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Peripheral blood stem cell collection in 24 low-weight infants: experience of a single centre
D Orbach1, S Hojjat-Assari, F Doz
1Department of Paediatrics, Curie Institute, Paris, France.
Insights
Peripheral blood stem cell (PBSC) collection in children under 15 kg can avoid routine blood priming. This method is safe and effective, reducing the need for transfusions and femoral catheterization in many young patients.
Area of Science:
- Pediatric Hematology
- Stem Cell Transplantation
- Apheresis Procedures
Background:
- Peripheral blood stem cell (PBSC) harvest in young children (<15 kg) presents challenges.
- Standard procedures often require red blood cell priming for hemodynamic stability and collection efficiency.
- Avoiding routine blood priming is desirable to minimize transfusion-related risks and resource utilization.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PBSC collection in children weighing less than 15 kg without routine blood priming.
- To assess the safety, efficacy, and resource implications of this modified apheresis approach.
Main Methods:
- Retrospective analysis of 48 PBSC apheresis procedures in 24 children (<15 kg) between January 1997 and September 1999.
- Systematic avoidance of extracorporeal circuit priming with red blood cells.
- Packed red blood cell transfusion administered only when pre-collection hemoglobin was <12 g/dl.
Main Results:
- PBSC collection was successful without transfusion in 37.5% of procedures.
- Median CD34+ cell yield was 7.1 x 10^6/kg and CFU-GM yield was 16.0 x 10^5/kg.
- The procedure was safe, with only mild transient side effects, and avoided femoral catheterization in 43% of children.
Conclusions:
- Avoiding routine blood priming is a safe and effective strategy for PBSC collection in low-weight pediatric patients.
- This approach reduces transfusion requirements and the need for central venous access, improving patient management.
- The study demonstrates the potential for successful stem cell mobilization and collection in this challenging pediatric population.
Abstract:
Peripheral blood stem cells (PBSC) harvest may be difficult in young children. Extracorporeal separator line priming by red blood cells is usually required to improve haemodynamic tolerance and efficacy of collection. We present our experience with 24 children weighing less than 15 kg treated between January 1997 and September 1999, in whom we tried to avoid systematic blood priming. The median age and weight at the time of apheresis were 2.4 years and 12 kg, respectively. A total of 48 PBSC were performed. When haemoglobin was less than 12 g/dl, packed red cells were transfused before collection (40% of aphereses). The median cell yield per apheresis was 7.1 (2.2-30.6)x10(6)/kg CD34(+) cells and 16.0 (3.3-44.3)x10(5) CFU-GM/kg. Initial collection failed in three cases. Four children required an additional haematopoietic progenitor mobilization. This procedure allowed PBSC collection without transfusion in 37.5% of children, and was safe (two serious and five mild transient side effects) and effective (median CD34(+) cells collected per child: 7.1 x 10(6)/kg (4.6-30.6) and CFU-GM: 15.1 x 10(5)/kg (4.7-44.3)). Despite their low weight, insertion of a femoral catheter was avoided in 43% of children.