BACKGROUND: Previous prediction algorithms to achieve target CD34+ goals have not been widely adopted, with many centers still using a set volume to process for hematopoietic progenitor cell collections. This may be because previous algorithms are challenging to implement. Additionally, no study has yet examined the utility of adjusting the collect flow rate (CFR) based on the donor's preprocedure total mononuclear cell (MNC) count, which correlates with CD34+ yield. ABBREVIATIONS: ACD = anticoagulant citrate dextrose; CE = collection efficiency; CFR = collect flow rate; CMNC = continuous mononuclear cell collection; HPC = hematopoietic progenitor cell; MNC = mononuclear cell; NMDP = National Marrow Donor Program; PB = peripheral blood; TBV = total blood volume. * Benchmark CE used was 55% (between mean and median). CE = collection efficiency; CFR = collect flow rate; NA = not available.Volume 59, February 2019 TRANSFUSION 661 A DUAL STRATEGY TO OPTIMIZE HPC COLLECTIONS 16.5 (3.5-46.9) 16.6 AE 9.0 0.0002 18.3 AE 11.7 21 (8-74) 28 AE 4.0 9.0 (4.5-22.5) NA Median (range) and/or mean AE standard deviation. * First number is multiple myeloma continuous subset, second number is other entities continuous subset. † Excluding large-volume leukaphereses of > 30 L and > 4 TBV processed, where CE was lower. CE = collection efficiency; MNC = mononuclear cell; NA = not available. Volume 59, February 2019 TRANSFUSION 665 A DUAL STRATEGY TO OPTIMIZE HPC COLLECTIONS

Background Hematopoietic progenitor cell (HPC) and immune effector cell (IEC) therapies often require high doses of mononuclear cells (MNCs), whether CD34+ cells, lymphocytes, or monocytes. Cells for IEC can be sourced from HPC products. We thus examined potentially modifiable variables affecting collection efficiencies (CEs) of MNC subsets in HPC collection and also of the typically undesired cell types of platelets, granulocytes, and red cells, which hinder downstream processing. Finally, we sought to confirm previously indeterminate studies of the effect of an adjusted collect flow rate (CFR) on CD34+ CE. Study Design and Methods We performed univariate and multivariate regression analyses of all 135 National Marrow Donor Program (NMDP) HPC collections in 2019 and compared these fixed CFR procedures to previous NMDP collections using adjusted CFRs. Results Target cell CEs decreased with increasing peripheral blood (PB) concentration and were associated with different cell type locations within the MNC layer. CEs of undesired cell types varied with standard procedural parameters (inlet flow rate, whole blood processed, etc.). Interestingly, some CEs increased with preapheresis hematocrit. Finally, adjusting the CFR by PB MNC count improved MNC CE but not CD34+ CE. Conclusion Correlation of target cell CEs with their PB concentration and different cell type locations by depth within the MNC layer indicates the importance of investigating the compensatory fine‐tuning of procedure variables to improve CE. Correlation of CEs with PB hematocrit, and CFR adjustment by a modified PB MNC and/or PB CD34 algorithm should be further explored. Adjusting standard procedural parameters may reduce product contamination.

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Background Mobile delivery of apheresis services is an increasingly important component of health care equity, as patients should not have to transfer care providers or travel far distances to receive critical therapeutic apheresis procedures or cell therapy‐based treatments. Therefore, the availability of such services should be expanded. Study design and methods In this “How Do I" article, we provide a detailed overview of the elements necessary to initiate and maintain a successful mobile apheresis service, including challenges and potential solutions. Results Safe and efficient operation of a mobile apheresis service must consider acquisition of physical assets, such as apheresis sites, personnel, equipment and supplies, communication devices, and transportation vehicles, and optimize organizational aspects, such as staff responsibilities, service partnerships, logistics management, case scheduling and triage, and billing. In the era of cellular therapy, additional critical considerations include regulatory compliance and facility accreditation. Discussion To our knowledge, no previous publication provides the extensive details described herein to set up and maintain a successful mobile apheresis service, and thus will be very helpful to those facilities wishing to initiate or expand mobile apheresis services.