Successful collection and transplantation of peripheral blood stem cells in cancer patients using large-volume leukaphereses

Abstract

It was the aim of our study to determine the collection efficiency and yield of CD34+ cells in 88 cancer patients (pts, 44 males/44 females) who underwent 154 large‐volume leukaphereses (LV‐LPs). The diagnoses were as follows: 18 patients had Non‐Hodgkin's lymphoma, 9 Hodgkin's disease, 24 multiple myeloma, 6 acute leukemia, 27 breast cancer, and 4 patients had solid tumors of different types. During the course of LV‐LPs, 20 liters (l) of blood were processed at a median flow‐rate of 85 ml/min (CS 3000 Baxter) and 130 ml/min (COBE Spectra), respectively. Peripheral blood stem cells (PBSC) were collected following granulocyte colony‐stimulating factor (G‐CSF)‐supported cytotoxic chemotherapy. A 31% and 21% mean decrease in the platelet and white blood count was noted at the end of the LV‐LPs when compared with the pre‐leukapheresis values. The aphereses were well tolerated without adverse effects. The level of circulating CD34+ cells was closely related to the number of CD34+ cells contained in the respective leukapheresis product (R = 0.89, P < 0.001). Compared with 270 patients who underwent 838 regular 101 LPs, the yield of CD34+ cells/kg was almost two‐fold greater (4.84 ± 0.63 × 106 [Mean ± SEM] vs 2.60 ± 0.16 × 106, P < 0.001). The antigenic profile of CD34+ cells was assessed in 54 separate products collected on the occasion of 27 LV‐LPs following the processing of 101 and 201, respectively. The intra‐individual comparison included differentiation as well as lineage‐associated markers (CD38, Thy‐1, c‐kit, CD33, CD45RA). No difference in the subset composition was observed between the first and second product, arguing against a preferential release of particular CD34+ cell subsets during the procedure. As shown by molecular biological or immunocytochemical examination, the likelihood of harvesting malignant cells using large‐volume aphereses was not increased in comparison with regular leukaphereses. Single harvests of ≥2.5 × 106 CD34+ cells/kg could be obtained in 74% of the patients, compared with 52% in case of regular LPs. As the majority of patients were autografted with more than 2.5 × 106 CD34+ cells/kg following high‐dose therapy, hematological recovery in general was rapid and not related to the type of apheresis product used. Considering patient comfort and savings in resource utilization, large‐volume leukaphereses have become the standard procedure for PBSC collection in our center. © 1996 Wiley‐Liss, Inc.

Non-cryopreserved peripheral blood progenitor cells collected by a single very large-volume leukapheresis: A simplified and effective procedure for support of high-dose chemotherapy

“…The ability to collect with a single large-volume leukapheresis enough PBPC for hematopoietic rescue after high-dose chemotherapy has been reported in 70 to 92% of patients with various hematologic or solid organ malignancies [14,19]. When standard volume leukaphereses are performed the proportion of patients presenting with single harvests of 2.5 × 10 6 or more, CD34+ cells/kg is significantly lower [14].…”

“…Fifteen patients required admission to the hospital for complications related to mobilization but there was no procedure-related death. Recent data have shown that adequate progenitors to sustain long-term hematopoiesis can be collected with a single leukapheresis [4][5][6]14,15]. In an attempt to limit the number of aphereses, which is a time-consuming and a cost-limiting factor, we developed a VLVL programme by processing up to 10× the patient blood volume.…”

“…When standard volume leukaphereses are performed the proportion of patients presenting with single harvests of 2.5 × 10 6 or more, CD34+ cells/kg is significantly lower [14]. Passos-Coelho et al [4] compared the efficiency of CD34+ collection by LVL with that of standard-volume leukaphereses and concluded that the former procedure was more efficient.…”

“…Cull et al [15] and Imrie et al [19] performed a VLVL programme, similar to our schedule, and showed that they collected a median of 1.4 and 1.7 times more CD34+ cells, respectively, than were in circulation at the start of the collection. The underlying mechanisms of mobilization have not been clarified, but ultimately sheer forces along the marrow sinusoids may be effective in reducing adhesive interactions between CD34+ cells and endothelial cells [14,24]. Eighty-one percent of our patients received at least 2 × 10 6 CD34+ cells/kg, and 63% had at least 2.5 × 10 6 CD34+ cells/kg.…”

Collection and Processing of Peripheral Blood Stem Cells and Bone Marrow

“…[169][170][171][172][173][174][175][176][177][178] Typically, the quantity of blood processed is 6 or more times the patient's blood volume, often 25 to 36 L of blood. Thus, for a consistent quantity of blood processed through the machine, the quantity of CD34+ cells collected is directly related to the number present in the peripheral blood.…”