Peripheral blood stem cell collection in 24 low-weight infants: experience of a single centre

Abstract

Summary:Peripheral blood stem cells (PBSC) harvest may be difficult in young children. Extracorporeal separator line priming by red blood cells is usually required to improve haemodynamic tolerance and efficacy of collection. We present our experience with 24 children weighing less than 15 kg treated between January 1997 and September 1999, in whom we tried to avoid systematic blood priming. The median age and weight at the time of apheresis were 2.4 years and 12 kg, respectively. A total of 48 PBSC were performed. When haemoglobin was less than 12 g/dl, packed red cells were transfused before collection (40% of aphereses). The median cell yield per apheresis was 7.1 (2.2-30.6) Â 10 6 /kg CD34 + cells and 16.0 (3.3-44.3) Â 10 5 CFU-GM/kg. Initial collection failed in three cases. Four children required an additional haematopoietic progenitor mobilization. This procedure allowed PBSC collection without transfusion in 37.5% of children, and was safe (two serious and five mild transient side effects) and effective (median CD34 + cells collected per child: 7.1 Â 10 6 /kg (4.6-30.6) and CFU-GM: 15.1 Â 10 5 /kg (4.7-44.3)). Despite their low weight, insertion of a femoral catheter was avoided in 43% of children.

Procedure‐related complications and adverse events associated with pediatric autologous peripheral blood stem cell collection

“…Citrate was the most common AE encountered, with at least one citrate AE observed in 25% of children. This is consistent with prior pediatric (7–25%, Table ) and adult studies . In our study, the risk of citrate AE was higher in older and heavier patients, who often required several procedures (Fig.…”

“…Sevilla et al reported cardiovascular symptoms in 48% of healthy pediatric donors < 20 kg undergoing allogeneic HPCC . A similar cardiovascular AE rate was noted by Orbach et al in small children undergoing A‐HPCC .…”

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

“…Blood flow rates during apheresis should never exceed 70 to 80 mL/min since high rates impair the collection efficiency. In children with body weights lower than 25 kg, flow rates should not exceed 1 to 2 mL/min 91 . The maximum number of procedures allowed to achieve the target CD34+ cell dose is usually four, but IBMDR recommends to perform not more than three procedures in unrelated donors 92 …”

Safety and efficacy of allogeneic PBSC collection in normal pediatric donors: The Pediatric Blood and Marrow Transplant Consortium Experience (PBMTC) 1996–2003

“…10 An impediment to further evaluation of PBSC in pediatrics is a lack of safety data regarding pediatric sibling donors. 11 There is published experience in the collection of PBSC in younger cancer patients for autologous use, [12][13][14][15] but only a limited number of studies with small patient numbers address normal pediatric donor safety and collection efficacy. [6][7][8]16 Most pediatric donors are close in age to their recipient siblings and therefore young and small.…”