Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies

Eliska Furlong, Jesper Jensen, Mark Woodard, Katherine Griffiths, Geoff Knight, Marian Sturm, Fiona Kerr, Hazel Gough, Natasha Bear, Tina L. Carter, Catherine H. Cole, Rishi S. Kotecha, Shanti Ramachandran

Research output: Contribution to journalArticle

Abstract

Background: Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. Patients/Methods: A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. Results: Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. Conclusion: Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.

Original languageEnglish
Article numbere13602
JournalPediatric Transplantation
DOIs
Publication statusE-pub ahead of print - 20 Oct 2019

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Cell Transplantation
Blood Component Removal
Blood Cells
Stem Cells
Hematopoietic Stem Cells
Hematopoietic Stem Cell Transplantation
Neoplasms
Granulocyte Colony-Stimulating Factor
Drug Therapy
Vascular Access Devices
Pediatric Intensive Care Units
Western Australia
Local Anesthetics
Blood Volume
Cyclophosphamide
General Anesthesia
Intercellular Signaling Peptides and Proteins
Retrospective Studies
Pediatrics

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Furlong, Eliska ; Jensen, Jesper ; Woodard, Mark ; Griffiths, Katherine ; Knight, Geoff ; Sturm, Marian ; Kerr, Fiona ; Gough, Hazel ; Bear, Natasha ; Carter, Tina L. ; Cole, Catherine H. ; Kotecha, Rishi S. ; Ramachandran, Shanti. / Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies. In: Pediatric Transplantation. 2019.
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title = "Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies",
abstract = "Background: Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30{\%}. Patients/Methods: A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. Results: Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4{\%} of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96{\%} of patients scheduled for a single aHSCT, 87.5{\%} for tandem, and 100{\%} for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. Conclusion: Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.",
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author = "Eliska Furlong and Jesper Jensen and Mark Woodard and Katherine Griffiths and Geoff Knight and Marian Sturm and Fiona Kerr and Hazel Gough and Natasha Bear and Carter, {Tina L.} and Cole, {Catherine H.} and Kotecha, {Rishi S.} and Shanti Ramachandran",
year = "2019",
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language = "English",
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Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies. / Furlong, Eliska; Jensen, Jesper; Woodard, Mark; Griffiths, Katherine; Knight, Geoff; Sturm, Marian; Kerr, Fiona; Gough, Hazel; Bear, Natasha; Carter, Tina L.; Cole, Catherine H.; Kotecha, Rishi S.; Ramachandran, Shanti.

In: Pediatric Transplantation, 20.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optimized peripheral blood progenitor cell mobilization for autologous hematopoietic cell transplantation in children with high-risk and refractory malignancies

AU - Furlong, Eliska

AU - Jensen, Jesper

AU - Woodard, Mark

AU - Griffiths, Katherine

AU - Knight, Geoff

AU - Sturm, Marian

AU - Kerr, Fiona

AU - Gough, Hazel

AU - Bear, Natasha

AU - Carter, Tina L.

AU - Cole, Catherine H.

AU - Kotecha, Rishi S.

AU - Ramachandran, Shanti

PY - 2019/10/20

Y1 - 2019/10/20

N2 - Background: Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. Patients/Methods: A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. Results: Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. Conclusion: Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.

AB - Background: Autologous hematopoietic stem cell transplantation (aHSCT) using hematopoietic progenitor cells (HPCs) has become an important therapeutic modality for patients with high-risk malignancies. Current literature on standardized method for HPC apheresis in children is sparse and failure rate reported as high as 30%. Patients/Methods: A retrospective study of 125 pediatric patients with high-risk malignancies undergoing aHSCT in Western Australia between 1997 and 2016 was conducted. Results: Mobilization was achieved by means of chemotherapy and granulocyte colony-stimulating factor (G-CSF). Patients underwent apheresis the day after CD34+ counts reached ≥20/µL and an additional dose of G-CSF. Peripheral arterial and intravenous lines were inserted in pediatric intensive care unit under local anesthetic and/or sedation, omitting the need for general anesthesia as well as facilitating an uninterrupted apheresis flow. Larger apheresis total blood volumes were processed in patients weighing ≤20 kg. The minimal dose of ≥2 × 106 CD34+ cells/kg was successfully collected in 98.4% of all patients. The optimal dose of 3-5 × 106 CD34+ cells/kg was collected in 96% of patients scheduled for a single aHSCT, 87.5% for tandem, and 100% for triple aHSCT. All HPC collections were completed in one apheresis session. Mobilization after ≤3 chemotherapy cycles and cycles including cyclophosphamide resulted in a significantly higher yield of CD34+ cells. Conclusion: Our approach to HPC mobilization by means of chemotherapy and single myeloid growth factor combined with optimal collection timing facilitated by continuous apheresis flow resulted in highly effective HPC harvest in children and adolescents with high-risk cancers.

KW - granulocyte colony-stimulating factor

KW - hematopoietic progenitor cell mobilization

KW - peripheral blood progenitor cell apheresis

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