Italian register of therapeutic apheresis: 30 years of activity

The Italian Registry of Therapeutic Apheresis (IRTA) collects clinical data on patients undergoing therapeutic apheresis procedures in Italy. In this study, we outline the main changes in IRTA activity from its inception to 2024 in terms of indications, approaches, and outcomes, and provide details on the main areas of development of therapeutic apheresis based on the IRTA data collected. Over the years, there has been a progressive increase in procedures, from about 13,000 in the initial years to approximately 37,000 in 2024. Overall, more than 300,000 procedures have been performed across all centers (median number of procedures per year: 28,673) and have been included in the IRTA. Indications for therapeutic apheresis have evolved in parallel with changes in American Society for Apheresis indications. IRTA data demonstrate the continued use of apheresis treatment in neurological medicine and solid organ, bone marrow, or stem cell transplantation. Starting from 2019, apheresis cell collections were also performed for the manufacture of CAR-T cells. The safety of these procedures has always been very high. Additionally, the transition from discontinuous to continuous-flow cell separators and the subsequent introduction of automated procedures have further improved overall treatment management. The IRTA proves to be an important tool both for monitoring therapeutic apheresis activity nationwide and for identifying its main areas of development. Emerging pathologies not yet covered by guidelines, especially in neurology, new areas of use for cell therapies, such as CAR-T cells, and the advancement of organ and tissue transplantation represent the challenges in the coming years.