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Procedure-related complications and adverse events associated with pediatric autologous peripheral blood stem cell
Laura Cooling1, Sandra Hoffmann1, Dawn Webb1
1Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Insights
Adverse events (AE) during pediatric autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) are linked to venous access and technical issues, impacting older, heavier children. While AE do not affect collection rates, they can decrease yields in certain cases.
Area of Science:
- Pediatric Hematology
- Apheresis Science
- Cellular Therapy
Background:
- Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) is a critical procedure in pediatric oncology.
- While generally considered safe, A-HPCC presents technical challenges and potential for adverse events (AE).
- Limited data exists on the incidence, risk factors, and impact of AE in pediatric A-HPCC.
Purpose of the Study:
- To prospectively investigate the incidence, types, and severity of AE during pediatric A-HPCC.
- To identify demographic and procedural risk factors associated with AE.
- To evaluate the impact of AE on product quality and collection efficiency.
Main Methods:
- Prospective 4.5-year review of AE during pediatric A-HPCC.
- AE were graded by severity and type.
- Demographic and procedural factors were analyzed using t-tests, chi-square, and linear regression.
Main Results:
- 55 AE occurred in 25.4% of A-HPCCs and 39% of children; citrate and access issues were most common.
- Severe AE were primarily related to venous access and technical difficulties, particularly line-related problems.
- AE were more frequent in older, heavier children and those requiring multiple procedures.
- Younger children experienced more citrate-related AE with gastrointestinal symptoms.
- AE did not impact CD34 collection rates, but technical AE decreased mean CD34 yields.
Conclusions:
- Venous access and flow-related issues are significant contributors to moderate and severe AE in pediatric A-HPCC.
- AE incidence increases with patient age, weight, and the number of procedures performed.
- Understanding these factors can help optimize A-HPCC procedures and mitigate risks in pediatric patients.
Introduction:
Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in pediatric patients is considered relatively safe although technically challenging. Very little is known regarding the incidence, risk factors and impact of procedure-related adverse events (AE) on pediatric A-HPCC outcomes.
Methods:
Prospective 4.5-year review of AE associated with pediatric A-HPCC. AE were graded by severity and type. Potential demographic and procedural risk factors, and the impact on product quality, were compared by t-test, chi-square, and linear regression.
Results:
Sixty-two children underwent 110 A-HPCC, including 36 (58%) under 20 kg. Fifty-five AE were documented in 25.4% A-HPCCs and 39% of children (citrate 25%, access 19%, technical 11%, cardiovascular 0%, allergic 1.8%). No AE were noted in children < 10 kg anticoagulated with heparin. Access and technical AE accounted for 73% of severe AE, with line-related problems underlying most technical AE (87.5%, P = 0.006). AE were more likely in older (P = 0.012), heavier patients (P = 0.02), who frequently required more than one A-HPCC (P = 0.012). In contrast, young children were more likely to experience citrate AE with gastrointestinal symptoms (median age, 6 years; P = 0.076). AE had no impact on CD34 collection rates; however, mean CD34 yields (4.2 vs. 20.4 million/kg; P = 0.0035) were decreased in patients with technical AE due to lower peripheral CD34 counts and a high number of aborted procedures (37%).
Conclusion:
Venous access and flow-related issues are a major factor associated with moderate and severe AE, effecting ∼10% of patients. AE are more frequent with increasing patient age, weight, and number of procedures. J. Clin. Apheresis 32:35-48, 2017. © 2016 Wiley Periodicals, Inc.
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