Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Abstract

We retrospectively studied 108 marrow harvests from 105 pediatric sibling donors. The median age of donors was 8 years (range: 1-15) and the median body weight was 27 kg (range: 10-100). The volumes of aspirated marrow were 5.0-23.8 mL/kg donor body weight, and harvested bone marrow volume exceeded 15 mL/kg in 42% of the donors. A total of 100 autologous blood donations were performed, and eight donors had red cells salvaged from their harvests reinfused. The median Hb levels before and after harvests were 12.3 g/dL (range: 10.0-14.7) and 11.0 g/dL (range: 8.9-13.8), respectively. None of the donors received allogeneic blood transfusions or hematopoietic growth factors such as EPO and G-CSF before or after collection. Transplanted dose was 1.4-10.8 × 10 8 cells/kg recipient body weight without differences due to donor age. Higher concentrations of nucleated and CD34 + cells were obtained from younger donors. All donors tolerated the procedures well, with no serious complications. Thus, children may safely donate marrow for allogeneic transplantation, and the yields of nucleated cells for engraftment are substantial.Bone Marrow Transplantation (2014) 49, 921-926;

Ethical considerations of using a single minor donor for three bone marrow harvests for three HLA‐matched siblings with primary immunodeficiency

“…Similarly, in our donor, each of the first two donations had yielded an adequate number of CD34 + cells for transplant, though the CD34 + yield (cells/mL) had decreased with the second donation (Table ). This is also consistent with other studies that have noted that younger age is correlated with a higher number of CD34 + cells/mL . Whether the lower CD34 + yield with subsequent donations represents the age‐related decrease observed in other studies, or is related to the donation itself, is unclear.…”

“…This is also consistent with other studies that have noted that younger age is correlated with a higher number of CD34 + cells/mL. 28,29 Whether the lower CD34 + yield with subsequent donations represents the age-related decrease observed in other studies, or is related to the donation itself, is unclear. Either way, the donor continued to have normal hematopoiesis as reflected in normal complete blood counts on follow-up.…”

Bone marrow harvesting from paediatric patients undergoing haematopoietic stem cell gene therapy

“…BM historically has been the preferred source for HSPCs collection in the GT setting, although MPB has been increasingly adopted in the last years [9]. To date, few data are available regarding BM harvest in paediatric population, mainly limited to the maximum amount that can be safely collected and the purification yields of CD34+ cells [18–19]. Moreover, scattered data on specific diseases such as primary immunodeficiency or lysosomal storage disorders are reported [13,20].…”

Transient apoptosis inhibition in donor stem cells improves hematopoietic stem cell transplantation

“…Graft failure and delayed engraftment can be caused by HLA incompatibility between donor and recipient, decreased fitness, or a low number of stem cells available for transfer ( Barrett et al, 2003 ; Chen et al, 2004 ; Mattsson et al, 2008 ; Maie et al, 2014 ). The risk factors for receiving insufficient numbers of vital cells are manifold and include relevant differences in body weight between patient and donor ( Yabe et al, 2014 ) and umbilical cord blood (UCB) as stem cell source, because a single UCB sample contains a limited number of hematopoietic stem and progenitor cells (HSPCs) that often do not suffice to successfully reconstitute an adult patient ( Wagner et al, 2002 ; Ballen et al, 2013 ). In the setting of peripheral blood stem cell transplantation, insufficient stem cell numbers might be collected from donors showing limited response to G-CSF treatment (poor mobilizers; Bakanay and Demirer, 2012 ).…”