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Successful blood stem cell collection and transplant in children weighing less than 25 kg
F Deméocq1, J Kanold, J Chassagne
1Departement de Pediatrie, Hotel-Dieu, Clermont-Ferrand, France.
Insights
Peripheral blood stem cell (PBSC) collection for pediatric autotransplantation is feasible. Hematopoietic growth factor (HGF) significantly increases PBSC yields, crucial for successful transplantation in children with malignant diseases.
Area of Science:
- Pediatric Hematology
- Oncology
- Stem Cell Transplantation
Background:
- Autotransplantation using peripheral blood stem cells (PBSCs) is a critical therapeutic option for children with malignant diseases.
- Efficient collection of adequate PBSC numbers is essential for successful engraftment and patient outcomes.
- Optimizing apheresis procedures in pediatric populations, particularly those weighing under 25 kg, requires careful consideration of mobilization strategies and collection parameters.
Purpose of the Study:
- To evaluate the efficacy and safety of peripheral blood stem cell (PBSC) collection for autotransplantation in pediatric patients.
- To assess the impact of hematopoietic growth factor (HGF) administration on PBSC yield in children.
- To analyze the procedural aspects, including apheresis techniques and blood flow rates, in a cohort of young patients.
Main Methods:
- Retrospective analysis of 20 pediatric patients (< 25 kg) undergoing PBSC collection for autotransplantation.
- PBSCs were collected using a Cobe Spectra continuous flow blood separator following various pre-mobilization regimens (chemotherapy, HGF, radiotherapy).
- Vascular access methods, extracorporeal line priming, blood flow rates, and total collection times were documented.
Main Results:
- A median of 37.7 x 10(4) CFU-GM/kg PBSCs were collected, with significant variability.
- PBSC collection after HGF administration yielded 7.8-fold higher CFU-GM compared to those without HGF (median 20.4 vs. 2.6 x 10(4) CFU-GM/kg).
- Procedures were generally well-tolerated, with a median 36% decrease in platelet counts post-apheresis.
Conclusions:
- PBSC autotransplantation is a viable strategy for pediatric patients with malignant conditions.
- Hematopoietic growth factor (HGF) significantly enhances PBSC collection efficiency in children, improving yield for transplantation.
- Apheresis procedures using continuous flow separators are effective and safe for pediatric PBSC collection, though careful monitoring of hematologic parameters is warranted.
Abstract:
Peripheral blood stem cells (PBSCs) were collected for autotransplantation in 20 children (median age 4 years, range 0.5-10 years) weighing < 25 kg (median 14.5 kg, range 6.8-24 kg) with various malignant diseases: leukemias and lymphomas (n = 6), solid tumours (n = 14). Cytaphereses were carried out after standard chemotherapy (n = 10), mobilizing high-dose chemotherapy (n = 9) or radiotherapy alone (n = 1). In 13 children PBSCs were harvested after haematopoietic growth factor (HGF) administration. PBSCs were collected using a continuous flow blood separator (Cobe Spectra). In 13 patients access was through a central catheter with peripheral venous return, in 4 patients access was through a central catheter with return through a femoral catheter; one patient had femoral catheter access with peripheral venous return and two patients had both access and return through peripheral veins. For 19 patients the extracorporeal line was primed with red blood cells. The median blood flow rate was 13.8 ml/min (range 7-22 ml/min). Sixty-six procedures (mean 3.3/patient, range 1-4) were performed with a mean total collection time of 8.5 h. The median number of granulocyte-macrophage colony-forming units (CFU-GM) collected was 37.7 x 10(4)/kg (mean 107 x 10(4)/kg, range 1.05-882 x 10(4)/kg). The number of CFU-GM collected per procedure in children with HGF was 7.8-fold higher than in children without HGF (median 20.4 versus 2.6 x 10(4) CFU-GM/kg body weight, respectively). There were no consistent effects on peripheral blood counts except on platelet counts which decreased following each procedure (median decrease in platelet count was 36%).(ABSTRACT TRUNCATED AT 250 WORDS)