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Target Value-Tailored Apheresis Can Improve Prediction of Product Hematopoietic Progenitor Cells Prior to Autologous Transplantation

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Dawn Sheppard, BSc, MSc, MD , The Ottawa Hospital, Ottawa, ON, Canada
Jason Tay, MD, Msc. , The University of Ottawa, Ottawa, ON, Canada
Lothar Huebsch, MD , Hematology, Ottawa Hospital, Ottawa, ON, Canada
Sheryl Ann McDiarmid, RN, BScN, MEd, MBA , BMT Program, Ottawa General Hospital, Ottawa, Ontario, Canada
Lisa Gilliard Martin , Canadian Blood Services, Ottawa, ON, Canada
Doug Palmer , Canadian Blood Services, Ottawa, ON, Canada
Paul Birch , Canadian Blood Services, Ottawa, ON, Canada
Anargyros Xenocostas, MD, FRCPC , Division of Hematology, London Health Sciences Centre/ U Western Ontario, London, ON, Canada
Linda Hamelin, APN , BMT, The Ottawa Hospital, Ottawa, ON, Canada
Christopher N. Bredeson, MD, MSc , The Ottawa Hospital Blood & Marrow Transplant Program, Ottawa, ON, Canada
Background

Collection of a minimum number of hematopoietic progenitor cells (HPC), usually defined as 2 x 106 CD34+ cells/kg, is required to ensure timely neutrophil and platelet recovery.1-4  The majority of centres use peripheral blood-mobilized HPCs as the source of progenitor cells for autologous transplantation,5 but the method used to predict the final apheresis product CD34+ cell content, and thus the whole blood volume to process during apheresis collection, has not been standardized.  In the mid-1990s, Mitterer et al. demonstrated on a 28-patient cohort that the correlation between the pre-apheresis peripheral blood CD34+ cell count and the number of CD34+ cells/kg collected could be used to determine the blood volume to process during apheresis to harvest the desired number of CD34+ cells/kg (target-value tailored, TVT, collection).  Using this concept and local data, the Ottawa Canadian Blood Services Stem Cell Laboratory created a similar regression model to help determine the blood volume to process during apheresis collection.

Methods

We conducted a retrospective study of all peripheral blood HPC apheresis collections performed at the Ottawa Hospital from January 1, 2003 to December 31, 2011.  Our objective was to validate the TVT approach, as modified by our institution.

Results

From 2003 to 2011, there were 815 peripheral blood HPC collections by apheresis.  The majority, 696 (85.4%), were autologous collections and 119 (14.6%) were allogeneic donors.  The most common diagnoses were multiple myeloma and aggressive non-Hodgkin lymphoma (NHL).  The median age of the cohort was 51.1 (range 14.3 – 70.4) years.  The median number of prior chemotherapy regimens was 1 (range 0 – 5).  The majority of collections, 635 (93.7%), were first attempts. 

The median pre-collection peripheral blood CD34+ cell count was 2.23 (interquartile range, IQR 1.07 – 5)/μL.  The median number of apheresis days was 1 (range 1 – 3).  In 721 (88.7%) collections one day of apheresis was required to achieve the minimum number of HPCs.  The median apheresis volume for day 1 collections was 20 (range 3.6 – 24) L.  The correlation coefficient between the pre-collection peripheral blood CD34+ cell count and the final product CD34+ cell content is 0.69 (p<0.001; Figure 1).  The TVT estimate was highly predictive of the final product CD34+ count (r=0.82, p<0.0001; Figure 2).  A minimum of 2 x 106 CD34+ cells/kg was collected in 90.4% of collections. 

 

Discussion

Using the correlation between the pre-collection peripheral blood CD34+ count and the final product HPC content, the TVT formula can accurately determine the blood volume to process during apheresis collection.  This has resulted in reduced apheresis time, fewer apheresis days, and less nursing time.  Ultimately, the TVT formula has allowed our program to improve our resource utilization by accurately predicating the required apheresis volume.

Disclosures:
J. Tay, Sanofi, Advisor: Honoraria

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