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Peripheral blood stem cell (PBSC) collection in extremely low-weight infants
W Nussbaumer1, D Schönitzer, T Trieb
1Department of Transfusion Medicine, University Hospital, Innsbruck, Austria.
Insights
Peripheral blood stem cell (PBSC) collection is safe and effective in extremely low-weight infants. This study demonstrates successful PBSC harvesting in infants under 10 kg with neuroblastoma, enabling successful transplantation.
Area of Science:
- Hematology
- Pediatric Oncology
- Cellular Therapy
Background:
- Peripheral blood stem cell (PBSC) collection is a standard procedure in adults.
- Limited data exists on PBSC collection efficacy and safety in pediatric patients, particularly in extremely low-weight infants.
Purpose of the Study:
- To evaluate the safety, efficacy, and feasibility of PBSC collection in infants weighing less than 10 kg.
- To assess the outcomes of transplantation using PBSC collected from these infants.
Main Methods:
- PBSC collection was performed in three infants (6.92-9.4 kg) with stage IV neuroblastoma after mobilization with chemotherapy and G-CSF.
- A Baxter CS-3000 Plus separator was used, with specific priming and dilution protocols to match patient hematocrit.
- Collections were initiated upon detection of 1.0% CD34+ cells, with a median of four procedures per patient.
Main Results:
- Sufficient nucleated cells (≥4 x 10^8/kg BW) were collected from all three infants.
- No serious side-effects were observed in the infants during the collection procedures.
- Successful transplantation was achieved with myeloid engraftment in 7-9 days, and independence from red cell and platelet support by 10-29 days.
Conclusions:
- PBSC harvesting using continuous flow cell separators is safe and feasible in low-weight infants, even those under 7 kg BW.
- This procedure facilitates successful transplantation in pediatric patients with high-risk cancers.
- Further research should explore larger cohorts to solidify these findings.
Abstract:
While PBSC collection has become a safe procedure for adults, only a few reports exist about its efficacy, safety and feasibility in paediatric patients, especially extremely low-weight infants. We describe successful PBSC collection in three infants of less than 10 kg body weight (BW; range: 6.92-9.4 kg) suffering from stage IV neuroblastoma. Harvest of PBSC started after mobilisation with high-dose chemotherapy and G-CSF, as soon as 1.0% CD34+ cells were detected. Collections were performed using a Baxter CS-3000 Plus separator primed with a mixture of irradiated, white cell-depleted and CMV-negative packed red cells resuspended in 5% human albumin and diluted with saline to match the patient's haematocrit. Performing a median of four, (4-7, median, range) procedures we collected at least 4 x 10(8)/kg BW nucleated cells (NC) from all three patients. The infants were not sedated and showed no serious side-effects. All three children were successfully transplanted with myeloid engraftment in 8 (7-9) days, independence from red cell support was achieved in 15 (10-20) days and from platelet transfusions in 25 (14-29) days after PBSC infusion. We conclude that PBSC harvesting using continuous flow cell separators is safe, even in low-weight infants of less than 7 kg BW.