Peripheral blood stem cell apheresis in normal donors: feasibility and yield of second collections

Abstract

Summary. We report 13 normal peripheral blood stem cell (PBSC) donors who had a second PBSC collection for allogeneic transplantation performed after the first. The median interval between the first and second collection was 5 months. Mobilization was achieved with filgrastim (12 mg/ kg/d). No significant difference was found in the median pre-apheresis leucocyte count (×10 9 /l) between the two donations (40 . 2 v 38 . 5; P ¼ 0 : 91). The median apheresis yield (×10 6 CD34 þ cells/litre blood processed, first apheresis) was also similar (28 v 27 . 3; P ¼ 0 : 91). Filgrastim-related adverse events were comparable. These data suggest that second PBSC collections are feasible, similarly tolerated and provide comparable apheresis yields.Keywords: peripheral blood stem cell(s), filgrastim, normal donors, allogeneic blood stem cell transplantation.G-CSF-mobilized peripheral blood stem cells (PBSCs) are increasingly viewed as a promising alternative to marrow for allografting in patients with haematological malignancies (Goldman, 1995;Russell et al, 1996;Lane, 1996). The avoidance of general anaesthesia or invasive procedures, as well as blood transfusions (Anderlini et al, 1996c;Russell et al, 1996;Dreger et al, 1994), makes this approach particularly attractive for repeated PBSC collections, which may be required to treat post-transplant relapse or graft failure. It is unclear whether second PBSC collections (particularly if performed soon after the first) are associated with similar apheresis yields or whether G-CSF exposure impacts the subsequent PBSC mobilization efficiency. Available literature on allogeneic PBSC transplantation (Goldman, 1995;Russell et al, 1996;Lane, 1996) has not addressed this issue. At our institution we have had now the opportunity to perform a sizeable number of second PBSC collections. We therefore reviewed our donor database to report our experience. DONORS AND METHODS Normal apheresis donors.We retrospectively reviewed our PBSC donor database during a 18-month period ( January 1995/June 1996. During this time a total of 181 donors underwent PBSC collections after filgrastim mobilization for allografting in HLA-compatible related patients with haematological malignancies. 16 of them (9%) donated a second time at least 4 weeks after the first. In two of them the exact number of CD34 þ cells in the apheresis product could not be determined because of complex manipulations performed immediately after collection, and the apheresis charts of one donor were not available for review. These donors were considered inevaluable. The others (n ¼ 13) were included in the study. The protocol for PBSC collection was approved by the Institutional Review Board and written informed consent was obtained from each donor.Mobilization and apheresis. PBSC donors received daily filgrastim (6 mg/kg subcutaneously every 12 h) followed by daily continuous-flow leukapheresis through a bilateral peripheral venous access generally beginning on day 4 or day 5 of filgrastim administration. The amount of blood to be p...

Re-mobilization of peripheral blood progenitor cells within a short time interval fails to achieve effective progenitor cell yields

“…4 The timing needed for the progenitor cell compartment to reconstitute after initial rhG-CSF mobilizing regimen in healthy donors remains unknown, but previous data indicate that effective CD34 ϩ harvesting is achieved during repetitive mobilization, with intervals between collections of more than 2 weeks. [1][2][3] In the present case, the short interval of 1 week between collections resulted in a similar increase in the preapheresis leukocyte count, in both procedures. In spite of that fact, fewer mononuclear cells were mobilized during the second rhG-CSF course, resulting in a poor CD34 ϩ yield.…”

“…This avoids the need for general anaesthesia and marrow harvest. To date, available literature on short-term second PBPC mobilization in healthy donors is limited [1][2][3] and, although a reduction in PBPC yield is inversely associated with time intervals between aphereses (shortest interval described between procedures of 16 days), 3 in all cases the reduction was not severe enough to prevent effective PBPC harvesting during the second mobilization. Thus, it is unclear what is the minimum period of time required to predict an adequate number of PBPCs being mobilized and subsequently collected after repeated rhG-CSF mobilization schedules.…”

Comparison between filgrastim and lenograstim plus chemotherapy for mobilization of PBPCs

“…This study looked for differences in HPC mobilization in response to glycosylated Hu or nonglycosylated rHu G-CSF in patients with hematological tumors that are the most frequent candidates for auto-SCT and that require combined mobilization with chemotherapy and G-CSF. The appropriate schedule of mobilization in terms of type of chemotherapy, doses and timing of G-CSF administration has been discussed in several studies, 3,18,[21][22][23][24][25][26] whereas the role of G-CSF glycosylation is still not well defined.…”

Uniform examination of stem cell donors

“…In contrast to animal studies the degree of spleen enlargement in humans is not clearly related to white blood cell count, race, gender or age, but the study cohorts are small [20,21]. Other frequent, sub-clinical findings are thrombocytopenia up to 2 weeks after leukopheresis and, up to at least 2 years, persistence of a lower leucocyte count, albeit without infectious symptoms [22].…”