Streamlining Apheresis: A Dual-Intervention Quality Improvement Initiative to Increase the Efficiency in Stem Cell...

Autologous stem cell transplantation (ASCT) requires efficient collection of peripheral blood stem cells. At London Health Sciences Centre (LHSC), high-risk multiple myeloma patients are routinely booked for three-day apheresis collections to meet higher CD34+ cell count targets, though many do not require all scheduled days, leading to resource inefficiencies. A quality improvement initiative was implemented to reduce unnecessary apheresis sessions through two interventions: (1) lowering CD34+ cell count target thresholds (from 6 × 10⁶ to 5 × 10⁶ cells/kg for tandem collections and from 3 × 10⁶ to 2.5 × 10⁶ for single collections), and (2) increasing total blood volume (TBV) processed from 3× to 4× for patients within certain target thresholds. Two Plan-Do-Study-Act (PDSA) cycles were conducted between March 2024 and March 2025 involving 76 patients. Outcome measures included collection days saved and cost savings, and post-transplant engraftment times served as a balancing measure. A total of 39.4% of patients avoided at least one collection day due to these interventions. Third-day collection usage in high-risk myeloma patients decreased from 25% to 5.9%. Mean collection days fell significantly in this group (2.21-1.8; p = 0.0015), with total cost savings of CAD $72 734.97. No significant differences were observed in neutrophil or platelet engraftment times, confirming preserved clinical efficacy. Implementing lower CD34+ cell count targets and increased TBV processing significantly reduced apheresis sessions and costs without compromising engraftment outcomes. These changes have become the standard of care at LHSC and may serve as a feasible model for other transplant centers.