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Taiwan Unrelated Donor PBSC Harvest Experience Shu-Huey Chen Hualien Tzu-Chi General Hosp ital
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Taiwan Unrelated Donor PBSC Harvest Experience

Jan 01, 2016

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Taiwan Unrelated Donor PBSC Harvest Experience. Shu-Huey Chen Hualien Tzu-Chi General Hospital. Impact of donor characteristics and procedural settings in yield Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect Second donation MCV. - PowerPoint PPT Presentation
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Page 1: Taiwan Unrelated Donor PBSC Harvest Experience

Taiwan Unrelated Donor PBSC Harvest Experience

Shu-Huey Chen

Hualien Tzu-Chi General Hospital

Page 2: Taiwan Unrelated Donor PBSC Harvest Experience

• Impact of donor characteristics and procedural settings in yield

• Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect

• Second donation

• MCV

Page 3: Taiwan Unrelated Donor PBSC Harvest Experience

Materials and Methods ( І)

• Jan. 2003〜Mar. 2008, 373 unrelated healthy donors. G-CSF sc, 8.3-11μg/kg, daily for 5 days, harvest on day 5 of G-CSF(Filgrastim)

Page 4: Taiwan Unrelated Donor PBSC Harvest Experience

Materials and Methods(Ⅱ)• CD34+ cell criteria : >5 106 CD34+ cells/ kg

recipient BW, If the first apheresis(D1) failed, following day a second apheresis(D2)

• D1 apheresis volume:

patient body weight <35 kg→12 liters;

35-45 kg →15 liters;

>45 kg →18 liters

D2 apheresis volume: 6-12 liters( D1 + D2 ≤24 liters)

Page 5: Taiwan Unrelated Donor PBSC Harvest Experience

Materials and Methods( )Ⅲ

• BMI (kg/m2) : body weight (kg) divided by the square of their height (m).

• CIC(circulating immature cell )= circulating myeloblasts, promyelocytes, and myelocytes, metamyelocytes and erythroblasts

• The number of CD34+ cells : resultant leukapheresis bag using a PE-conjugated anti-CD34+ cell antibody (HPCA2) and flow cytometry (Becton Dickinson, San Jose, Ca, USA).

Page 6: Taiwan Unrelated Donor PBSC Harvest Experience

Yield

• Convention outcome: CD34+ cells /donor BW (106/kg )

CD34+ cells / recipient BW (106/kg)

• This study outcome: CD34+ cell yield (106/L of processed blood)

Poor yield: <10 x 106 CD34+ cells per L of processed blood

volume a maximum of two aphereses of 24 liters of processed blood volume

yielding 4 x 106 CD34+ cells/ kg for a recipient with BW of 60 kg

Page 7: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅰ

Page 8: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅱ

Page 9: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅲ

Female: low BMI, high artery, low total CD34, CD34/recipient kg, and yield

Page 10: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅳ

•female donors artery

access did exhibit hig

her CD34+ cell yields

Page 11: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅴ

donor age↑, female, low BMI, low pre-harvest WBC and circulating immature cell count, venous access type and high flow rate correlated with low Day 1 yield

Page 12: Taiwan Unrelated Donor PBSC Harvest Experience

Results Ⅵ

female gender, an older age, a higher flow rate and venous access a higher risk for poor yield

Page 13: Taiwan Unrelated Donor PBSC Harvest Experience

DISCUSSION

• Outcome of harvest: mobilization and harvest

• Harvest(procedural setting): less been studies

• Suzuya : flow rate negatively correlated with the outcome of stem cell har

vest ; CD34+ cells were higher in the arterial group but the differences di

dn’t reach the significance

• Our study: the mean harvest stem cell counts were also not significantly d

ifferent if data viewed as a whole, but in female donors venous access did

exhibit lower CD34+ cell yields

• Difficult to explain: arterial access will have a lesser stem cells trapping i

n the pulmonary circulation; more obvious in low circulating stem cells.

Page 14: Taiwan Unrelated Donor PBSC Harvest Experience

Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect

Jan./2008 to Dec./2009

Page 15: Taiwan Unrelated Donor PBSC Harvest Experience

Table 2 Incidences of adverse events

Percentage of the side effect

Bone pain 64.9%

Myalgia/arthralgia 58.2%

Fatigue 44.1%

Headache 33.0%

Insomnia 16.6%

Nausea/anorexia 13.9%

Sweats 9.5%

Fever 9.5%

Vomiting 5.9%

Chills 5.3%

Page 16: Taiwan Unrelated Donor PBSC Harvest Experience

Female(all S/S), high BMI(fatigue, myalgia/arthralgia, sweat), High G-CSF dose(bone pain), High 3rd day WBC(fatigue)

Page 17: Taiwan Unrelated Donor PBSC Harvest Experience

Second Donation(May./1994 to May./2009)

63.6%(7/11) donor choose BM; Fixed experienced staff for vascular access, Routine concomitant calcium gluconate supplement, Reduce processing blood volume for low body weight donor

Page 18: Taiwan Unrelated Donor PBSC Harvest Experience

MCV ≥80 (n=731) MCV <80 (n=62) p value

Gender (Male/Female) 451/280 (61.7/38.3) 40/22 (64.5/35.5) 0.76

Age (year) 31 33 0.03 Donor BW (Kg) 66.0 70.0 0.74

Access (Artery/Vein) 319/412 (43.6/56.4) 25/37 (40.3/59.7) 0.71

Process volume (L) 18 18 0.81

Flow rate (ml/min) 44 45 0.42

Recipient BW (Kg) 60 61.5 0.63

CD34 count in PB (uL) 69.2 68 0.38

Total CD34 cell (106) 455 277.6 <0.0001

CD34 dose (106/RBW) 8.2 4.9 <0.0001

CD34 yield (106/L) 27.3 16.9 <0.0001

Page 19: Taiwan Unrelated Donor PBSC Harvest Experience

Poor mobilizer

年度 2005 2006 2007 2008 2009 2010 2011.Aug

Total

總案例數 70 127 183 252 261 282 214 1389

poor_mobilizer

2 9 11 1 6 4 2 35

poor_mobilizer(%)

2.9 7.1 6.0 0.4 2.3 1.4 0.9 2.5

Page 20: Taiwan Unrelated Donor PBSC Harvest Experience

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