Cellular Therapy Laboratory, Division of Transfusion Medicine and Cellular Therapy, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Cytotherapy. 2022 Jan;24(1):37-44. doi: 10.1016/j.jcyt.2021.04.005. Epub 2021 Jul 23.
BACKGROUND AIMS: The Division of Transfusion Medicine and Cellular Therapy at New York-Presbyterian/Columbia University Irving Medical Center (NYPH-CUIMC) comprises the immunohematology laboratory and blood bank (transfusion service), hemotherapy/apheresis and the cellular therapy laboratory (CTL). The CTL processes and stores hematopoietic progenitor cells for bone marrow transplantation from all currently acceptable sources, including bone marrow, peripheral blood and umbilical cord blood. The laboratory provides services for the pediatric and adult blood and marrow transplant programs at both NYPH-CUIMC and the Morgan Stanley Children's Hospital of New York-Presbyterian. The laboratory processes and stores approximately 200 cellular therapy products per year, and the division participates in numerous clinical trials within the institution and with external pharmaceutical manufacturing facilities. As a licensed tissue bank, commercial chimeric antigen receptor T-cell products and other cellular-based therapies that are approved by the US Food and Drug Administration (FDA) are routed through the CTL for storage, processing, coordination of transportation, chain of custody and, eventually, thaw and distribution. Currently, we are distributing four such products from Kite Pharma, Novartis and Bristol Meyers Squid. In comparison to the amount of work, we employ a small staff of only four full-time clinical laboratory technologists, one technical specialist, one quality and operations manager and one medical director. In recent years, the growing use of the hematology/oncology service and the introduction of new immunotherapies have put significant pressure on our division to accommodate and scale up operations. Accompanying this growth is a mounting administrative burden and upsurge in regulatory and protocol-specific oversight. The purpose of this article is to share lessons learned and creative solutions to help better accommodate the surge in development of novel cellular therapies. METHODS: To handle this increase in demand, the CTL worked to standardize administrative procedures, implement comprehensive document control solutions, digitize data collection and implement lean design concepts to increase effectiveness and mitigate risk. RESULTS: Distribution of a standard operating procedure for clinical trial management improved the "on-boarding" process and allowed the laboratory to have more influence in the decision-making process. Implementation of digital workflows and a comprehensive document control system allowed for improved organization of critical documents and proved to be flexible enough to accommodate various protocol-specific requirements. Introduction of visual ques and reorganization of the workspace facilitated better organization, mitigated risk and assisted the laboratory in maintaining regulatory compliance. CONCLUSIONS: Better-defined, structured and controlled laboratory processes helped laboratory management implement new clinical trials and track critical data. Implementing digital solutions using widely available tools like Microsoft SharePoint has proven to be a very secure, low-cost and flexible solution to keeping us "up-to-date" and inspection-ready.
背景目的:纽约长老会/哥伦比亚大学欧文医学中心(NYPH-CUIMC)的输血医学和细胞治疗科由免疫血液学实验室和血库(输血服务)、血液治疗/单采和细胞治疗实验室(CTL)组成。CTL 从所有目前可接受的来源(包括骨髓、外周血和脐带血)处理和储存造血祖细胞,用于骨髓移植。该实验室为 NYPH-CUIMC 和纽约长老会摩根士丹利儿童医院的儿科和成人血液和骨髓移植项目提供服务。该实验室每年处理和储存约 200 种细胞治疗产品,该部门还参与机构内和外部制药制造设施的多项临床试验。作为一家获得许可的组织库,经美国食品和药物管理局(FDA)批准的商业嵌合抗原受体 T 细胞产品和其他基于细胞的疗法都要经过 CTL 进行储存、处理、运输协调、监管链,最终进行解冻和分发。目前,我们正在从 Kite Pharma、诺华和 Bristol Meyers Squid 分发四种此类产品。与工作量相比,我们只雇用了四名全职临床实验室技术员、一名技术专家、一名质量和运营经理以及一名医学主任。近年来,血液科/肿瘤科服务的广泛应用和新免疫疗法的引入给我们部门带来了巨大的压力,需要我们适应并扩大业务规模。随着业务的增长,管理负担也在增加,对监管和特定方案的监督也在增加。本文的目的是分享经验教训和创造性的解决方案,以帮助更好地适应新型细胞疗法的发展。 方法:为了满足这一需求的增长,CTL 努力使行政程序标准化,实施全面的文件控制解决方案,使数据收集数字化,并实施精益设计理念,以提高效率和降低风险。 结果:临床试验管理标准操作规程的分发改善了“入职”流程,并使实验室能够在决策过程中发挥更大的作用。数字化工作流程和全面文件控制系统的实施使关键文件的组织更加完善,并具有足够的灵活性来适应各种特定方案的要求。引入可视化问题和工作区的重新组织促进了更好的组织,降低了风险,并帮助实验室保持法规遵从性。 结论:定义更明确、结构更合理、控制更严格的实验室流程有助于实验室管理实施新的临床试验并跟踪关键数据。使用 Microsoft SharePoint 等广泛可用的工具实施数字化解决方案已被证明是一种非常安全、低成本且灵活的解决方案,可使我们保持“最新”状态并随时接受检查。
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