An alternative procedure to leukapheresis for peripheral hematopoietic progenitor cell collection in very‐low‐weight children: A single pediatric center experience

Abstract

Background PBSC collection using a blood cell separator in very low weight patients can be frequently complicated by severe adverse effects and technical difficulties. Material and Methods From March 2013 to January 2017, 14 PBSC collections were performed in 12 children weighing less than 10 kg, affected by different solid tumours. PBSC collection was performed with a “homemade” aseptically assembled circuit. The circuit is composed by a 150 mL collection bag connected with a 4 stopcock ramp, perfused with ACD. This circuit allows collection of a specific total blood amount from CVC, depending on CD34+/kg target. Results Mean CD34+cell performance per collection was 9.3 × 106/kg. Tolerance to the procedure was very good as none of the patients experienced complications, with the exception of a patient who showed mild cyanosis and pallor after collection. Moreover, no bleeding or thrombotic complications have been observed. To date, 16 PBSC reinfusions have been performed in 7 children with a mean CD34+ cells viability of 98.1% ± 2.7 and mean WBC viability of 57% ± 10. Cell recovery after thawing was 87% ± 10.8. A rapid graft intake for both neutrophils and platelets, between day 7 and 20 after reinfusion was observed. Discussion The procedure of total blood collection without the use of a cell separator is feasible and allows a good PBSC collection without significant side effects in very low‐weight children. Moreover, this method could represent a valid and safe alternative to leukapheresis in patients where classic procedure could be difficult to apply.

Successful stem cell collection for atypical teratoid rhabdoid tumor in an extremely low‐body weight child: A case report

“…PBSC collections in patients of extremely low BW are therefore very complex procedures requiring foresight and planning. In fact, some groups such as Becherucci et al, and Koristek Z et al have described alternative procedures consisting of alternating cycles of phlebotomy with a phase of isovolemic reinfusion as an alternative to automated cell collections 15,16 . Although this technique was found to be safe and effective for PBSC collection, it requires a powerful mobilization and, in our opinion, it's difficult to reproduce and standardize according to current quality and safety criteria.…”