Peripheral blood stem cell collection in pediatric patients: Feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors

Abstract

Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34(+) cell target was achieved at a single harvest; the median number of CD 34(+) cells was 10.8 x 10(6)/kg/leukapheresis (range 1-117) and the median collection efficiency was 63.4% (range 25-100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease.

Mobilization and Harvesting of Peripheral Blood Stem Cells in Pediatric Patients With Solid Tumors

“…A dilemma exists in relation to the ease of HSC mobilization in the youngest pediatric patients with solid tumors compared to older children and adults (15). Our results show that through cancer‐specific chemotherapy and G‐CSF, we achieved satisfactory mobilization of CD34+ cells (>20 µL) in the majority of patients (77%), which coincides with the results of other authors (15–17). We also used higher doses of G‐CSF for successful mobilization in two children who failed to mobilize HSC with disease‐specific chemotherapy and standard dose G‐CSF (18,19).…”

CD34+ collection efficiency as a function of blood volumes processed in pediatric autologous peripheral blood stem cell collection

“…1B) due to more than 1 chemotherapy cycle before harvest, and in our study 50% of NB patients required LVL or ULVL (Table I). The data indicated that these prolonged procedures continue to have efficiencies of 50% to 65%, which are not significantly different from SVL CE, or from previously reported CE [12][13][14][15][16]. Steady state kinetics of peripheral CD34 1 cells is supported by Yamaguchi et al, which showed minimal drop off in CD34 1 counts in pediatric patients for up to 10 BV apheresed [20].…”

“…These studies varied in using different cell separators and programs and mobilization regimens. Reported pediatric collection efficiencies for leukapheresis range from 33% to 67% [12][13][14][15][16]. Adult efficiencies have been reported to have a broader range: from 38% to 91% [17,18].…”

Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process

“…Nevertheless, it is associated with an increased risk of thrombotic and infectious events. The insertion of a CVC in a child might require sedation 65,66 . Moreover, temporary peripheral radial arterial catheters proved to be safe accesses for PBPC collection in children and may therefore be an alternative to CVC in this setting 67 …”