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Donor apheresis technologies in the new millennium
S4
Speaker abstracts / Transfusion and Apheresis Science 50 (2014) S1–S4
• Hemolysis • Air embolism There must be also attention for long term effects from apheresis donations. A plateletapheresis donor may lose 80–100 mL of blood, both in the harness and by blood sampling at each donation. Reports of decreased ferritine levels in repeat apheresis donors with over 20 donations per year are published. Also low immunoglobulin levels in frequent plasmapheresis donors are described. Since compromised bone mineral densities at the lumbar spine in frequent plateletapheresis donors are described, there is also a concern regarding the long-term effects of frequent increased PTH levels caused by apheresis, although the clinical consequence remains open. S8 Immune effector clinical depletion in haploidentical transplants S. Rutella. Department of Pediatric Hematology/Oncology and Transfusion Medicine, IRCCS Bambino Ges` u Children’s Hospital, Rome, Italy Haploidentical hematopoietic stem cell transplantation (HSCT) is a feasible therapeutic option for patients at high risk of leukemia relapse, and without human leukocyte antigen (HLA)-matched donors. Clinical success, i.e., full donor-type engraftment in 95% of patients with acute leukemia and negligible incidence of acute and chronic graft-versus-host disease (GVHD), has been achieved with grafts containing a mega-dose (10×106 /kg) of negatively or positively selected CD34+ cells, without any post-transplant immunosuppression. We have recently developed a novel graft manipulation strategy aimed at removing ab+ T cells and CD19+ B cells with the Miltenyi technology, prior to HSC infusion into HLA-haploidentical children with malignant or nonmalignant disorders. TCR-ab and B-cell depletion allow the prevention of intolerable GVHD and post-transplantation lymphoproliferative disorders (PTLD), respectively. Thus far, we have mobilized 86 healthy HLA-haploidentical relatives of children with hematological disorders using standard-dose G-CSF. In donors with suboptimal PB CD34level or with suboptimal apheresis yield or both at the expected day of HSC collection, we opt for an ‘immediate salvage’ strategy and we administer a single dose of plerixafor the night before apheresis. It is now recognized that G-CSF exerts pleiotropic activities on cells of both the innate and the adaptive immune system, including functional polarization of monocytes and DC, mobilization of Treg cells and promotion of Treg type 1 (Tr1) differentiation. When analyzing HSC graft obtained after HSC mobilization either with G-CSF alone or with G-CSF and plerixafor, we detected statistically significant differences in the frequency of cells belonging to both the innate and the adaptive immune system, such as NK cells, NK-like T cells, myeloid dendritic cells and plasmacytoid dendritic cells. These data suggest that the mobilization regimen may impact on graft composition, potentially translating into different immunological outcomes of the transplant.
S9 Donor apheresis technologies in the new millennium J.L. Winters. Director, Therapeutic apheresis treatment unit, Professor of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA One hundred years ago, Abel, Rowntree, and Turner first used the term “apheresis” to describe the manual removal of plasma. Cohn, utilizing the work of de Laval, created the first continuous flow device and applied it to the separation of plasma from whole blood for the manufacture of albumin and other derivatives. Over the subsequent decades, there has been expansion of the use of automated apheresis to collect not only plasma but also platelets, granulocytes, and red blood cells. With the availability of these products, there has been an associated increase in the use of apheresis derived blood products for transfusion. In the new millennium, the collection of blood products by apheresis continues with a mixture of old and new devices. While the basic separation methods for the collection of blood products, filtration and centrifugation, have stayed the same, enhancements in separation chamber design have enhanced product yields and purity. Increased apheresis device automation through automated interface detection and computer control of the device has simplified the collection process for the device operator while further enhancing the quality of the collected blood product. These improvements have enhanced the safety for both the apheresis donor and the recipient of the apheresis blood product.
Speaker abstracts / Transfusion and Apheresis Science 50 (2014) S1–S4
• Hemolysis • Air embolism There must be also attention for long term effects from apheresis donations. A plateletapheresis donor may lose 80–100 mL of blood, both in the harness and by blood sampling at each donation. Reports of decreased ferritine levels in repeat apheresis donors with over 20 donations per year are published. Also low immunoglobulin levels in frequent plasmapheresis donors are described. Since compromised bone mineral densities at the lumbar spine in frequent plateletapheresis donors are described, there is also a concern regarding the long-term effects of frequent increased PTH levels caused by apheresis, although the clinical consequence remains open. S8 Immune effector clinical depletion in haploidentical transplants S. Rutella. Department of Pediatric Hematology/Oncology and Transfusion Medicine, IRCCS Bambino Ges` u Children’s Hospital, Rome, Italy Haploidentical hematopoietic stem cell transplantation (HSCT) is a feasible therapeutic option for patients at high risk of leukemia relapse, and without human leukocyte antigen (HLA)-matched donors. Clinical success, i.e., full donor-type engraftment in 95% of patients with acute leukemia and negligible incidence of acute and chronic graft-versus-host disease (GVHD), has been achieved with grafts containing a mega-dose (10×106 /kg) of negatively or positively selected CD34+ cells, without any post-transplant immunosuppression. We have recently developed a novel graft manipulation strategy aimed at removing ab+ T cells and CD19+ B cells with the Miltenyi technology, prior to HSC infusion into HLA-haploidentical children with malignant or nonmalignant disorders. TCR-ab and B-cell depletion allow the prevention of intolerable GVHD and post-transplantation lymphoproliferative disorders (PTLD), respectively. Thus far, we have mobilized 86 healthy HLA-haploidentical relatives of children with hematological disorders using standard-dose G-CSF. In donors with suboptimal PB CD34level or with suboptimal apheresis yield or both at the expected day of HSC collection, we opt for an ‘immediate salvage’ strategy and we administer a single dose of plerixafor the night before apheresis. It is now recognized that G-CSF exerts pleiotropic activities on cells of both the innate and the adaptive immune system, including functional polarization of monocytes and DC, mobilization of Treg cells and promotion of Treg type 1 (Tr1) differentiation. When analyzing HSC graft obtained after HSC mobilization either with G-CSF alone or with G-CSF and plerixafor, we detected statistically significant differences in the frequency of cells belonging to both the innate and the adaptive immune system, such as NK cells, NK-like T cells, myeloid dendritic cells and plasmacytoid dendritic cells. These data suggest that the mobilization regimen may impact on graft composition, potentially translating into different immunological outcomes of the transplant.
S9 Donor apheresis technologies in the new millennium J.L. Winters. Director, Therapeutic apheresis treatment unit, Professor of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA One hundred years ago, Abel, Rowntree, and Turner first used the term “apheresis” to describe the manual removal of plasma. Cohn, utilizing the work of de Laval, created the first continuous flow device and applied it to the separation of plasma from whole blood for the manufacture of albumin and other derivatives. Over the subsequent decades, there has been expansion of the use of automated apheresis to collect not only plasma but also platelets, granulocytes, and red blood cells. With the availability of these products, there has been an associated increase in the use of apheresis derived blood products for transfusion. In the new millennium, the collection of blood products by apheresis continues with a mixture of old and new devices. While the basic separation methods for the collection of blood products, filtration and centrifugation, have stayed the same, enhancements in separation chamber design have enhanced product yields and purity. Increased apheresis device automation through automated interface detection and computer control of the device has simplified the collection process for the device operator while further enhancing the quality of the collected blood product. These improvements have enhanced the safety for both the apheresis donor and the recipient of the apheresis blood product.