BACKGROUND:Previous studies have demonstrated the importance of bone marrow (BM) harvest yield in determining transplant outcomes, but little is known regarding donor and procedure variables associated with achievement of an optimal yield. We hypothesized that donor demographics and variables relating to the procedure were likely to impact the yield (total nucleated cells [TNCs]/kg recipient weight) and quality (TNCs/mL) of the harvest. STUDY DESIGN AND METHODS:To test our hypothesis, BM harvests of 110 consecutive unrelated donors were evaluated. The relationship between donor or procedure characteristics and the BM harvest yield was examined. RESULTS:The relationship between donor and recipient weight significantly influenced the harvest yield; only 14% of BM harvests from donors who weighed less than their recipient achieved a TNC count of more than 4 3 10 8 /kg compared to 56% of harvests from donors heavier than their recipient (p 5 0.001). Higher-volume harvests were significantly less likely to achieve an optimal yield than lower-volume harvests (32% vs. 78%; p 5 0.007), and higher-volume harvests contained significantly fewer TNCs/mL, indicating peripheral blood contamination. BM harvest quality also varied significantly between collection centers adding to recent concerns regarding maintenance of BM harvest expertise within the transplant community. CONCLUSION:Since the relationship between donor and recipient weight has a critical influence yield, we recommend prioritizing this secondary donor characteristic when selecting from multiple well-matched donors. Given the declining number of requests for BM harvests, it is crucial that systems are developed to train operators and ensure expertise in this procedure is retained.T he past two decades have seen a reduction in the number of unrelated donor (UD) bone marrow (BM) harvests performed, as the proportion of transplants using peripheral blood stem cells (PBSCs) has increased. Although several studies have examined the clinical impact of BM composition on the outcome of hematopoietic stem cell transplantation, relatively few studies have concentrated on the donor or procedure characteristics that influence the yield from BM harvests. To achieve a concentrated high-quality harvest, minimization of peripheral blood contamination is essential. Several early studies demonstrated the benefit of small-volume aspirations (<5 mL) from multiple punctures sites as opposed to larger-volume aspirations.13-15 Stimulation of the BM by prior granulocyte-colony-stimulating factor administration can also improve the TNC yield per donor weight, 16 but this is not routine practice in UDs, where donor safety considerations are paramount. A study of 166 BM donors reported that both a higher donor body mass index (BMI) and donor weight were associated with an improved CD34 yield at BM harvest, while donor age, sex, and height had no impact on yield. 17Other studies have noted a correlation between high donor weight and increased quality (TNCs/mL) of BM harvested. 18,19 It is...
Introduction The factors influencing the quality of bone marrow (BM) harvests and total nucleated cell count (TNC) achieved are poorly understood. As the number of BM harvest procedures falls (due to an increasing proportion of harvest requests for peripheral blood stem cells), concerns are raised around maintaining expertise in this area. We investigate, in four Anthony Nolan collection centers, the procedure- and donor -related factors influencing the quality of harvests, and likelihood of achieving the requested TNC. Materials & Method 110 consecutive BM harvests of healthy unrelated donors (UD)s were performed according to standard Anthony Nolan protocols. Harvest quality was defined as TNC/ml volume collected. Univariate analyses of factors influencing the TNC and harvest quality were performed using Chi squared or Fisher’s test where appropriate. Results 110 BM harvests were performed in 80 male and 30 female donors. The median donor age was 28 years (range 18-56 years). The median TNC requested was 4x108/kg, and median harvested TNC 4.2x108/kg recipient weight, with the requested TNC dose achieved in 50% of harvests. Higher volume harvests (greater than the median volume 1200 mls) were significantly less likely to achieve TNC> 4x108/kg recipient weight (38% vs 70% p=0.001), as were harvests with a procedure time greater than 30 minutes (p=0.037). We investigated donor factors influencing the harvest yield and found that donor/recipient weight discrepancy significantly impacted the TNC achieved: with only 18% of BM harvests from donors who weighed less than their recipient achieving TNC >4x108/kg compared to 62% harvests from donors who were heavier than their recipient (p=0.001). No other donor factor had a significant influence on the TNC. The median TNC/ml collected was 18.2x10^6/ml and harvests in donors>40 years were more likely to be of lower quality (p=0.036). No other donor factors affected harvest quality, however a significant variation between the 4 collection centers was observed: both the harvest quality (p=0.014) and volume collected (p=0.035) varied significantly between centers. Conclusions Donor weight is a strong determinant of bone marrow harvest yield; we recommend that when multiple matched UDs are available, a donor with high body weight should be selected for BM harvest. Procedure factors including large volume harvests and long procedure times reduce the likelihood of achieving the requested TNC, and significant variation was seen between centers. Given the declining number of requests for BM harvests, it is crucial these are performed by the most experienced centers and that systems exist to ensure operators retain their expertise. Disclosures No relevant conflicts of interest to declare.
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