Hematopoietic progenitor cell large volume leukapheresis (LVL) on the Fenwal Amicus blood separator

Abstract

A technique for large volume leukapheresis (LVL) for hematopoietic progenitor cell (HPC) collection using the Fenwal Amicus is presented. It was compared to standard collections (STD) with regard to CD34+ cell yields and cross-cellular content. Optimal cycle volumes and machine settings were evaluated for LVL procedures. A total of 68 patients underwent 80 HPC collection procedures. Because of differences in CD34+ cell yields associated with peripheral white blood cell counts (WBC), the comparison was divided into groups of 20 with WBC < or =35 x 10(9)/L (< or =35 K) and those >35 x 10(9)/L (>35 K). Baseline CD34+ cell counts (peripheral count when patient started HPC collection) were used (median 18-23 cells/microl). Significantly more whole blood (corrected for anticoagulant) was processed with LVL (LVL 20 l vs. STD 13.5 l). For < or =35 K, median CD34+ x 10(6), WBC x 10(9), RBC ml, Plt x 10(11) yields/collection were 183, 21.2, 14, 0.8, respectively, for STD vs. 307, 22.1, 11, 1.0, respectively, for LVL. For >35 K, median CD34+ x 10(6), WBC x 10(9), RBC ml, Plt x 10(11) yields/collection were 189, 32.7, 15, 1.4, respectively, for STD vs. 69, 40.8, 21, 1.3, respectively, for LVL. We have described a method of LVL using the Amicus that, in patients with pre-procedure WBC < or =35 x 10(9)/L, collects more CD34+ cells than a standard procedure with acceptable cross-cellular content. This method is not recommended when pre-procedure WBC counts are >35 x 10(9)/L.

Apheresis instrument settings influence infused absolute lymphocyte count affecting survival following autologous peripheral hematopoietic stem cell transplantation in non-Hodgkin's lymphoma: the need to optimize instrument setting and define a lymphocyte collection target

“…11 We continue to observe the same strong correlation between A-ALC/kg and ALC-15 in the study (r s ¼ 0.60, Po0.0001). Therefore, not surprisingly, the higher A-ALC/kg collected by SP led to a higher ALC-15 recovery.…”

“…The AMLVL procedure has been described in detail. 11 Whole blood flow rates of 90 ml/min (maximum recommended by the manufacturer) were used when possible for the LVL procedures. The instrument determined the whole blood flow rates for the AM4 and AM5 procedures according to patient blood volume.…”

“…Previous studies indicated that the new settings could be used without significant loss of CD34 þ cells. 11 The settings used were MNC sense ¼ 0.45, MNC offset ¼ 1.5, RBC offset ¼ 5.0 and plasma flush ¼ 8. The citrate infusion rate (CIR) for the AM4 and AM5 procedures was 1.25 mg/kg/ min and the anticoagulant was ACD-A except in cases of citrate toxicity.…”

SCT without growth factor in multiple myeloma: engraftment kinetics, bacteremia and hospitalization

“…This database was searched for the records of all consecutive patients with multiple myeloma undergoing SCT from 1 April 2003 through 31 December 2009. These dates were selected to encompass a period when the techniques for apheresis, 16 stem cell cryopreservation, cell thawing and reinfusion remained unchanged. In addition, antibiotic prophylaxis and criteria for hospitalization did not change during this period.…”

“…All patients who received SCT had a minimum of 2 Â 10 6 CD34 þ cells/kg. Apheresis was performed by processing 11-14 L of blood in 4 h. 16 Patients who received SCT from 1 April 2003 through 31 March 2008 received standard filgrastim or sargramostim, 5 mg/kg per day beginning on posttransplant day þ 6 and continuing until neutrophil engraftment was established. The subsequent consecutive patients, beginning 1 April 2008, received no growth factors after transplant.…”