This study has shown that preapheresis PB WBC and granulocyte counts were associated with leukapheresis CE. Additionally, the leukapheresis product TNC and granulocyte content was correlated with thawed graft infusion side effect occurrence.
Objective: To evaluate factors affecting peripheral blood hematopoietic stem cell yield in patients undergoing large-volume leukapheresis for autologous peripheral blood stem cell collection. Methods: Data from 304 consecutive autologous peripheral blood stem cell donors mobilized with hematopoietic growth factor (usually G-CSF), associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 × 106 CD34+ cells/kg of body weight. Pre-mobilization factors analyzed included patient's age, gender and diagnosis. Post mobilization parameters evaluated were pre-apheresis peripheral white blood cell count, immature circulating cell count, mononuclear cell count, peripheral blood CD34+ cell count, platelet count, and hemoglobin level. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches). Results: Pre-mobilization factors correlating to poor CD34 + cell yield in univariate analysis were acute myeloid leukemia (p = 0.017) and other hematological diseases (p = 0.023). Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001), granulocytes (p = 0.002), hemoglobin level (p = 0.016), and CD34+ cell concentration (p < 0.001) in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001) was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. Conclusion: In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.
Background Although Hematopoietic Stem Cells (HSC) donation through bone marrow (BM) and peripheral blood (PB) are usually safe procedures, adverse events are expected. One of the most common events especially among BM donors (BMD) is the development of anemia. To protect the BMD and preserve the hemoglobin levels, many centers collect autologous pre‐procedure blood, but the actual benefits of this procedure is controversial. Methods and Materials This study analyzed retrospectively data to observe what factors may influence the occurrence of post‐donation anemia and also evaluate the relevance of autologous red blood cell pre procedure donation (PAD). Results The development of immediately post donation anemia (IP) was higher in BMD than in PB donors (64.2% BMD and 10.7% PBD, P < .001) and also in late post donation (LP) (28.4% BMD and 3.6% PBD, P = .007). The study demonstrated an association between PAD and anemia in IP (72.7% with anemia and 27.3% without anemia, P = .006) and an association between the volume of red blood cells in the donated hematopoietic product and the development of anemia in LP (356.3 mL and 297.8 mL, P = .037). Conclusion In conclusion, collection of HSC through BM is a risk factor for anemia and PAD is a risk factor for IP anemia.
Introduction: Autologous hematopoietic progenitor cell (HPC) transplantation after high-dose chemotherapy has been used for several years in the treatment of various diseases. Over the past few years, peripheral blood have become the standard hematopoietic progenitor cell source. This process requires frozen HPC graft storage in mechanical freezers or liquid nitrogen for their subsequent infusion. Addition of a cryoprotectant solution such as dimethylsulfoxide (DMSO) is required in order to prevent ice crystals formation during HPC freezing process. Clinical toxicity has been classically attributed to thawed HPC DMSO content. However, adverse events still have been described after DMSO removal. The amount of granulocytes in the apheresis product has been correlated to adverse event occurrence and severity. In this study, we evaluated correlation between pre leukapheresis peripheral blood granulocytes count and adverse event occurrence during thawed HPC infusion. Patients and Methods: We retrospectively analyzed data from 361 patients submitted to autologous HPC transplantation from January 1999 to December 2013. HPC collection was performed with large volume leukapheresis, in a continuous-flow blood separator (Spectra, TerumoBCT, USA), with the mononuclear cell collection protocol, and ACD-A as anticoagulant solution. The apheresis product was diluted to maintain cell concentration less than 150x109 cells/L or 300x109 cells/L for storage in mechanical freezer or liquid nitrogen, respectively. A 5% DMSO solution was added to the HPC stored in mechanical freezer, whereas 10% DMSO was added for storage in liquid nitrogen. Complete blood count and CD34+ cell determination were performed in pre collection peripheral blood and the apheresis product. CD34+ cell determination was performed in the equipment Coulter Epics XL-MCL Flow Cytometer (Beckman Coulter, USA) according to the ISHAGE protocol. The HPC graft was thawed and infused without further manipulation. Infused volume limit was 10 ml/kg b.w or 40 mL of DMSO/day. Infusion was fractionated whenever required. Antihistamine drug and corticosteroid were given before all infusion. Adverse events included: nausea, vomiting, fever; hemodynamic, neurological, gastrointestinal, renal disorders; cardiac conduction disturbances, and hypersensitivity. Results: The patients´ median age was 50±17 yo (min: 1 max: 86), weight 74±19 kg (10-143). The underlying diseases were: Multiple Myeloma, 105 (29%), NonHodgkin lymphoma, 99 (27%), Acute Myeloid Leukemia, 37 (10%), solid tumor and multiple sclerosis 32 (9%) each and Hodgkin Lymphoma, 30 (8%) patients. CBC median values: hemoglobin, 10.9±1.6 g/dl (9.8-12.0), platelet 74,2±86 x109/L (44-138), white blood cell 20.8±18.3x109/L(9.6-34.4), granulocyte 16.5±15.8x109/L (6.6-28.9), and CD34+ cell, 23±79/mm3 (12-54). Apheresis product median values: total volume 235±47 mL (215-256), white blood cell 175±113x109/L (122-257), granulocyte 43.5±67.6x109/L (13.4-93.9), and CD34+ 0.8±2.4x109/L (0.4-2.0). Total nucleated cell collected was 5.7±4.5x108/kg b.w (3.9-8.5), total CD34+ 2.5±7.3x106/kg b.w (1.2-6.3). A total of 490 (74%) apheresis products were stored in mechanical freezer. A total of 289 thawed HPC infusions occurred in the study period. Adverse event occurred in 28 (10%) cases. The most common manifestations were hypertension and nausea/vomiting. Mild or moderate adverse event occurred in 26 infusions and severe adverse event in 02 cases. There was no difference in the infused HPC variables between patients with and without adverse event. However, significant difference was found in the apheresis product variables: median granulocyte count in the group with adverse reaction 74.7±52.5x109/L (39.2-103.6) vs. 43.1±61.6x109/L (12.6 to 89.2) in the group without adverse reaction, p=0.0158; total nucleated cells 8.1± 8.3x108/kg b.w (5.8-13) vs. 5.8±4.7x108/kg b.w (3.8-8.6), p=0.0033. Conclusion: The apheresis product granulocyte count and total nucleated cells were correlated with adverse event during infusion of HPC cryopreserved without further manipulation after thawing. Disclosures No relevant conflicts of interest to declare.
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