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Taiwan Unrelated Donor PBSC Harvest Experience

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.

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Taiwan Unrelated Donor PBSC Harvest Experience

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  1. Taiwan Unrelated Donor PBSC Harvest Experience Shu-Huey Chen Hualien Tzu-Chi General Hospital

  2. 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

  3. 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)

  4. 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)

  5. 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).

  6. 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

  7. Results Ⅰ

  8. Results Ⅱ

  9. Results Ⅲ Female: low BMI, high artery, low total CD34, CD34/recipient kg, and yield

  10. Results Ⅳ • female donors artery access did exhibit higher CD34+ cell yields

  11. 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

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

  13. DISCUSSION • Outcome of harvest: mobilization and harvest • Harvest(procedural setting): less been studies • Suzuya : flow rate negatively correlated with the outcome of stem cell harvest ; CD34+ cells were higher in the arterial group but the differences didn’t reach the significance • Our study: the mean harvest stem cell counts were also not significantly different 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 in the pulmonary circulation;more obvious in low circulating stem cells.

  14. Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect Jan./2008 to Dec./2009

  15. Table 2 Incidences of adverse events

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

  17. 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

  18. Poor mobilizer

  19. 感恩您的聆聽! 人本醫療 尊重生命 福田一方邀天下善士 心蓮萬蕊造慈濟世界

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