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Extracorporeal photopheresis in paediatric patients: A retrospective comparison between different 'off-line'
Elena Sebastián1,2, Eva María Andrés Esteban2,3, Marta González-Vicent1
1Onco-Hematology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
Extracorporeal photopheresis (ECP) effectively treats graft-versus-host disease (GvHD) in children. The Spectra Optia system with the CMNC protocol optimizes lymphocyte collection, showing better efficiency and safety for pediatric GvHD treatment.
Area of Science:
- Pediatric Hematology
- Immunology
- Cellular Therapy
Background:
- Graft-versus-host disease (GvHD) is a significant complication following allogeneic stem cell transplantation.
- Extracorporeal photopheresis (ECP) is an established treatment for GvHD, but data on pediatric lymphocyte collection are limited.
- Optimizing lymphocyte collection is crucial for effective ECP in pediatric patients.
Purpose of the Study:
- To compare lymphocyte collection for ECP in children using different devices and protocols.
- To analyze the safety and efficacy of ECP based on collected lymphocyte parameters.
- To identify optimal protocols for pediatric ECP.
Main Methods:
- Retrospective analysis of 1524 apheresis procedures in 91 pediatric patients.
- Comparison of COBE Spectra and Spectra Optia systems, focusing on Optia CMNC and MNC protocols.
- Analysis of lymphocyte collection efficiency, safety, and treatment response variables.
Main Results:
- The Optia CMNC protocol demonstrated superior lymphocyte collection efficiency per kg body weight (p < 0.001).
- ECP procedures were generally well-tolerated, with most adverse events related to venous access (21.7%).
- Seventy-one percent of patients achieved partial or complete GvHD response; younger age and increased B lymphocytes post-treatment correlated with better outcomes.
Conclusions:
- Lymphocyte collection for ECP is safe and effective in pediatric GvHD patients, with over half achieving significant response.
- The CMNC protocol on the Spectra Optia system is the preferred method for pediatric lymphocyte collection for ECP.
- Further research into B lymphocyte dynamics may enhance ECP efficacy in children.
Background And Objectives:
Extracorporeal photopheresis (ECP) has been shown to be an effective treatment for graft-versus-host disease (GvHD). However, information regarding lymphocyte collection for ECP in children is limited. The aim of this study was to analyse and compare lymphocyte collection for ECP in children using different devices and protocols. Moreover, we have studied both safety and variables of the infused product related to treatment efficacy.
Patients And Methods:
This was a retrospective study of 91 patients who underwent 1524 apheresis procedures with either the COBE Spectra or Spectra Optia system. The comparison study between the Optia protocols (MNC and CMNC) was prioritized. We analysed 578 procedures using the Optia blood cell separator: 204 and 374 using the MNC and the CMNC protocol, respectively.
Results:
The Optia CMNC protocol showed better collection efficiency, with increased lymphocyte collection per kg of body weight (p < 0.001). On multivariate analysis, the type of protocol showed no relationship with haematocrit or platelet loss. Most procedures were well-tolerated, with the most frequent adverse events related to venous access (21.7%). Seventy-one percent of patients had either partial or complete clinical GvHD response. In the multivariate model, only two variables were associated with a better response to ECP, younger age and a greater increase of B lymphocytes after treatment.
Conclusion:
Lymphocyte collection for ECP is well-tolerated in most children, achieving complete or partial response in more than half of GvHD patients. CMNC is the optimal software to perform lymphocyte collection in children.
