Large-Volume Leukapheresis for Collection of Peripheral Blood Stem Cells: A Comparison of Two Continous Flow Cell Separators

Nahm, Chung Hyun; Lim, Hwan Sup; Cho, Sung Ran; Kim, Hyun Ok; Kwon, Oh Hun; Min, Yoo Hong

Abstract

BACKGROUND: Mobilized peripheral blood stem cells (PBSCs) are now used increasingly in patients with hematologic and solid tumors to reconstitute hematopoiesis after dose-intensive chemotherapy. We evaluated the efficacy of large-volume leukapheresis (LVL) and compared the ability of Fenwal CS3000 Plus and Cobe Spectra to collect mononuclear cells (MNCs) for PBSCT.
METHODS
Twenty liters of whole blood per LVL were processed in 22 patients with acute leukemia and lymphoma. LVL were performed in rapid recovery phase (white cells >3x109/L, or CD34+ cells > 1% of white cells) after chemotherapy followed by granulocyte-colony stimulating factor. The end point of LVL was mononuclear cells (MNCs) >8x108/kg, or CD34+ cells > 6x106/kg. A-35 collection chamber was used in Fenwal CS3000 Plus and whole blood flow was set at 85mL/min, whole blood to anticoagulant ratio 11~13:1, interface offset 150. MNC procedure was used in Cobe Spectra, whole blood flow was 90~100mL/min, whole blood to anticoagulant ratio 24:1 with heparin to anticoagulant and product bags, collection rate 1mL/min, and hematocrit 2~3%.
RESULTS
Total 53 LVL (35 with Fenwal CS3000 Plus and 18 with Cobe Spectra) were performed on 22 patients. An average of 2.4 LVL per patient (range 1~4) were performed. With Fenwal CS3000 Plus, post-LVL values of hematocrit, platelets and MNCs were reduced by 12.4%, 53.1%, and 33.0% and with Cobe Spectra, 9.2%, 36.1%, and 39.6%, respectively. Mean collection volume of Fenwal CS3000 Plus and Cobe Spectra were 135.7mL and 175.2mL per LVL, respectively. There was no statistical significant difference in the yields of LVL between Fenwal CS3000 Plus (3.4+/-1.9x108/kg MNCs, 7.2+/-11.2x106/kg CD34+ cells) and Spectra (4.7+/-2.1x108/kg MNCs, 7.4+/-9.6x106/kg CD34+ cells). The yields of LVL were correlated well with patients' pre-MNC counts in both cell separators. Mean percentages of MNC were 95.4% with Fenwal CS3000 Plus and 74.0% with Cobe Spectra (P<0.001) and collection efficiencies were 53.6+/-18.8% and 57.3+/-27.8%, respectively (P> 0.05). LVL product with Cobe Spectra contained less red cells (10.5+/-2.7mL) than Fenwal CS3000 Plus (34.1+/-10.8mL) (P<0.001). Platelet contamination was not different for Fenwal CS3000 Plus (2.3+/-2.1x1011) and Cobe Spectra (3.1+/-1.0x1011).
CONCLUSION
LVL could be conveniently used for PBSC collection with good collection efficiency and safety without serious citrate toxicities. LVL products with Fenwal CS3000 Plus showed less collection volume and granulocyte contamination. The products with Cobe Spectra showed less red cell contamination and less decrease in patients' platelet counts.