DOCSLIB.ORG

Progenitor Cell Mobilisation Influence of Preapheresis Clinical Factors On

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Progenitor Cell Mobilisation Influence of Preapheresis Clinical Factors On Bone Marrow Transplantation (2003) 31, 851–855 & 2003 Nature Publishing Group All rights reserved 0268-3369/03 $25.00 www.nature.com/bmt Progenitor Cell Mobilisation Influence of preapheresis clinical factors on the efficiency of CD34+ cell collection by large-volume apheresis C Sarkodee-Adoo, I Taran, C Guo, F Buadi, R Murthy, E Cox, R Lopez, S Westphal, S Shope, B O’Connell, L Wethers and B Meisenberg University of Maryland School of Medicine, Greenebaum Cancer Center, Baltimore, MD, USA Summary: that transplants with peripheral blood HPC are associated with faster engraftment and lower costs than those We evaluated 120 leukapheresis procedures (93 patients), supported by steady-state bone marrow harvests.1 These in order to detect clinical factors that influence the advantages of peripheral blood stem cell transplantation efficiency of CD34+ collection using Cobe Spectrat cell (PBSCT) are partly dependent on the number of HPC separators. Hematocrit was 427% and platelet count infused, with CD34+ cell enumeration emerging as the 430 000/llin495% of patients. Platelet transfusions most usefulway of quantifying HPC dose. 2 The efficiency were given if the postprocedure count was o20 000/ll. of leukapheresis for CD34+ cell collection (EffCD34) has Multiple regression analysis was used to analyze putative been defined as the number of CD34+ cells collected per factors, and a predictive equation defined by stepwise volume processed at a given circulating CD34+ cell count.3 regression modeling. The mean efficiency was 0.59 (s.d. Thus, higher EffCD34 is valuable in enabling sufficient HPC 0.27). Sex (M4F; P ¼ 0.01), the volume processed (inver- to be collected in fewer procedures and over a shorter time, sely; P ¼ 0.01) and CD34+ cell count (inversely; P ¼ 0.04) minimizing the costs and risks of leukapheresis and graft were associated with efficiency, whereas hematocrit, processing, and potentially translating into safer ABMT. platelet or leukocyte count, catheter type and patient Yet, few studies have focused on identifying the determi- weight were not. The effect size for predictive factors was nants of EffCD34, and fewer still have involved Cobe small (R2 ¼ 0.21). Adverse events were limited to hypo- Spectrat apheresis machines, although they are frequently calcemia. We conclude that female sex, volume processed used for this purpose. In one study, focusing on the effects 4 and CD34+ cell count adversely influence the efficiency of hematocrit on EffCD34, Mehta et al did not find a of CD34+ cell leukapheresis. However, the impact of correlation, although the other existing study, reported by volume and CD34+ cell count is small, and likely to be Ford et al,3 suggested a correlation between hematocrit and offset by the influence of these same factors on overall EffCD34. In both of these studies, however, Fenwal3000 yield. Leukapheresis appears to be safe and efficient for (Plus) apheresis machines were used. In a more recent 5 autologous blood and marrow transplantation patients with study, Mehta et al did not find a relation between EffCD34 hematocrit 427% and platelet count 430 000/ll. of the Cobe Spectrat machine and the totalleukocyte Bone Marrow Transplantation (2003) 31, 851–855. count, and only a modest inverse relation with the doi:10.1038/sj.bmt.1704034 circulating CD34+ cell count. That study, however, was Keywords: leukapheresis; efficiency; CD 34; cobe not designed to identify other clinical factors that might influence EffCD34. Moreover, as observed by Mehta et al,4 many institutions (including ours) base leukapheresis eligibility on an Autologous blood and marrow transplantation (ABMT) is arbitrarily chosen preapheresis hematocrit, usually ranging useful in the treatment of selected patients with hematolo- from 25 to 30%. This may lead to delays in leukapheresis gic malignancies. In recent years, hematopoietic progenitor while blood transfusions are provided, since a substantial cell (HPC) mobilization followed by leukapheresis has number of patients mobilized with chemotherapy and almost supplanted bone marrow harvesting as a means of growth factors for ABMT are likely to be anemic. The obtaining HPC for ABMT, mainly because it obviates the determination of a threshold hematocrit above which use of generalor spinalanesthesia. At leastin theory, leukapheresis can be performed safely and with high peripheral blood HPC collections in patients with bone EffCD34 would likely reduce the impact of this problem. marrow diseases may also be less contaminated with tumor This is likely to be true for platelet counts also. cells than bone marrow harvests. Studies have also shown We analyzed data collected during leukapheresis with Cobe Spectrat apheresis machines in patients undergoing ABMT in our institution in order to identify preapheresis Correspondence: Dr C Sarkodee-Adoo, City of Hope Samaritan Bone clinical factors that influence Eff . We were particularly Marrow Transplant Unit, 1111 E McDowell Street, Phoenix, AZ 85006, CD34 USA interested in factors such as the catheter type, volume Received 21 October 2002; accepted 9 December 2002 processed, CD34+ cell or platelet count and hematocrit, Determinants of CD34+ cell leukapheresis efficiency C Sarkodee-Adoo et al 852 which could potentially be manipulated in the future as a manufacturer. Large-volume leukapheresis (up to 30 l at way to increase the yield of HPC collections. We also peak flow rates of 125 ml/min) was employed. Leukapher- sought to identify a threshold hematocrit and platelet count esis was repeated the next day if an insufficient number of above which large-volume leukapheresis could be consid- CD34+ cells was obtained. Conversely, in those patients ered safe. whose high CD34+ cell count predicted for adequate yields at smaller volumes, the duration of apheresis (rather than flow rates) was reduced. Anticoagulant consisted of Materials and methods ACDA (970 ml) plus heparin (10 000 ml), with an AC ratio of 30:1. Calcium supplements (oral or by central vein) were Patient selection given only if symptoms of hypocalcemia appeared. The type of centralvenous catheter used for leukapheresis, Between January and December 1999, 93 consecutive classified as having staggered (Bard-Hickman apheresis; patients underwent leukapheresis for collection of HPC as Bard, Salt Lake City, UT, USA) or nonstaggered (Neostar; part of University of Maryland at Baltimore Institutional Horizon MedicalProducts, Manchester, GA, USA) ports, Review Board approved treatment protocols. Informed was based on treating physician preference and was not consent was obtained from all patients. Men (n ¼ 57) decided by apheresis personnel. The EffCD34 was defined in outnumbered women (n ¼ 36). Baseline, preleukapheresis this study as laboratory results of the patients are shown in Table 1. The mean patient weight was 71.56 kg (s.d. 13.52). Staggered- Total# CD34 þ cells collected port catheters were used in 29 patients, and nonstaggered- Circulating CD34þ cell countÂnumber of liters processed port catheters in 60 patients, while peripheral veins or an unknown, previously placed catheter type was used in four All computations were based on complete blood counts patients. Two patients had platelet counts less than 20 000/ and circulating CD34+ cell counts obtained on the ml prior to leukapheresis, and were processed as planned morning of apheresis. Thrombocytopenia and anemia were deviations from our standard operating procedure. The not considered to be contraindications to leukapheresis mean volume processed was 22.8 l (s.d. 7.1 l). provided the platelet count and hematocrit were greater than 20 000/mland 25%, respectively.Instead, our standard Procedures operating procedure was to measure the complete blood count again after leukapheresis, and administer a platelet Mobilization consisted of treatment with cyclophospha- transfusion if the count was less than 20 000/ml. The mide with or without etoposide, followed by GCSF 10 mg/ CD34+ progenitor cell content of apheresis products was kg or GMCSF 250 mg/m2 administered subcutaneously measured using a dualplatformflow cytometric method once a day. Four patients, who failed to obtain enough (FACSCAN, Becton Dickinson, San Jose CA, USA) as circulating CD34+ cells to undergo leukapheresis, under- previously described.6 In order not to confound the analysis went a second attempt using a combination of GCSF 10 mg/ for patient-related (as distinct from procedure-related) kg and GMCSF 250 mg/m2 without chemotherapy, begin- factors, only the first apheresis procedure for each patient ning at least 3 weeks after the initial mobilization attempt. was included in the primary analysis. However, to gain Circulating CD34+ cell counts, determined by flow some independent measure of the variation in EffCD34 cytometry (ProCOUNT, Becton Dickinson, San Jose, between procedures rather than between patients, a CA, USA), were followed when the leukocyte count separate analysis was conducted using pairs of data sets recovered to 42000/ml after mobilization, and leukapher- obtained from patients who had more than one apheresis esis was begun when the CD34+ cell count exceeded 20– procedure. No interim analyses were performed, and the 40/ml or was felt to have peaked. Each patient’s transplant results of EffCD34 were not reported to apheresis staff until physician prescribed the target CD34+ cell number to be completion of the study. collected. Since ABMT protocols in our institution during this period were designed to deliver multiple cycles of post- Statistical methods transplant chemotherapy,
Load more

Recommended publications
  • Factors Affecting Mobilization of Peripheral Blood Progenitor Cells in Patients with Lymphoma’
    Vol. 4, 311-316, February 1998 Clinical Cancer Research 311 Factors Affecting Mobilization of Peripheral Blood Progenitor Cells in Patients with Lymphoma’ Craig H. Moskowitz,2 Jill R. Glassman, (median, 13 versus 22 days; P 0.06). Patients who received 1l cycles of chemotherapy prior to PBPC mobilization David Wuest, Peter Maslak, Lilian Reich, tended to have delayed platelet recovery to >20,090/&l and Anthony Gucciardo, Nancy Coady-Lyons, to require more platelet transfusions than less extensively Andrew D. Zelenetz, and Stephen D. Nimer pretreated patients (median, 13.5 versus 23.5 days; P 0.15; Division of Hematologic Oncology, Department of Medicine median number of platelet transfusion episodes, 13 versus 9; [C. H. M., D. W., P. M., L. R., A. G., N. C-L., A. D. Z., S. D. N.] and P = 0.17). Department of Biostatistics [J. R. G.], Memorial Sloan-Kettering Cancer Center, New York, New York 10021 These data suggest that current strategies to mobilize PBPCs may be suboptimal in patients who have received either stem cell-toxic chemotherapy or 11 cycles of chem- ABSTRACT otherapy prior to PBPC mobilization. Alternative ap- The objective of this study was to identify factors asso- proaches, such as ex vivo expansion or the use of other ciated with poor mobilization of peripheral blood progenitor growth factors in addition to G-CSE, may improve mobili- cells (PBPCs) or delayed platelet engraftment after high- zation of progenitor cells for PBPC transplantation. dose therapy and autologous stem cell transplantation in patients with lymphoma. INTRODUCTION Fifty-eight patients with Hodgkin’s disease or non- The use of high-dose chemoradiotherapy supported by Hodgkin’s lymphoma underwent PBPC transplantation as cryopreserved autologous hematopoietic progenitor cells is ef- the “best available therapy” at Memorial Sloan-Kettering fective in treating relapsed HD3 and NHL; a high complete Cancer Center (New York, NY) between 1993 and 1995.
    [Show full text]
  • 45 Part 606—Current Good Man- Ufacturing Practice
    Food and Drug Administration, HHS Pt. 606 a presentation. The presiding officer ucts approved under § 601.91, the re- may, as a matter of discretion, permit strictions would no longer apply when questions to be submitted to the pre- FDA determines that safe use of the bi- siding officer for response by a person ological product can be ensured making a presentation. through appropriate labeling. FDA also (f) Judicial review. The Commissioner retains the discretion to remove spe- of Food and Drugs’ decision constitutes cific postapproval requirements upon final agency action from which the ap- review of a petition submitted by the plicant may petition for judicial re- sponsor in accordance with § 10.30 of view. Before requesting an order from a this chapter. court for a stay of action pending re- view, an applicant must first submit a PART 606—CURRENT GOOD MAN- petition for a stay of action under § 10.35 of this chapter. UFACTURING PRACTICE FOR BLOOD AND BLOOD COMPO- [67 FR 37996, May 31, 2002, as amended at 70 NENTS FR 14984, Mar. 24, 2005] § 601.93 Postmarketing safety report- Subpart A—General Provisions ing. Sec. Biological products approved under 606.3 Definitions. this subpart are subject to the post- marketing recordkeeping and safety Subpart B—Organization and Personnel reporting applicable to all approved bi- ological products. 606.20 Personnel. § 601.94 Promotional materials. Subpart C—Plant and Facilities For biological products being consid- 606.40 Facilities. ered for approval under this subpart, unless otherwise informed by the agen- Subpart D—Equipment cy, applicants must submit to the agency for consideration during the 606.60 Equipment.
    [Show full text]
  • 0985.03CC Non-Mobilized Donor Consent
    Fred Hutchinson Cancer Research Center Consent to take part in a research study: 985.03CC – Non-Mobilized Donor Consent to Participate as a Donor of Non-Mobilized Peripheral Blood Mononuclear Cells for Laboratory Research and Process Development Studies. Principal Investigator: Derek Stirewalt, MD, Member, FHCRC, (206 667-5386) Investigators: Michael Linenberger, M.D., FACP Professor, Division of Hematology, UW, Robert & Phyllis Henigson Endowed Chair, Program Director, Hematology/Oncology Fellowship Medical Director, Apheresis and Cellular Therapy, SCCA, Member, FHCRC, Associate Professor of Medicine, UW, (206 667-5021); Laura Connelly Smith, Assistant Member, FHCRC, Assistant Professor, UW (206 606 -6938) Research Coordinator: Aubrey McMillan, (206) 667-3539 Emergency Phone (24 hours) UW Transplant unit 8NE: (206) 598-8902 UW Nocturnist on call provider (7:00 PM -7:00 AM): (206) 598-1062 Donor recruitment and participation: 206-667-5318 Important things to know about this study. You are invited to participate in a research study. The purpose of this research is to collect blood cells by a procedure called “leukapheresis”. Leukapheresis is a procedure that allows for a greater collection of peripheral blood cells than can be obtained by standard blood donation. Our purpose is to collect both small blood draws and larger samples of peripheral blood cells for laboratory research studies. This research may involve analysis of your genetic material called DNA and RNA. The studies may also examine other components of the cell like proteins. These analyses can be used to better understand cancer and other diseases. People who agree to join the study will be asked to attend 2 appointments over up to 30 days.
    [Show full text]
  • Leukapheresis Protocol for Nonhuman Primates Weighing Less Than 10 Kg
    Journal of the American Association for Laboratory Animal Science Vol 52, No 1 Copyright 2013 January 2013 by the American Association for Laboratory Animal Science Pages 70–77 Leukapheresis Protocol for Nonhuman Primates Weighing Less than 10 Kg Vimukthi Pathiraja, Abraham J Matar, Ashley Gusha, Christene A Huang, and Raimon Duran-Struuck* Leukapheresis is a common procedure for hematopoietic cell transplantation in adults. The main challenge in applying this procedure to human infants and small monkeys is the large extracorporeal blood volume (165 mL on average) necessary for priming the apheresis machine. This volume represents greater than 50% of the total circulating blood volume of a human neonate or small monkey. In this report, we document a safe leukapheresis protocol developed for rhesus macaques (3.9 to 8.7 kg). To avoid sensitizing donor animals undergoing leukapheresis to third-party blood products, autologous blood col- lected during the weeks prior to leukapheresis was used to volume-expand the same donor while priming the machine with saline on the day of leukapheresis. During the procedures, blood pressure was controlled by monitoring the inlet volume, and critical-care support was provided by the anesthesia team. Electrolytes and hemogram parameters were monitored intermit- tently. Overall, our research subjects underwent effective 4- to 6-h leukapheresis. A total of 9 leukapheresis procedures were performed, which yielded 1 × 109 to 6 × 109 peripheral blood mononuclear cells containing 1.1 to 5.1 × 106 CD34+ cells (assessed in 4 of 9 macaques) in a volume of 30 to 85 mL. All macaques showed decreases in Hct and platelet counts.
    [Show full text]
  • Current Challenges in Providing Good Leukapheresis Products for Manufacturing of CAR-T Cells for Patients with Relapsed/Refractory NHL Or ALL
    cells Article Current Challenges in Providing Good Leukapheresis Products for Manufacturing of CAR-T Cells for Patients with Relapsed/Refractory NHL or ALL Felix Korell 1,*, Sascha Laier 2, Sandra Sauer 1, Kaya Veelken 1, Hannah Hennemann 1, Maria-Luisa Schubert 1, Tim Sauer 1, Petra Pavel 2, Carsten Mueller-Tidow 1, Peter Dreger 1, Michael Schmitt 1 and Anita Schmitt 1 1 Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; [email protected] (S.S.); [email protected] (K.V.); [email protected] (H.H.); [email protected] (M.-L.S.); [email protected] (T.S.); [email protected] (C.M.-T.); [email protected] (P.D.); [email protected] (M.S.); [email protected] (A.S.) 2 Institute of Clinical Transfusion Medicine and Cell Therapy (IKTZ), 89081 Heidelberg, Germany; [email protected] (S.L.); [email protected] (P.P.) * Correspondence: [email protected] Received: 9 April 2020; Accepted: 13 May 2020; Published: 15 May 2020 Abstract: Background: T lymphocyte collection through leukapheresis is an essential step for chimeric antigen receptor T (CAR-T) cell therapy. Timing of apheresis is challenging in heavily pretreated patients who suffer from rapid progressive disease and receive T cell impairing medication. Methods: A total of 75 unstimulated leukaphereses were analyzed including 45 aphereses in patients and 30 in healthy donors. Thereof, 41 adult patients with Non-Hodgkin’s lymphoma (85%) or acute lymphoblastic leukemia (15%) underwent leukapheresis for CAR-T cell production.
    [Show full text]
  • Transfusion Reactions 7
    HEMATOLOGY Immunohematology, transfusion medicine and bone marrow transplantation Institute of Pathological Physiology First Facultry of Medicine, Charles University in Prague http://patf.lf1.cuni.cz Questions and Comments: MUDr. Pavel Klener, Ph.D., [email protected] Presentation in points 1. Imunohematology 2. AB0 blood group system 3. Rh blood group system 4. Hemolytic disease of the newborn and neonatal alloimmune thrombocytopenia 5. Pre-transfusion examinations 6. Transfusion reactions 7. Transfusion medicine and hemapheresis 8. HLA system 9. Stem cell/ bone marrow transplantation Origins of immunohematology and transfusion medicine Imunohematology as a branch of medicine developed hand in hand with the origins of transfusion therapy. It focuses on concepts and questions associated with transfusion therapy, immunisation (as a result of transfusion therapy and pregnancy) and organ transplantation. In 1665, an English physiologist, Richard Lower, successfully performed the first animal- to-animal blood transfusion that kept ex-sanguinated dogs alive by transfusion of blood from other dogs. In 1667, Jean Bapiste Denys, transfused blood from the carotid artery of a lamb into the vein of a young man, which at first seemed successful. However, after the third transfusion of lamb’s blood the man suffered a reaction and died. Due to the many disastrous consequences resulting from blood transfusion, transfusions were prohibited from 1667 to 1818- when James Blundell of England successfully transfused human blood to women suffering from hemorrhage at childbirth. Revolution in 1900 In 1900 Karl Landsteiner discovered the AB0 blood groups. This landmark event initiated the era of scientific – based transfusion therapy and was the foundation of immunohematology as a science.
    [Show full text]
  • How Do I Perform Whole Blood Exchange?
    HOW DO I? How do I perform whole blood exchange? † † † David Ming-Hung Lin ,1, Joanne Becker,2, YanYun Wu,1 and Laura Cooling3, here are a number of clinical scenarios in which crossmatched against plasma or adsorbed plasma, if avail- simultaneous exchange of the patient’s plasma able. Because preparation of reconstituted WB is considered and red blood cells (RBCs) are indicated. Some of an open system with a 24-hour outdate, we prepared only these clinical indications for therapeutic whole one reconstituted WB unit at a time (i.e., after dispensing Tblood exchange (WBEx) include hemolytic disease of the one unit, the next unit was prepared). WBEx was performed newborn, severe autoimmune hemolytic anemia (AIHA), by physically removing WB with a syringe, followed by infu- – babesiosis, sickle cell disease, and hyperleukocytosis.1 4 sion of reconstituted WB. In adult patients, this involved WBEx has been performed with manual, semiautomated, removal of 200 mL (50 mL per draw with 60-mL syringes) and fully automated methods using replacements fluids over 10 minutes through a triple-lumen central venous (i.e., RBCs with plasma, RBCs with 5% albumin, and whole catheter, followed by infusion of WB over 1 to 1.5 hours. blood [WB]) reconstituted to a prespecified target hemato- Overall, it required 20 hours to complete a manual WBEx crit (Hct); however, methodologies vary widely and each exchange with 12 units of WB as replacement. For pediatric carry advantages and disadvantages. Here, we describe our patients, a similar process was followed using a central or combined experiences in performing WBEx, including clini- femoral venous catheter (5 mL/kg per draw).
    [Show full text]
  • Leukopak PBMC Sample Processing for Preparing Quality Control Material to Support Proficiency Testing Programs
    JIM-11874; No of Pages 8 Journal of Immunological Methods xxx (2014) xxx–xxx Contents lists available at ScienceDirect Journal of Immunological Methods journal homepage: www.elsevier.com/locate/jim Leukopak PBMC sample processing for preparing quality control material to support proficiency testing programs Ambrosia Garcia a, Sarah Keinonen a, Ana M. Sanchez a, Guido Ferrari a,d,e, Thomas N. Denny a,b,e, M. Anthony Moody a,c,⁎ a Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, USA b Departments of Medicine, Duke University Medical Center, Durham, NC, USA c Departments of Pediatrics, Duke University Medical Center, Durham, NC, USA d Departments of Surgery, Duke University Medical Center, Durham, NC, USA e Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA article info abstract Article history: External proficiency testing programs designed to evaluate the performance of end-point Received 19 November 2013 laboratories involved in vaccine and therapeutic clinical trials form an important part of Received in revised form 14 May 2014 clinical trial quality assurance. Good clinical laboratory practice (GCLP) guidelines recommend Accepted 31 May 2014 both assay validation and proficiency testing for assays being used in clinical trials, and such Available online xxxx testing is facilitated by the availability of large numbers of well-characterized test samples. These samples can be distributed to laboratories participating in these programs and allow Keywords: monitoring of laboratory performance over time and among participating sites when results Proficiency testing are obtained with samples derived from a large master set. The leukapheresis procedure Leukocytes provides an ideal way to collect samples from participants that can meet the required number Leukapheresis of cells to support these activities.
    [Show full text]
  • Leukapheresis: an Overview
    IMPORTANCE OF IMMUNE CELLS IN RESEARCH Your immune cell donation may assist researchers to advance medical treatments, lead to a scientific breakthrough or even develop cures for certain diseases or disorders. Immunologists worldwide have a need for high quality immune cells and cellular subsets, and this is where you come in! Researchers will use donations like yours in an attempt to find novel ways to prime the immune system against cancers and other diseases such as HIV, auto-immune disorders, multiple sclerosis, Crohn’s, CONTACT US allergies and asthma. Immunotherapy treatments are especially effective against lung cancer, skin cancer and blood cancers such (267) 310-1400 LEUKAPHERESIS: as leukemia and lymphoma. [email protected] AN OVERVIEW biospecialty.com WHITE BLOOD CELL DONATION PROCESS Blood is made up of many components, specifically platelets, red blood cells, plasma and white blood cells, which can all be Biological Specialty Company individually collected. FDA-registered donor center operating under Investigational Review Board (IRB) approval 2165 N. Line Street | Colmar, PA 18915 1401 W. Green Street | Allentown, PA 18102 22 South 4th Street | Reading, PA 19602 LEUKAPHERESIS, noun leu· ka· phe· re· sis | \ ˌlü-kə-fə-ˈrē-səs\ The process of leukapheresis allows for peripheral blood Derived from the latin roots mononuclear cells (PBMCs) to be collected from the blood while returning red blood cells, platelets and plasma back to the donor. An of leuk (meaning white) and apheresis machine is used to draw blood through a vein in one arm, aphaeresis (translates to take remove the needed component and return the unneeded parts back away).
    [Show full text]
  • Peripheral Blood Stem Cell Transplantation As an Alternative to Bone Marrow Transplantation: an Overview
    Henry Ford Hospital Medical Journal Volume 39 Number 2 Article 10 6-1991 Peripheral Blood Stem Cell Transplantation as an Alternative to Bone Marrow Transplantation: An Overview Nalini Janakiraman Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Janakiraman, Nalini (1991) "Peripheral Blood Stem Cell Transplantation as an Alternative to Bone Marrow Transplantation: An Overview," Henry Ford Hospital Medical Journal : Vol. 39 : No. 2 , 103-107. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol39/iss2/10 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Peripheral Blood Stem Cell Transplantation as an Alternative to Bone Marrow Transplantation: An Overview Nalini Janakiraman, MD' Slem cells capable of resloring hemalopoiesis following lethal bone marrow injury circulate in Ihc blood of many animals, including humans. When collected ihrough leukapheresis and reinfused following high-dose chenwiherapy, slem cells offer a Irealmenl optiim not currently open lo some patients who are unable lo undergo autologous hone marrow transplantation because of tumor involvement in the pelvis, prior pelvic radiation, or intolerance to general anesthesia. After stem cell infusion, hematologic and immunologic recovery are rapid in comparison lo that after autologous hone marrow reinfusion: however, in some cases platelet engraftment is slower. There is some evidence lhal tumor conlaminalion in the peripheral hlood is much less than in the marrow.
    [Show full text]
  • Blood Transfusions an Overview
    Blood Transfusions: An Overview Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. Abstract Being able to replace blood and blood components that a patient has lost or that his or her body is not able to produce is a vital part of providing excellent medical care. With the aid of donor blood, or even sometimes the patient’s own blood that has been previously banked, medical professionals have a safe strategy for treatment of patients who have lost blood to illness or injury. This course will explain the different types of blood products, the requirements for performing a transfusion, and how to recognize and respond to complications of the transfusion process.
    [Show full text]
  • Case Reports
    CASE REPORTS units that were group A, D+, E−, K−, and Fy(a−). Severe delayed hemolytic transfusion reaction Although anti-Le a was microscopically positive at poly - due to anti-Fy3 in a patient with sickle cell disease ethylene glycol (PEG) IgG, anti-Lea is not routinely undergoing red cell exchange prior to matched for at the study institution nor had been hematopoietic progenitor cell collection for gene matched for with transfusions at his primary medical therapy facility. After RCE, his Hb rose from 9.3 to 11.2 g/dL, and his HbS% decreased from 78% to 22% (HbA% of 72%). To our knowledge, most patients with sickle cell di- The following day, the patient was given a single 240 sease (SCD) who have undergone hematopoietic progen - µg/kg dose of plerixafor for HPC mobilization and started itor cell (HPC) collection for gene therapy have been con - leukapheresis about 3 hours afterward. He had no ditioned with a series of monthly simple or exchange adverse events and was discharged home after his leuka - transfusions. The rationale for this practice is to improve pheresis. safety and decrease bone marrow inflammation, poten - Five days after RCE, the patient developed throbbing + tially leading to higher CD34 mobilization and low back pain, subjective fevers, dark urine, and scleral decreased risk of adverse events during HPC collection. icterus, symptoms differing from his typical vaso-occlu - + Whether transfusion actually improves CD34 mobiliza - sive crises usually manifesting as right-sided flank/upper tion is not clear however, and we previously showed that back discomfort and priapism.
    [Show full text]