Safe Peripheral Stem Cell Collection in Pediatric Sibling Donors: A Single-Centre Experience From South India

Peripheral blood stem cell (PBSC) collection from healthy pediatric sibling donors is increasingly preferred for allogeneic hematopoietic stem cell transplantation (HSCT) because of higher yields and faster engraftment. However, challenges such as small circulating blood volumes, difficult venous access, and the need for sedation pose safety concerns, particularly in low-weight donors. Data from developing countries remain scarce.

We retrospectively analyzed 35 healthy pediatric sibling donors who underwent PBSC mobilization and collection at a single center in South India between June 2019 and April 2024. All donors received granulocyte colony-stimulating factor (G-CSF) 10 μg/kg/day for 5 days. Plerixafor (0.24 mg/kg) was administered on day 4 in donors with a donor-recipient weight ratio (DRWR) < 0.75. Apheresis was performed on day 5 using the Spectra Optia continuous mononuclear cell collection protocol. Donor demographics, procedural characteristics, collection efficiency, and adverse events were recorded.

135 allogeneic pediatric PBSCTs were performed, of which 35 were pediatric sibling donors, predominantly for haemoglobinopathies (n = 22). Higher donor weight was associated with greater blood volume processed, anticoagulant use, and higher product leukocyte and platelet counts (p < 0.05), without differences in CD34⁺ yield or collection efficiency. Plerixafor use resulted in higher peripheral blood CD34⁺ counts and final CD34⁺ yield compared with G-CSF alone (p < 0.01). All procedures were well tolerated, with only mild, transient adverse events in 15.7% of collections and no serious adverse events.

PBSC collection in healthy pediatric sibling donors, including those with low DRWR, is safe and effective when supported by individualized priming strategies and multidisciplinary care.