Comprehensive technical and patient-care optimization in the management of pediatric apheresis for peripheral blood stem cell harvesting

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• 作者：Yoshihiro Ohara^a ; ^b ; Hitoshi Ohto^c ; ^{hit-ohto@fmu.ac.jp} ; Tetsunori Tasaki^d ; Hideki Sano^b ; Kazuhiro Mochizuki^b ; Mitsuko Akaihata^a ; ^b ; Shogo Kobayashi^b ; Tomoko Waragai^a ; ^b ; Masaki Ito^a ; Mitsuaki Hosoya^a ; Kenneth E. Nollet^c ; Kazuhiko Ikeda^c ; Chitose Ogawa^e ; Takahiro Kanno^f ; Yayoi Shikama^g ; Atsushi Kikuta^b
• 关键词：Peripheral blood stem cell ; Apheresis ; CD34+ cell ; Stem cell ; Transplantation
• 刊名：Transfusion and Apheresis Science
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：55
• 期：3
• 页码：338-343
• 全文大小：387 K
• 卷排序：55

文摘

Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload.Study Design And MethodsWe retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg.ResultsThe median CD34+ cell yield per apheresis procedure was 2.3 × 106 CD34+ cells/kg (0.2–77.9 × 106 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990–1997 versus 5.8% during 1998–2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration.ConclusionBy employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg.