RESUMEN
Leukapheresis is used for the mechanical removal of leukaemic cells in hyperleukocytosis. However, the effectiveness of leukapheresis remains unclear due to selection and confounding factors in the cohorts. We compared the effectiveness of leukapheresis among the subgroups according to either the 2016 World Health Organization classification or the number of cytogenetic abnormalities with a retrospective, single-centre study from January 2009 to December 2018. Acute myeloid leukaemia (AML, n = 212) and acute lymphoblastic leukaemia (ALL, n = 97) were included. The 30-day survival rates (95% confidence interval, 95% CI) for AML and ALL were 86.3% (81.6-90.9%) and 94.8% (90.3-99.2%), respectively. For AML, 'primary AML with myelodysplasia-related changes' and 'AML with biallelic mutation of CEBPA' showed better 30-day survival outcomes (P = 0.026) than the other subgroups. A higher platelet count after leukapheresis was associated with better 30-day survival in AML patients (P = 0.029). A decrease in blast percentage count after leukapheresis was associated with better 30-day survival in ALL patients (P = 0.034). Our study suggested that prophylactic platelet transfusion to raise the platelet count to 50 × 109/L or greater might improve clinical outcome in AML patients undergoing leukapheresis.
Asunto(s)
Leucaféresis/estadística & datos numéricos , Leucemia Mieloide Aguda/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Potenciadoras de Unión a CCAAT/genética , Comorbilidad , Femenino , Humanos , Leucaféresis/normas , Leucemia Mieloide Aguda/epidemiología , Leucemia Mieloide Aguda/genética , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Análisis de SupervivenciaRESUMEN
Lenalidomide (LEN) is commonly used as part of induction therapy in transplant-eligible patients with multiple myeloma. However, LEN use is associated with increased chance of peripheral blood stem cell (PBSC) collection failure. This has led to early collection in patients receiving induction with LEN-containing regimens, and the use of mobilization agents such as plerixafor. Despite potential significant clinical implications, the impact of LEN on autograft composition is unclear. We examined the effect of LEN exposure on hematopoietic progenitors in collected grafts of 94 patients who underwent autologous stem cell transplantation (HSCT) at our institution. LEN exposure resulted in lower myeloid and erythroid progenitors in collected grafts, but this effect was not seen in patients who received plerixafor-based mobilization. Exposure to LEN did not affect PBSC collection, possibly due to high plerixafor use in our cohort (70%). LEN changes the composition of PBSC grafts; the clinical implication of this finding is unknown.
Asunto(s)
Movilización de Célula Madre Hematopoyética/efectos adversos , Lenalidomida/efectos adversos , Leucaféresis/estadística & datos numéricos , Mieloma Múltiple/terapia , Trasplante de Células Madre de Sangre Periférica , Adulto , Anciano , Autoinjertos/efectos de los fármacos , Bencilaminas , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/métodos , Ciclamas , Femenino , Movilización de Célula Madre Hematopoyética/métodos , Compuestos Heterocíclicos/administración & dosificación , Compuestos Heterocíclicos/efectos adversos , Humanos , Quimioterapia de Inducción/efectos adversos , Quimioterapia de Inducción/métodos , Lenalidomida/administración & dosificación , Masculino , Persona de Mediana Edad , Mieloma Múltiple/sangre , Mieloma Múltiple/inmunología , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/métodos , Análisis de Regresión , Estudios Retrospectivos , Trasplante Autólogo , Resultado del TratamientoRESUMEN
While extensive data demonstrated that plerixafor improves stem cell harvest in difficult-to-mobilize patients, economic concerns limit a broader application. We retrospectively assessed the effect of an early plerixafor rescue regimen for mobilization in patients with multiple myeloma. Patients were intended for high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ABSCT) and therefore received cyclophosphamide-based mobilization chemotherapy and consecutive stimulation with granulocyte colony-stimulating factor (G-CSF). Fifteen patients with poor stem cell harvest in the first leukapheresis session received plerixafor. Data were compared with a matched historic control group of 45 patients who also had a poor stem cell yield in the first apheresis session, but continued mobilization with G-CSF alone. Patients in the plerixafor group collected significantly more CD34+ cells in total (median 4.9 vs. 3.7 [range 1.6-14.1 vs. 1.1-8.0] × 10(6) CD34+ cells /kg bw; P < 0.05), and also more CD34+ cells per leukapheresis procedure (P < 0.001). Consequently, they required a significantly lower number of leukapheresis procedures to achieve the collection goal (median 2.0 vs. 4.0 [range 2-3 vs. 2-9] procedures; P < 0.001). The efficiency of the collected stem cells in terms of hematologic engraftment after ABSCT was found to be equal in both groups. These data demonstrate that rescue mobilization with plerixafor triggered by a low stem cell yield in the first leukapheresis session is effective. Although the actual economic benefit may vary depending on the local leukapheresis costs, the median saving of two leukapheresis procedures offsets most of the expenses for the substance in this setting. An exemplary cost calculation is provided to illustrate this effect.
Asunto(s)
Factor Estimulante de Colonias de Granulocitos/farmacología , Movilización de Célula Madre Hematopoyética/métodos , Compuestos Heterocíclicos/farmacología , Leucaféresis/economía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bencilaminas , Recuento de Células Sanguíneas , Terapia Combinada , Costos y Análisis de Costo , Ciclamas , Ciclofosfamida/administración & dosificación , Evaluación de Medicamentos , Sinergismo Farmacológico , Supervivencia de Injerto , Movilización de Célula Madre Hematopoyética/economía , Trasplante de Células Madre Hematopoyéticas/economía , Humanos , Leucaféresis/estadística & datos numéricos , Mieloma Múltiple/sangre , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/terapia , Estudios Retrospectivos , Trasplante AutólogoRESUMEN
BACKGROUND: Cardiopulmonary adverse events after transfusion include transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), which are potentially lethal and incompletely understood. STUDY DESIGN AND METHODS: To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before-and-after study of acute transfusion reactions for the 7years before and after introduction of universal leukoreduction in 2000, involving 778,559 blood components. RESULTS: Substantial decreases occurred in the rates of TRALI (-83%; from 2.8 cases per 100,000 components before to 0.48 after universal leukoreduction; p=0.01), TACO (-49%; 7.4 to 3.8 cases per 100,000; p=0.03), and febrile reactions (-35%; 11.4 to 7.4 cases per 10,000; p<0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 before and after universal leukoreduction). These outcomes were primarily attributable to decreased TRALI and/or TACO associated with red blood cell (RBC) and platelet (PLT) transfusions (-64%) with notably smaller decreases associated with fresh-frozen plasma or cryoprecipitate transfusions (-29%). The incidence of TRALI and/or TACO after 28,120 washed RBC and 69,325 washed transfusions was zero. CONCLUSION: These data suggest novel hypotheses for further testing in animal models, in prospective clinical trials, and via the new US hemovigilance system: 1) Is TACO or TRALI mitigated by leukoreduction? 2) Is the mechanism of TACO more complex than excessive blood volume? and 3) Does washing mitigate TRALI and TACO due to PLT and RBC transfusions?
Asunto(s)
Lesión Pulmonar Aguda/epidemiología , Lesión Pulmonar Aguda/etiología , Transfusión Sanguínea/estadística & datos numéricos , Leucaféresis/estadística & datos numéricos , Reacción a la Transfusión , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/etiología , Implementación de Plan de Salud , Humanos , Incidencia , Leucaféresis/métodos , Transfusión de Plaquetas/efectos adversos , Transfusión de Plaquetas/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Circulación Pulmonar/fisiología , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Because of a high risk of graft-versus-host disease (GVHD), donor lymphocyte infusions with unmodified lymphapheresis products are not used after haploidentical hematopoietic stem cell transplantation. Natural killer (NK) cells have antitumor activity and may consolidate engraftment without inducing GVHD. Production of NK cells under good manufacturing practice (GMP) conditions in a sufficient number is difficult. STUDY DESIGN AND METHODS: Twenty-four apheresis procedures and subsequent NK-cell enrichment from 14 haploidentical donors were performed. NK-cell enrichment was performed using a GMP suitable immunomagnetic procedure. Factors influencing the NK-cell recovery, purity, and NK-cell dose were analyzed. RESULTS: A median number of 4.9 x 10(8) NK cells were obtained and median NK-cell recovery was 58 percent. Median T-cell depletion was 4.32 log. The absolute NK-cell number in the final product after processing significantly correlated with the preharvest NK-cell content of the peripheral blood (p = 0.002, r = 0.867). The NK-cell recovery was inversely correlated to the absolute NK-cell number in the apheresis product (p = 0.01, r = -0.51). The NK-cell dose per kg of body weight of the patient was inversely correlated to the weight of the patient (p = 0.007, r = -0.533). CONCLUSION: Donors with a high NK-cell count in peripheral blood are likely to provide NK-cell products with the highest cell number. However, maximal NK-cell dose is limited and high NK-cell doses may only be obtained for patients with a low body weight, making children and young adults the best candidates for NK-cell therapy.
Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Haplotipos/genética , Trasplante de Células Madre Hematopoyéticas/métodos , Células Asesinas Naturales/inmunología , Niño , Supervivencia de Injerto/inmunología , Humanos , Separación Inmunomagnética , Leucaféresis/métodos , Leucaféresis/estadística & datos numéricos , Depleción Linfocítica , Guías de Práctica Clínica como Asunto , Trasplante Homólogo/efectos adversos , Trasplante Homólogo/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
The National Marrow Donor Program (NMDP) has been facilitating hematopoietic cell transplants since 1987. Volunteer donors listed on the NMDP Registry may be asked to donate either bone marrow (BM) or peripheral blood stem cells (PBSC); however, since 2003, the majority of donors (72% in 2007) have been asked to donate PBSC. From the donor's perspective these stem cell sources carry different recovery and safety profiles. The majority of BM and PBSC donors experienced symptoms during the course of their donation experience. Pain is the number 1 symptom for both groups of donors. BM donors most often reported pain at the collection site (82% back or hip pain) and anesthesia-related pain sites (33% throat pain; 17% post-anesthesia headache), whereas PBSC donors most often reported bone pain (97%) at various sites during filgrastim administration. Fatigue was the second most reported symptom by both BM and PBSC donors (59% and 70%, respectively). PBSC donors reported a median time to recovery of 1 week compared to a median time to recovery of 3 weeks for BM donors. Both BM and PBSC donors experienced transient changes in their WBC, platelet, and hemoglobin counts during the donation process, with most counts returning to baseline values by 1 month post-donation and beyond. Serious adverse events are uncommon, but these events occurred more often in BM donors than PBSC donors (1.34% in BM donors, 0.6% in PBSC donors) and a few BM donors may have long-term complications. NMDP donors are currently participating in a randomized clinical trial that will formally compare the clinical and quality-of-life outcomes of BM and PBSC donors and their graft recipients.
Asunto(s)
Terapia Biológica/efectos adversos , Trasplante de Médula Ósea , Leucaféresis , Programas Nacionales de Salud , Trasplante de Células Madre de Sangre Periférica , Donantes de Tejidos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Leucaféresis/métodos , Leucaféresis/estadística & datos numéricos , Programas Nacionales de Salud/historia , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/estadística & datos numéricos , Sistema de Registros , Riesgo , Trasplante Homólogo , Estados UnidosRESUMEN
BACKGROUND: The rate of utilizing peripheral blood stem cells (PBSC) as a source for allogeneic stem cells is growing rapidly. We aimed to demonstrate our 4 years experience as the largest apheresis center in Turkey and analyzed the content of the apheresis material. PATIENTS AND METHODS: From 1998 to the end of April 2002, 151 leukopheresis procedures were performed on 116 healthy donors (M/F:66/50) with a median age of 30 years (14-53). The HLA identical sibling donors received rhG-CSF 10 microg/kg/day sc. for 4 days and at the 5th day leukopheresis was started until collecting >4 x 10e6/kg CD34+ cells. Two times the donors' total blood volume was processed in 195 min (178-245) on continuous flow cell separators using peripheral venous access. RESULTS: Preapheresis WBC was 51.5 x 10e9/L (range, 13.11-91.3). Mono nuclear cell, CD34 and CD3 quantity of the harvest material were 5.35 x 10e8/kg (range, 0.45-23.46), 6.4 x 10e6/kg (range, 2.49-33.27) and 2.79 x 10e8/kg (range, 0.46-30.95), respectively. We were able to reach the target CD34 count after 1st cycle in 39% and 2nd cycle 61% of the procedures. In all donors with a peripheral blood CD34 count >80/mcl we succeeded to collect enough stem cells with only one leukopheresis. CONCLUSION: Collection of peripheral blood stem cells with continuous flow cell separators is well tolerated, with no mobilization failures or poor mobilizers. We collected high values of CD34+ cells (med. 6.4 x 10e6/kg) at the expense of high CD3+lymphocytes (med. 2.79 x 10e8/kg), which may increase the risk of acute and chronic GVHD after allogeneic hemapoietic cell transplantation.
Asunto(s)
Donantes de Sangre , Trasplante de Células Madre Hematopoyéticas/métodos , Leucaféresis/métodos , Leucaféresis/estadística & datos numéricos , Adolescente , Adulto , Antígenos CD34/análisis , Donantes de Sangre/estadística & datos numéricos , Complejo CD3/análisis , Femenino , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Células Madre Hematopoyéticas/inmunología , Humanos , Leucocitos/inmunología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Recombinantes , Trasplante Homólogo , TurquíaRESUMEN
Xenobiotic metabolizing cytochrome P450 (P450) enzymes were investigated in leukapheresed samples from 50 human individuals. It was the aim of the study (a). to get insight into the extent of extrahepatic P450 variability, (b). to investigate whether and to which extent P450 expression and variability as it is seen in the liver corresponds to P450 expression at extrahepatic sites, and (c). to contribute to the replacement of traditionally used default factors (usually 10 for interindividual variability) by data-derived factors in the risk assessment process. P450 enzymes were determined by Western Blotting. Immunoquantification was performed for P450 1A, 1B1, 2C, 2D6, 2E1, and 3A which were-with the exception of the polymorphically expressed CYP2D6-detectable in all samples investigated. Amounts of P450 enzymes in leukapheresed samples were (except CYP1B1) lower compared to those reported for the liver. The P450 variabilities were expressed by the ratios between the 95th and the 5th percentiles. They displayed 7-(CYP1A), 4-(CYP1B1), 6-(CYP2C), 30-(CYP2D6), 3-(CYP2E1), and 4-(CYP3A) fold variability in specific protein content. The results show (a). qualitative and quantitative differences in the expression of P450 proteins in leukapheresed samples from 50 individuals compared to liver, (b). a different extent of variability depending on the P450 enzyme, and (c). in cases where polymorphically distributed P450 enzymes are involved, the traditionally used factor of 10 might be too low to account for interindividual variability in both toxicokinetics and toxicodynamics.
Asunto(s)
Sistema Enzimático del Citocromo P-450/análisis , Variación Genética , Leucaféresis , Leucocitos/enzimología , Adulto , Sistema Enzimático del Citocromo P-450/genética , Femenino , Humanos , Inmunoquímica , Leucaféresis/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Medición de RiesgoRESUMEN
The administration of steroids is not always effective for the treatment of ulcerative colitis (UC). Their long-term use often causes adverse effects which sometimes result in their stoppage and acute exacerbation. Therefore, an alternative treatment is necessary in order to decrease steroid dosage and avoid the clinical problems associated with steroids. Methods The effectiveness and adverse effects of a leukocytapheresis (LCAP) were investigated in a controlled multicenter trial with randomized assignment of 76 active-stage UC patients in two groups. In the LCAP group (39 patients), LCAP weekly for 5 weeks as an intensive therapy was added to the on-going drug therapy, while steroids were maintained but not increased, and then LCAP was gradually reduced to once every 4 weeks as a maintenance therapy. In the high dose prednisolone (h-PSL) group (37 patients), PSL was added or increased 30 approximately 40 mg/day for moderately severe and 60 approximately 80 mg/day for severe patients and then gradually tapered. Findings The LCAP group showed a significantly higher effectiveness (74% vs. 38%; p=0.005) and lower incidence of adverse effects (24% vs. 68%; p<0.001). The patients were able to continue the trial for a longer period in the LCAP group than the h-PSL group (p=0.012). Clinical activity and endoscopic indexes showed the LCAP group had better improvements than the h-PSL group. Interpretation The results of the trial show that LCAP permits a reduction in total PSL dosage and is more effective and safer than high-dose PSL administration for intensive therapy, and LCAP may maintain remission longer than PSL.
Asunto(s)
Colitis Ulcerosa/terapia , Leucaféresis/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/inmunología , Femenino , Humanos , Leucaféresis/métodos , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Estadísticas no ParamétricasRESUMEN
There is increasing demand for mononuclear cell (MNC) harvests not only for PBPC but also for immune therapies using dendritic cells and donor lymphocytes. We determined the collection efficiencies (CE) of various MNC subpopulations during CD34+ cell harvests using a Fenwal CS 3000 Plus Omnix system in small children and adolescents. The cell content of 140 leukapheresis products (LP) was prospectively evaluated in 45 pretreated patients with solid tumors and hematological malignancies. The median age was 12 years (range 0.8-22), and the median body weight (BW) 43 kg (range 9-92). Depending upon the BW of the patients, the media used for priming were saline (SP) in 86, human albumin (HA, HAP) in 10, and packed red blood cells (BP) in 44 apheresis procedures. The major nucleated cell (NC) fractions collected were monocytes (52% of NC) and CD3+ T cells (26%). The median cell yield for monocytes was 174 * 10(6)/kg (range 24-613) representing a CE of 55%. The median number of CD3(+) T cells was 84 * 10(6)/kg (range 5.6-380; CE = 74%). CD34+ cells represented a very small cell fraction of the LP (1.3% of NC), with a median yield of 4.2 * 10(6)/kg (range 0.2-87) and a CE of 63%. The cell yield of various MNCs was significantly correlated with the cell count in the peripheral blood (PB) and with the blood volume processed (ANOVA, P < 0.0001). No influence on the CE was observed for the priming procedure, the patients' age or sex, or the other adaptations used in the harvesting protocol. In conclusion, the Fenwal CS 3000 Plus OMNIX system with the CD34+ cell program and the described adaptations, is also predictably useful for harvest of monocytes or lymphocytes in pediatric patients. We present regression equations that predict the cell yield of various MNC subpopulations in apheresis products.
Asunto(s)
Leucaféresis/estadística & datos numéricos , Recuento de Leucocitos , Leucocitos Mononucleares , Adolescente , Antígenos CD34/análisis , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Sangre , Niño , Preescolar , Terapia Combinada , Femenino , Neoplasias Hematológicas/sangre , Neoplasias Hematológicas/terapia , Factores de Crecimiento de Célula Hematopoyética/farmacología , Movilización de Célula Madre Hematopoyética , Células Madre Hematopoyéticas , Humanos , Inmunofenotipificación , Lactante , Leucaféresis/instrumentación , Leucaféresis/métodos , Leucocitos Mononucleares/clasificación , Subgrupos Linfocitarios , Masculino , Monocitos , Neoplasias/sangre , Neoplasias/terapia , Estudios Prospectivos , Cloruro de Sodio , Soluciones , Trasplante AutólogoAsunto(s)
Transfusión de Plaquetas/estadística & datos numéricos , Sistema del Grupo Sanguíneo ABO , Plaquetas/inmunología , Plaquetas/microbiología , Plaquetas/efectos de la radiación , Humanos , Leucaféresis/normas , Leucaféresis/estadística & datos numéricos , Leucocitos , Recuento de Plaquetas , Factores de Riesgo , Virosis/transmisiónRESUMEN
We introduce a population model to design optimal apheresis schedules to collect blood stem cells from cancer patients. Blood stem cells are collected prior to the patient undergoing high-dose chemoradiotherapy and are returned after this treatment to enable reconstitution of the white blood cell components. Maximizing the number of cells collected in as few apheresis as possible is desirable. We use a longitudinal data model with random effects to describe profiles of individual patients. A hierarchical prior model introduces common mean profiles for patients undergoing different treatments. We find the optimal apheresis schedule for a new patient by minimizing an expected loss over the posterior predictive distribution of the patient's predicted CD34 profile. We implement estimation of the model and solution of the optimal design problem by a simulation approach, which allows us to accommodate arbitrary shapes for the profiles and realistic loss functions that include relative penalties for the number of scheduled stem cell collections and for collecting fewer than a specified target quantity of total collected stem cells.
Asunto(s)
Teorema de Bayes , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Leucaféresis/estadística & datos numéricos , Modelos Estadísticos , Antígenos CD34/sangre , Volumen Sanguíneo/fisiología , Simulación por Computador , Humanos , Recuento de Leucocitos , Estudios Longitudinales , Neoplasias/terapia , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Granulocyte collection relies on the use of a red cell-sedimenting agent and is influenced by poorly defined intrinsic donor characteristics. The donor's baseline red cell (erythrocyte) sedimentation rate (ESR), a readily measurable intrinsic donor variable, may influence the effectiveness of red cell-sedimenting agents and affect the granulocyte yield. STUDY DESIGN AND METHODS: The in vitro and in vivo effects of 6-percent hydroxyethyl starch on the donor ESR were prospectively studied in 67 granulocytapheresis procedures with a blood cell separator, and the findings were correlated with granulocyte collection efficiency (GCE). A relationship that predicts the GCE on the basis of the donor ESR was then derived and tested. RESULTS: The 3.7-fold mean increase in the donor ESR measured after in vitro addition of hydroxyethyl starch approximated the 3.3-fold increase measured when it was administered to the donors. Higher baseline ESR correlated with larger in vitro and in vivo hydroxyethyl starch-induced increases in ESR and predicted more efficient cell collections and greater cell yields. Furthermore, both ESR and GCE, which varied significantly among donors, remained constant for a given donor undergoing repeat procedures. The results could be summarized by a simple predictive formula that relates the GCE (%) to the ESR (mm/hour): GCE = 1.3ESR + 45. The GCE and yield as predicted by the formula were accurate within 10 percent of the observed values in six subsequent procedures. CONCLUSION: In granulocyte harvests using a blood cell separator with hydroxyethyl starch as the sedimenting agent, 1) both ESR and GCE vary widely among donors yet may remain relatively constant for a given donor; 2) the baseline ESR correlates with hydroxyethyl starch-modified ESR and with GCE; and 3) it may be possible to predict GCE and yield from the donor's baseline ESR.
Asunto(s)
Donantes de Sangre , Sedimentación Sanguínea , Granulocitos , Leucaféresis/métodos , Centrifugación , Humanos , Leucaféresis/estadística & datos numéricos , Recuento de Leucocitos , Matemática , Estudios ProspectivosAsunto(s)
Eliminación de Componentes Sanguíneos/métodos , Leucaféresis/métodos , Plasmaféresis/métodos , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Eliminación de Componentes Sanguíneos/tendencias , Estudios de Evaluación como Asunto , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Inmunoglobulinas Intravenosas/efectos adversos , Leucaféresis/estadística & datos numéricos , Leucaféresis/tendencias , Intercambio Plasmático/métodos , Intercambio Plasmático/estadística & datos numéricos , Intercambio Plasmático/tendencias , Plasmaféresis/estadística & datos numéricos , Plasmaféresis/tendencias , SueciaRESUMEN
This study was designed to define leukapheresis practice. A voluntary questionnaire on leukapheresis was sent to 280 FDA-registered blood-collecting establishments performing leukapheresis. Of the facilities questioned, 67.9 percent responded. The survey results indicate that most facilities use intermittent-flow blood cell separators, while 22.6 percent use more than one separation method. Establishments routinely use 6% hydroxyethyl starch (HES 450/0.70) and the majority using trisodium citrate as the anticoagulant. Forty-eight percent use corticosteroids, primarily dexamethasone, to pretreat the donor. The frequency of donation was not specified by 25.3 percent of the report. Forty-two percent chose an individual donation frequency of two times per week. A limit on the total number of donations allowed per donor was not specified by 78.4 percent of the facilities. Community blood banks (including regional centers) performed 55.6 percent of all leukocyte concentrate collections. The donor reaction incidence was of 3.64 percent. Hospitals, of all types, performed 37.8 percent of the collections. The adverse reaction rate ranged from 2.84 to 9.72 percent. Adverse reactions occurred in donors 54.9 times per 1000 procedures. Ninety-four percent of reported reactions were mild, whereas moderate and severe reactions accounted for 5.9 and 0.4 percent, respectively. Granulocyte yields varied by the type procedure and the use of corticosteroids as well as among facilities. The majority (56.3%) held leukocytes at 22 to 25 degrees C prior to transfusion, while most of the remainder stored at 4 degrees C.