Download - Taiwan Unrelated Donor PBSC Harvest Experience Shu-Huey Chen Hualien Tzu-Chi General Hospital
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
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)
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)
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).
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
Results Ⅰ
Results Ⅱ
Results Ⅲ
Female: low BMI, high artery, low total CD34, CD34/recipient kg, and yield
Results Ⅳ
•female donors artery
access did exhibit hig
her CD34+ cell yields
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
Results Ⅵ
female gender, an older age, a higher flow rate and venous access a higher risk for poor yield
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.
Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect
Jan./2008 to Dec./2009
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%
Female(all S/S), high BMI(fatigue, myalgia/arthralgia, sweat), High G-CSF dose(bone pain), High 3rd day WBC(fatigue)
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
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
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
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