Algorithms utilizing peripheral blood hematopoietic progenitor cell counts in lieu of some <scp>CD</scp>34+ cell counts predict successful peripheral blood stem cell collections with substantial time and cost savings

Steussy, Bryan; Capper, M.; Krasowski, Matthew D.; Rosenthal, Nancy S.; Schlueter, Annette J.

doi:10.1111/voxs.12289

Cited by 13 publications

(18 citation statements)

References 23 publications

(72 reference statements)

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“…In a study utilizing a test set of 83 PB samples collected pre‐apheresis, the authors proposed a similar algorithm for decision‐making with different cutoffs. They calculated that a negative HPC count <0.5 × 10 6 /L was an indication to delay apheresis, and this value correctly predicted poor mobilization (CD34+ cell count <10 × 10 6 /L) in 93% of the samples.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield

Furundarena

Uranga

Alkorta

et al. 2019

Int J Lab Hematology

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Introduction We evaluated the value of hematopoietic progenitor cells (HPCs) counted in Sysmex XN analyzers to predict the mobilization and collection of CD34+ cells in apheresis for stem cell transplantation. Methods Eighty patients who underwent stem cell transplantation were enrolled (50 autologous and 30 allogeneic). In the autologous group, patients were considered poor mobilizers when the CD34+ count was <10 × 106/L or <20 × 106/L in patients with multiple myeloma who were going to undergo two transplants. ROC curves were generated, and HPC cutoffs were calculated. Results The correlation between the HPC and CD34+ cell counts was good. Two algorithms were proposed. In the first algorithm, samples collected the day before apheresis, negative and positive HPC cutoffs were selected to detect poor and good mobilization and, therefore, the need or not to administer plerixafor. In the second algorithm, samples collected pre‐apheresis, the negative HPC cutoff was an indication to delay apheresis; an HPC higher than the optimal cutoff was an indication to start apheresis. When the HPC values were between these cutoffs, there was an indication to count CD34+ cells for a better decision‐making. Finally, in samples collected pre‐apheresis, HPC counts could be used to predict patients who would have poor CD34+ cell collections. In the allogeneic group, all the donors mobilized well, and very few needed two apheresis procedures. Conclusions The HPC count is useful for decision‐making in the management of patients subjected to apheresis procedures to collect peripheral blood stem cells.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield

Furundarena

Uranga

Alkorta

et al. 2019

Int J Lab Hematology

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“…Some patients received plerixafor (at the same dosing as chemotherapy‐mobilized patients) on the evening before each PBSC collection based on their HPC and/or PB CD34+ cell counts. Patients who had HPC counts of 0.5/μL or less or PB CD34+ cell counts of 10 CD34+ cells/μL or less received plerixafor administration before PBSC collection as described previously …”

Section: Methodsmentioning

confidence: 99%

Factors influencing platelet clumping during peripheral blood hematopoietic stem cell collection

et al. 2017

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BACKGROUND Platelet clumping is a common occurrence during peripheral blood hematopoietic stem cell (HSC) collection using the Spectra Optia mononuclear cell (MNC) protocol. If clumping persists, it may prevent continuation of the collection and interfere with proper MNC separation. This study is the first to report the incidence of clumping, identify precollection factors associated with platelet clumping, and describe the degree to which platelet clumping interferes with HSC product yield. STUDY DESIGN AND METHODS In total, 258 HSC collections performed on 116 patients using the Optia MNC protocol were reviewed. Collections utilized heparin in anticoagulant citrate dextrose to facilitate large-volume leukapheresis. Linear and logistic regression models were utilized to determine which precollection factors were predictive of platelet clumping and whether clumping was associated with product yield or collection efficiency. RESULTS Platelet clumping was observed in 63% of collections. Multivariable analysis revealed that a lower white blood cell count was an independent predictor of clumping occurrence. Chemotherapy mobilization and a lower peripheral blood CD34+ cell count were predictors of the degree of clumping. Procedures with clumping had higher collection efficiency but lower blood volume processed on average, resulting in no difference in collection yields. Citrate toxicity did not correlate with clumping. CONCLUSION Although platelet clumping is a common technical problem seen during HSC collection, the total CD34+ cell-collection yields were not affected by clumping. WBC count, mobilization approach, and peripheral blood CD34+ cell count can help predict clumping and potentially drive interventions to proactively manage clumping.

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“…Multiple projects focused on various aspects of assay validation, modification, or discontinuation. These included validation of plasma as an acceptable specimen for κ and λ free light chain analysis, 34 comparison of diazo and vanadate oxidase direct bilirubin assays, 35 validation of hematopoietic progenitor count on automated hematology analyzer for use in stem cell transplant, 51 and introduction of lamellar bodies assay for fetal lung maturity testing. A transfusion medicine-related project involved innovative use of an inexpensive device to limit blood loss for Jehovah’s Witness patients.…”

Section: Resultsmentioning

confidence: 99%

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

et al. 2017

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Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

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Algorithms utilizing peripheral blood hematopoietic progenitor cell counts in lieu of some CD34+ cell counts predict successful peripheral blood stem cell collections with substantial time and cost savings

Cited by 13 publications

References 23 publications

Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield

Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield

Factors influencing platelet clumping during peripheral blood hematopoietic stem cell collection

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

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