Immunohemotherapy Department, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Immunohemotherapy Department, University Hospital Center of São João, Porto, Portugal.
J Clin Apher. 2023 Feb;38(1):24-32. doi: 10.1002/jca.22021. Epub 2022 Oct 9.
Hematopoietic stem cell transplantation is used in the treatment of children with malignant and non-malignant diseases. However, apheresis of peripheral blood stem cells (PBSC) represents a challenge in children below 10 kg.
A retrospective trial was conducted in the Cellular Therapy Department of Portuguese Oncology Institute of Porto.
children with body weight inferior to 10 kg who underwent autologous PBSC apheresis until 2021. Demographic and clinical data were collected and our institutional protocol was described. COBE Spectra apheresis system (TerumoBCT, Lakewood, Colorado) until 2012 and then Spectra Optia (TerumoBCT) were used.
Sixteen leukocytaphereses were performed in 13 patients-nine females (69%). Mean age and weight were 13.31 months (±5.26) and 8.31 kg (±1.17), respectively. The initial CD34+ cells/μL in peripheral blood was 70.8 (±61.9). A central venous catheter (CVC) was exclusively used in all but one patient, in whom a peripheral vein was also required. In 10 procedures, both heparin and anticoagulant citrate dextrose solution-formula A (ACD-A) were used; in the remaining ones, only ACD-A was employed. The median duration of each procedure was 168 minutes (±45) and 2.96 blood volumes (±0.31) were processed. Median CD34+ cells yield per leukocytapheresis was 6.52 × 10 /kg (±9.87 × 10 ). CD34+ cell extraction rates were not significantly different between the two apheresis systems. Platelet and magnesium levels were significantly lower after collection (P < .001 and P = .009, respectively).
Although recommendations are lacking, we have successfully and safely performed leukocytaphereses in children with body weight below 10 kg. The authors believe that a permanent and dynamic comprehensive evaluation of each child is paramount for attaining good results.
造血干细胞移植用于治疗儿童恶性和非恶性疾病。然而，对于体重低于 10 公斤的儿童，采集外周血造血干细胞（PBSC）具有挑战性。
葡萄牙波尔图肿瘤研究所细胞治疗科进行了一项回顾性试验。
2021 年前接受过自身 PBSC 白细胞分离术的体重低于 10 公斤的儿童。收集人口统计学和临床数据，并描述我们的机构方案。2012 年前使用 COBE Spectra 白细胞分离系统（TerumoBCT，科罗拉多州莱克伍德），然后使用 Spectra Optia（TerumoBCT）。
13 例患者中有 16 例进行了白细胞分离术，其中 9 例为女性（69%）。平均年龄和体重分别为 13.31±5.26 个月和 8.31±1.17 公斤。外周血初始 CD34+细胞/μL 为 70.8±61.9。除 1 例患者外，所有患者均使用中心静脉导管（CVC），另 1 例患者还需要外周静脉。10 例手术中同时使用肝素和抗凝剂枸橼酸钠葡萄糖溶液配方 A（ACD-A）；其余仅使用 ACD-A。每次手术的中位持续时间为 168±45 分钟，处理 2.96 个血容量（±0.31）。每次白细胞分离术的中位 CD34+细胞产量为 6.52×10 /kg（±9.87×10 ）。两种白细胞分离系统的 CD34+细胞提取率无显著差异。血小板和镁水平在采集后显著降低（P<0.001 和 P=0.009）。
尽管缺乏建议，但我们已成功且安全地为体重低于 10 公斤的儿童进行了白细胞分离术。作者认为，对每个儿童进行全面的、持续的评估至关重要，这有助于获得良好的结果。
