methodologies. RESULTS Health professionals considered that some paediatric donors experience pressure to donate. Situations that were likely to increase the risk of pressure being placed on donors were identified, and views were expressed about the ethical 'appropriateness' of these practices within the family setting. CONCLUSIONS Children may be subject to pressure from family and health professionals to be tested and act as donors, Therefore, our ethical obligation to these children extends to implementing donor-focused processes - including independent health professionals and the appointment of a donor advocate - to assist in detecting and addressing instances of inappropriate pressure being placed on a child.
Collapse
Affiliation(s)
- Shih-Ning Then
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.,Law School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Hutt D, Nehari M, Munitz-Shenkar D, Alkalay Y, Toren A, Bielorai B. Hematopoietic stem cell donation: psychological perspectives of pediatric sibling donors and their parents. Bone Marrow Transplant 2015; 50:1337-42. [DOI: 10.1038/bmt.2015.152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/30/2015] [Accepted: 05/14/2015] [Indexed: 12/14/2022]
|
46
|
Karakukcu M, Unal E. Stem cell mobilization and collection from pediatric patients and healthy children. Transfus Apher Sci 2015; 53:17-22. [PMID: 26116046 DOI: 10.1016/j.transci.2015.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Today, hematopoietic stem cell transplantation (HSCT) is a standard treatment for a variety of conditions in children, including certain malignancies, hemoglobinopathies, bone marrow failure syndromes, immunodeficiency and inborn metabolic disease. Two fundamentally different types of HSCT are categorized by the source of the stem cells. The first, autologous HSCT represents infusion of patient's own hematopoietic stem cells (HSCs) obtained from the patient; the second, allogeneic HSCT refers to the infusion of HSCs obtained from a donor via bone marrow harvest or apheresis. Bone marrow has been the typical source for HSCs for pediatric donors. Bone marrow harvest is a safe procedure mainly related to mild and transient side effects. Recently, a dramatically increased use of mobilized peripheral blood stem cells (PBSCs) in the autologous as well as allogeneic setting has been seen worldwide. There are limited data comparing mobilization regimens; also mobilization practices vary widely in children. The most commonly used approach includes granulocyte colony stimulating factor (G-CSF) at 10 mg/kg/day as a single daily dose for 4 days before the day of leukapheresis. G-CSF induced pain was less reported in children compared to adult donors. For the collection, there are several technical problems, derived from the size of the patient or donor, which must be considered before and during the apheresis. Vascular access, extracorporeal circuit volume, blood flow rates are the main limiting factors for PBSC collection in small children. Most children younger than 12 years require central vascular access for apheresis; line placement may require either general anesthesia or conscious sedation and many of the complications arise from the central venous catheter. In this review, we discuss that the ethical considerations and some principals regarding children serving as stem cell donors and the commonest sources of HSCs are presented in children, together with a discussion of how to collect and process these cells.
Collapse
Affiliation(s)
- Musa Karakukcu
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey.
| | - Ekrem Unal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Erciyes Pediatric Stem Cell Transplantation Center, Erciyes University, Kayseri, Turkey
| |
Collapse
|
47
|
Related hematopoietic cell donor care: is there a role for unrelated donor registries? Bone Marrow Transplant 2015; 50:637-41. [PMID: 25730182 DOI: 10.1038/bmt.2015.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 11/08/2022]
Abstract
In almost half of allogeneic hematopoietic progenitor cell (HPC) transplants, a related donor (RD) is used, yet a lack of standardized guidelines means that their care is heterogeneous. Changes to regulatory standards aim to improve uniformity, but adherence to these regulations can prove logistically difficult for the transplant centers (TCs) managing RDs. Discussion has ensued around possible alternative models of related donor care and a session at the European Society for Blood and Marrow Transplantation (EBMT) annual meeting in 2013 debated the question of whether a role exists for unrelated donor registries in the management of 'related' donors. In this overview, we discuss the issues raised at this debate and the pros and cons of donor registry involvement in various aspects of RD management. By examining existing models of related donor care that have been adopted by members of the World Marrow Donor Association (WMDA), we look for ways to enhance and homogenize RD care, while also enabling transplant centers to meet standards required for mandatory accreditation.
Collapse
|
48
|
Tucunduva L, Volt F, Cunha R, Locatelli F, Zecca M, Yesilipek A, Caniglia M, Güngör T, Aksoylar S, Fagioli F, Bertrand Y, Addari MC, de la Fuente J, Winiarski J, Biondi A, Sengeloev H, Badell I, Mellgren K, de Heredia CD, Sedlacek P, Vora A, Rocha V, Ruggeri A, Gluckman E. Combined cord blood and bone marrow transplantation from the same human leucocyte antigen-identical sibling donor for children with malignant and non-malignant diseases. Br J Haematol 2014; 169:103-10. [DOI: 10.1111/bjh.13267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/17/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Luciana Tucunduva
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
- Centro de Oncologia; Hospital Sirio-Libanes; Sao Paulo Brazil
| | - Fernanda Volt
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
| | - Renato Cunha
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
| | - Franco Locatelli
- Dipartimento di Oncoematologia Pediatrica; Ospedale Bambino Gesù; IRCSS; Università di Pavia; Rome Italy
| | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | | | - Maurizio Caniglia
- Dipartimento di Medicina Clinica e Sperimentale; Università di Perugia; Perugia Italy
| | - Tayfun Güngör
- Stem Cell Transplantation Department; University Children's Hospital; Zürich Switzerland
| | | | - Franca Fagioli
- Ospedale Infantile Regina Margherita Oncoematologia Pediatrica e Centro Trapianti; Torino Italy
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique de Lyon; Lyon France
| | | | | | - Jacek Winiarski
- Astrid Lindgren Children's Hospital, Huddinge; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Andrea Biondi
- Ospedale San Gerardo/Fondazione MBBM; Clinica Pediatrica dell Università di Milano-Bicocca; Monza Italy
| | | | | | - Karin Mellgren
- The Queen Silvia's Hospital for Children and Adolescents; Goeteborg Sweden
| | | | | | - Ajay Vora
- Sheffield Children's Hospital; Sheffield UK
| | - Vanderson Rocha
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
- Department of Clinical Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - Annalisa Ruggeri
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
- Hospital Saint Antoine; Service d'Hématologie et Thérapie Cellulaire; AP-HP; Paris France
| | - Eliane Gluckman
- Hospital Saint Louis, AP-HP, and IUH University Paris VII; Eurocord; Paris France
- Monacord; Centre Scientifique de Monaco; Monaco Monaco
| | | |
Collapse
|
49
|
Children as hematopoietic cell donors in research: when is it approvable? Bone Marrow Transplant 2014; 50:15-9. [PMID: 25330224 DOI: 10.1038/bmt.2014.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/22/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
Abstract
With increasing frequency, allogeneic hematopoietic cell transplantation involving children is being performed in the research setting. Allogeneic hematopoietic cell transplantation, however, cannot be performed without a hematopoietic stem cell (HSC) donor. This donor is often a sibling of the recipient and may also be a child. In such circumstances, it is unclear whether or how the federal regulations for pediatric research apply to the minor donors. This introductory paper reviews the issues to be considered while evaluating studies that use HSCs obtained from minor donors and identifies areas where further research is needed. In the era of increasing applicability for donor-derived cellular therapies, we provide a suggested framework for determining when minor donors qualify as human research subjects and when their participation can be approved under the federal regulations.
Collapse
|
50
|
Duong HK, Savani BN, Copelan E, Devine S, Costa LJ, Wingard JR, Shaughnessy P, Majhail N, Perales MA, Cutler CS, Bensinger W, Litzow MR, Mohty M, Champlin RE, Leather H, Giralt S, Carpenter PA. Peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2014; 20:1262-73. [PMID: 24816581 DOI: 10.1016/j.bbmt.2014.05.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 02/03/2023]
Abstract
Peripheral blood progenitor cell mobilization practices vary significantly among institutions. Effective mobilization regimens include growth factor alone, chemotherapy and growth factor combined, and, more recently, incorporation of plerixafor with either approach. Many institutions have developed algorithms to improve stem cell mobilization success rates and cost-effectiveness. However, an optimal stem cell mobilization regimen has not been defined. Practical guidelines are needed to address important clinical questions, including which growth factor is optimal, what chemotherapy and dose is most effective, and when to initiate leukapheresis. We present recommendations, based on a comprehensive review of the literature, from the American Society of Blood and Marrow Transplantation.
Collapse
Affiliation(s)
- Hien K Duong
- Department of Blood and Marrow Transplant, Blood and Marrow Transplant Program, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ed Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Steven Devine
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Luciano J Costa
- Division of Hematology and Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - John R Wingard
- Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Paul Shaughnessy
- Department of Adult Bone Marrow Transplant, Texas Transplant Institute, San Antonio, Texas
| | - Navneet Majhail
- Department of Blood and Marrow Transplant, Blood and Marrow Transplant Program, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Weill Cornell Medical College, New York, New York
| | - Corey S Cutler
- Department of Hematologic Oncology, Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Bensinger
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark R Litzow
- Division of Hematology, Division of Palliative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Mohty
- Department of Haematology, Saint Antoine Hospital, Paris, France
| | - Richard E Champlin
- Department of Stem Cell Transplantation, M.D. Anderson Cancer Center, Houston, Texas
| | - Helen Leather
- Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, Florida
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Weill Cornell Medical College, New York, New York
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|