Large-Volume Leukapheresis Using Regional Citrate Anticoagulation to Collect Peripheral Blood Progenitor Cells

Abstract

The use of peripheral blood progenitor cells (PBPC) for hematopoietic rescue after high-dose chemotherapy is limited by the number of leukaphereses required to collect an adequate number of hematopoietic progenitors. To optimize the collection of PBPC, we evaluated a single large-volume leukapheresis protocol with citrate anticoagulation. A group of 23 patients received cyclophosphamide (4 g/m2) and GM-CSF (5 micrograms/kg/day for 15 days) as PBPC mobilization, with a single outpatient 6 h leukapheresis performed on the COBE Spectra 15 days later. Citrate (0.190 mmol/ml) was infused at 1.2 ml/L of blood/minute with a whole blood to citrate ratio between 17:1 and 25:1. Calcium chloride (50 mM) was administered at a citrate to calcium molar ratio between 10:1 and 5:1 to prevent hypocalcemia. A median 36.6 L (range 24.4-46.4) blood was processed using 338 mM citrate (269-473) and 50 mM calcium (25-75). A median 5 x 10(6) CD34+ cells/kg (< 0.3-24) and 6.2 x 10(5) CFU-GM/kg (< 0.001-29) were collected, representing 5.6 and 5.9 more PBPC, respectively, than were in circulation at the initiation of leukapheresis. We conclude that a 6 h large-volume leukapheresis following cyclophosphamide and GM-CSF mobilization is safe, can recruit hematopoietic progenitors into the circulatory compartment, and allows the collection of high numbers of PBPC in a single procedure.

Ancestim (recombinant human stem cell factor, SCF) in association with filgrastim does not enhance chemotherapy and/or growth factor-induced peripheral blood progenitor cell (PBPC) mobilization in patients with a prior insufficient PBPC collection

“…[7][8][9] To overcome the inconvenience and cost of multiple procedures, large volume leukaphereses (LVL), defined as the processing of more than three blood volumes (BVs) or 15 l of blood in a single session, have been used as a way of processing a high number of patients' BVs in a single session. [10][11][12][13][14] LVL can also recruit PBPC into the circulatory compartment, allowing the continuous harvest of large numbers of progenitors throughout the procedure. [10][11][12]14 Similar recruitment of PBPC has been reported by some 15 but not others 16 with standard volume leukapheresis (SVL).…”

“…[10][11][12][13][14] LVL can also recruit PBPC into the circulatory compartment, allowing the continuous harvest of large numbers of progenitors throughout the procedure. [10][11][12]14 Similar recruitment of PBPC has been reported by some 15 but not others 16 with standard volume leukapheresis (SVL). The group in Lisboa 10 and others [11][12][13][14] have shown that LVL is safe and at least as efficient as SVL for PBPC harvesting, allowing the collection of an adequate PBPC product in the majority of cancer patients in a single session.…”

Continuous infusion of macrophage inflammatory protein MIP-1alpha enhances leucocyte recovery and haemopoietic progenitor cell mobilization after cyclophosphamide

“…This property has been well described and has been exploited clinically for transplantation purposes (Passos-Coelho et al, 1995). Lord et al (1995) have recently shown that MIP-la also increases blood leucocyte numbers and progenitor cell release in mice.…”

Trafficking of CD34+ cells into the peripheral circulation during collection of peripheral blood stem cells by apheresis

“…[7][8][9][10][11][12] The advantage of LVL is that a greater quantity of blood can be processed in fewer days, thereby reducing the costs of cytokine administration and laboratory processing and testing. LVL is feasible only if the level of CD34 ϩ cells in the blood is maintained throughout the apheresis procedure.…”

“…[9][10][11][12] Consequently, CD34 ϩ cells removed during the apheresis procedure must be replaced by others released from reservoirs of these cells, presumably the bone marrow. This clinical observation, as well as the demonstration of increased blood levels of HSC in studies involving humans and animals not treated with cytokines, [13][14][15][16] led some authors to suggest that CD34 ϩ cells are recruited into the peripheral blood as a consequence of the LVL procedure itself, 11,12 although other investigators reported an exhaustion of CD34 ϩ cells in the peripheral blood during or after LVL. 17 This study was designed to explore the kinetics of CD34 ϩ cell release from the bone marrow or other reservoirs during the apheresis procedure.…”