Contributions
Abstract: EP1255
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
The peripheral blood stem cells (PBSC) are the source of haematopoietic stem cells (HSC) currently most used in the allograft of malignant and non malignant haematological diseases in our practice. The procedure of mobilization and collection is similar for adult and children. However, many technical sides must be taken into account in the paediatric apheresis because of extracorporal volume related to the weak weight of the donors.
Aims
We report our experience of collection of PBSC in pediatric sibling donors weighing 20 kg or less over one 14 years period for allogeneic stem cell transplantation.
Methods
From January 2005 to December 2018, 29 children donors (17 boys and 12 girls) weighing 20 kg or less had a collection of PBSC by technic of apheresis after parental consent. The median age and weight at the time of apheresis were 5 years (range:3-9) and 18 kg (range: 13-20), respectively. Stem cell mobilization was obtained by once-daily subcutaneous injections of G-CSF (10µg/kg/day) for five consecutive days. PBSC were collected using a continuous flow blood cell separator (Cobe spectra or Optia) at the 5th day and repeated, if necessary, at the 6th and 7th days.
Results
A total of 54 PBSC were performed. Insertion of a femoral catheter was avoided in 58,6% of children. A single apheresis was sufficient to obtain the required cell number in 10 cases (34,4%). Two apheresis were performed on consecutive days in 13 cases (44,8%) and 3 apheresis were performed in 6 cases (20,6%). Five donors (17%) received transfusion of red blood cells before the second or third harvests. Insertion of a femoral central venous line was necessary in 17 children (58,6%). No child experienced any collection-related occlusion or infection. The median duration of the apheresis per donor, was 223 mn (range: 115-351) with a median blood flow rate of 25 ml/mn (range: 20-50) using a median ACD-A of 375 ml (range: 128-717). The median cell yield per apheresis was 5,9×106 CD34+cells/kg (0,58–24,64) recipient body weight (RBW) of whom 18 donors (62%) achieved the target CD34+ cell dose more than 4.106/kg. Males had a higher mean collected CD34+ cell yields (≥ 4.106/kg) than females (82% vs 33%). The mean ratio between donor and recipient (D/R) body weight was 0,74 (0,25-1,36). Donors with this ratio ˂ 1 failed to reach CD34+ cell dose > 4.106/kg. Morbidity related to PBSC collections was low and 26 children (90%) expressed their willingness to donate again.
Conclusion
The results suggest that G-CSF mobilization and harvesting of PBSCs are safe and effective in low-weight pediatric donors. An efficient and well-experienced team of physicians and nurses involved in CVC positioning and apheresis is crucial to perform a safe PBSC collection in children donors weighing 20 kg or less. Males and D/R body weight ≥ 1 have a higher mean collected CD34+ cell yields.
Keyword(s): Collection, Donor, Pediatric, Peripheral blood stem cell mobilization
Abstract: EP1255
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
The peripheral blood stem cells (PBSC) are the source of haematopoietic stem cells (HSC) currently most used in the allograft of malignant and non malignant haematological diseases in our practice. The procedure of mobilization and collection is similar for adult and children. However, many technical sides must be taken into account in the paediatric apheresis because of extracorporal volume related to the weak weight of the donors.
Aims
We report our experience of collection of PBSC in pediatric sibling donors weighing 20 kg or less over one 14 years period for allogeneic stem cell transplantation.
Methods
From January 2005 to December 2018, 29 children donors (17 boys and 12 girls) weighing 20 kg or less had a collection of PBSC by technic of apheresis after parental consent. The median age and weight at the time of apheresis were 5 years (range:3-9) and 18 kg (range: 13-20), respectively. Stem cell mobilization was obtained by once-daily subcutaneous injections of G-CSF (10µg/kg/day) for five consecutive days. PBSC were collected using a continuous flow blood cell separator (Cobe spectra or Optia) at the 5th day and repeated, if necessary, at the 6th and 7th days.
Results
A total of 54 PBSC were performed. Insertion of a femoral catheter was avoided in 58,6% of children. A single apheresis was sufficient to obtain the required cell number in 10 cases (34,4%). Two apheresis were performed on consecutive days in 13 cases (44,8%) and 3 apheresis were performed in 6 cases (20,6%). Five donors (17%) received transfusion of red blood cells before the second or third harvests. Insertion of a femoral central venous line was necessary in 17 children (58,6%). No child experienced any collection-related occlusion or infection. The median duration of the apheresis per donor, was 223 mn (range: 115-351) with a median blood flow rate of 25 ml/mn (range: 20-50) using a median ACD-A of 375 ml (range: 128-717). The median cell yield per apheresis was 5,9×106 CD34+cells/kg (0,58–24,64) recipient body weight (RBW) of whom 18 donors (62%) achieved the target CD34+ cell dose more than 4.106/kg. Males had a higher mean collected CD34+ cell yields (≥ 4.106/kg) than females (82% vs 33%). The mean ratio between donor and recipient (D/R) body weight was 0,74 (0,25-1,36). Donors with this ratio ˂ 1 failed to reach CD34+ cell dose > 4.106/kg. Morbidity related to PBSC collections was low and 26 children (90%) expressed their willingness to donate again.
Conclusion
The results suggest that G-CSF mobilization and harvesting of PBSCs are safe and effective in low-weight pediatric donors. An efficient and well-experienced team of physicians and nurses involved in CVC positioning and apheresis is crucial to perform a safe PBSC collection in children donors weighing 20 kg or less. Males and D/R body weight ≥ 1 have a higher mean collected CD34+ cell yields.
Keyword(s): Collection, Donor, Pediatric, Peripheral blood stem cell mobilization