Leukapheresis* by Continuous Flow Centrifugation (CFC) in Patients with Chronic Myelocytic Leukemia (CML)

Abstract

A closed continuous flow centrifuge (NCI-IBM Blood Cell Separator) was utilized to collect large quantities of leukocytes from donors with chronic myelocytic leukemia. Ninety-eight separate centrifugations of one to six hours duration were performed in 12 patients. Quantities of blood between 2.4-20.3 liters were processed during each centrifugation representing 0.4-3.2 donor blood volumes. An additional five centrifugations were attempted unsuccessfully. Buffy coat cells were collected while plasma and red blood cells were returned to the donor without change in flow or gravitational field. White blood cell yields of up to 75 per cent were obtained while platelet yields were electively varied from 0.1 per cent in donors with thrombocytopenia to 61.0 per cent in donors with thrombocytosis. Red blood cell hemolysis and excessive platelet losses with thrombocytopenia were not observed. One patient developed chills and fever of unknown etiology on two separate occasions, once during and once following CFC Leukocytes collected by this method and transfused into granulocytopenic recipients resulted in granulocyte increments of 2.0 x 103 per mm3 per 1011 granulocytes per m2 of body surface area. The persistence of cells with the Ph1 chromosome in the bone marrow of recipients demonstrated that viable proliferating cells survived the procedure.

Standardized protocol to identify high‐risk patients undergoing therapeutic apheresis procedures

“…Since automated TA was first reported in 1969 [8], the scope of TA has been expanded from leukapheresis (leukodepletion), plasmapheresis (plasma exchange), plateletpheresis (plateletdepletion), and erythrocytapheresis (RBC exchange), to peripheral blood progenitor cell collection, photopheresis, and granulocyte collection [9]. The clinical applications of TA have been categorized by the American Society for Apheresis (ASFA) according to evidence of safety and efficacy of the procedure in 1985, 1993, 2000 [10-13] with the most recent expansion and update published in 2007 [14].…”

Increased Granulocyte Collection with the Blood Cell Separator and the Addition of Etiocholanolone and Hydroxyethyl Starch

“…Thus, the granulocytes could not be collected without removing large quantities of red blood cells along with the buffy coat which prevented the multiple leukapheresis of single donors for granirlocyte collections. 2 The initial attempts at collection and transfusion of normal donor leukocytes have been only partially successful because of the low yield of granulocytes although the transfer of immunity has been demonstrated.3 Because of this low yield of granulocytes, various iimdifications of the technique have been made in ;in attempt to improve the quantity collected. Etiocholanolone (5-1iydroxy-5-p-androstan-I 7-one),+ a naturally occurring steroid inetaboli te,10 was given intramuscularly 10 to 12 hours before leukapheresis.…”

Use of heparin for cytapheresis and plasmapheresis in a continuous flow centrifuge

“…''~ The Lee-White coagulation time has been done every hour trying t o maintain its length to two or three times its normal value, and, when it was four times normal at the end of the procedure, the subject would be given protamine. 20 Although hemorrhagic problems have occurred in normal donors, no comment was made relative to the control of the administration of heparin. Efforts have been made t o use the minimum amount of antic o a g~l a n t ,~ and this has resulted in coagulation within the centrifuge system.…”