Collection, Cryostorage, Transplantation, and Disposal of Hematopoietic Stem Cell Products

Abstract

Many transplantation centers routinely collect 1 or more autologous peripheral blood stem cell (PBSC) grafts in patients with hemato-oncologic and autoimmune disorders. However, subsequent high-dose chemotherapy and autologous blood stem cell transplantation (ABSCT) are often not performed, for various reasons. Currently, little is known about the actual utilization rate of stored PBSCs. We retrospectively analyzed the collection, storage, and disposal practices of PBSC products from a large cohort of patients (n = 1020) with hematologic, oncologic, and autoimmune disorders at our institution over a 12-year period. Patients with multiple myeloma were excluded. Based on our institution-specific charges, we estimated the costs for PBSC collection/processing and storage. The median number of sufficient PBSC collections per patient in the whole cohort was 2 (range, 1 to 6). We could demonstrate that only 67% of all patients who had collected sufficient PBSCs for transplantation actually underwent ABSCT, and only a small minority of all patients (4%) underwent multiple ABSCTs. The actual use of the stored PBSC grafts varied among disease entities from >80% to 0%. From a retrospective standpoint, the collected and discarded (definitively not used) or stored (potentially not used) cryostored PBSCs were associated with considerable costs of collection, cryopreservation, and long-term cryostorage. Although keeping open the therapeutic option for future transplantations may be important, there is currently a huge discrepancy between collection/storage practices and actual utilization of the cryopreserved PBSCs, at a considerable cost and strain on patients. Our study provides a rationale for reevaluating the present standards.

Cryostorage to What End? – Autologous Stem Cell Products in Burkitt Lymphoma, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, and Myeloproliferative Neoplasm Patients

“…In most stem cell collection facilities worldwide, huge numbers of autologous stem cell products are kept stored for many years and often decades. The resulting costs may rise up to millions of Euros over the years, depending on the size of the collection center [13]. However, it is challenging to define a comprehensive strategy for handling these grafts due to various legal, ethical, and medical issues that have to be taken into account.…”

“…However, it must be borne in mind that storage policies may considerably differ in centers worldwide. The standard approach applied currently in most centers results in substantial additional costs and clinical efforts, and strain on the patient for unnecessary PBSC mobilization, collection, processing, and cryostorage [13]. The current analysis specifically focused on PBSC collection, storage, and disposal while referring to patients’ treatment status.…”

“…Burkitt lymphoma ( n = 18), ALL ( n = 22), MPN ( n = 18), and AML ( n = 71) patients who underwent autologous PBSC collection at the Department of Hematology, Oncology, and Rheumatology at the University Hospital Heidelberg and Mannheim between January 2001 and December 2012 were included. Some of these patients were previously analyzed as a part of a larger cohort with regard to PBSC collection and storage costs [13]. However, the current study focuses on the treatment strategy and clinical course that led to an ABSCT and the storage or disposal of PBSC grafts.…”

“…Recently, we analyzed the collection, storage, and disposal practices of PBSC products from a large cohort of patients with hematological, oncological, and autoimmune disorders over a 10-year period [13]. We identified a huge discrepancy between the collection and storage practices on the one hand and the actual utilization of the cryopreserved PBSCs on the other hand, causing considerable PBSC collection and storage costs.…”

Flow Cytometric Characterization of Hematopoietic Stem and Progenitor Cell Subpopulations in Autologous Peripheral Blood Stem Cell Preparations after Cryopreservation

“…Autologous hematopoietic stem cell transplantation after high-dose chemotherapy is part of the therapeutic regimen for various hematopoietic diseases, such as multiple myeloma (MM) and B-and T-cell lymphoma [1][2][3]. Since the late 1980s, mobilized peripheral blood stem cells (PBSCs) have become established as the preferred source for hematopoietic stem cell transplantation, as they are less cumbersome to obtain and associated with faster engraftment than bone marrow (BM) [4,5].…”