Keywords
marrow transplantation
automated processing
How to Cite
Abstract
Introduction. In major blood group incompatible bone barrow hematopoietic progenitor cells (HPCBM) transplant efficient red blood cells (RBC) depletion is essential to minimize adverse effects during and after the product infusion. Different procedures are used to reduce RBC in this case, particularly the hydroxyethyl starch sedimentation (HES) technique is widely used but is very laborious and requires experienced personnel. In this work we show the results of our laboratory in the validation of another methodology for this purpose; processing with Sepax 2 automated equipment, using the martRedux v314 protocol. Materials and methods. We evaluated 9 BM hematopoietic progenitor cell products. Data of post processing recovery nucleated cells (NC) and CD34+ cells, viability results, microbiological studies and processing time were obtained. Besides the adverse reactions during the infusion of the products and their engraftment. Results. A mean reduction of GR of 92.5% (88.2 - 95.4%), a recovery of NC of 74.1% (60.1 - 84.3%) and a recovery of CD34+ cells of 83.6% (62.6 - 99.5%) was obtained. The mean viability of CD45+ cells was 93.3% (87% - 98%) and of CD34 cells was 97% (94% - 99%). All microbiology results were negative. After processing, the products were all infused to patients at our institution without relevant adverse reactions, with the median hematopoietic recovery being 15 days for absolute neutrophils and 28 days for platelets. All patients achieved complete chimerism. Discussion. Having the possibility of implementing a new methodology for the processing of BM progenitor cell products with major blood group incompatibility, the procedure was validated according to the INCUCAI regulations and voluntary standards. An option is proposed for the processing of these products, with advantages and disadvantages. Each center must evaluate and validate the procedure with best adjustment to its needs.
References
Ljungman P, Bregni M, Brune My col. Allogeneic and autologous transplantation for haematological diseases, solid tumours and inmune disorders: definitions and current practice in Europe 2009. Bone Marrow Transplantatio2010;45:219-34. https://pubmed.ncbi.nlm.nih.gov/19584824
Raimondi R, Soli M, Lamparelli T y col. ABO-incompatible bone marrow transplantation: a GITMO survey of current practice in Italy and comparison with the literature. Bone Marrow Transplant 2004; 34:321-330. https://doi.org/10.1038/sj.bmt.1704579
Georg Stusi, Jorg Halter, Urs Schanz y col. ABO-histo blood group incompatibility in hematopoietic stemcell and solid organ transplantation. Transfusion and Apheresis Science 2006; 35:59-69. https://doi.org/10.1016/j.transci.2006.05.009
SD Rowley, ML Donato, P Bhattacharyya. Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplantation, 2011; 46:1167-1185. https://doi.org/10.1038/bmt.2011.135
RafiyeCiftciler, Hakan Goker,Yahya Buyukasik y col. Impact of ABO bloodgroup incompatibility on the outcomes of allogeneic hematopoietic stem cell transplantation. Transfusion and Apheresis Science 2019. https://doi.org/10.1016/j.transci.2019.06.024
Marco Alejandro Jimenez-Ochoa, Maria Margarita Contreras-Serrato,Marta Leticia Gonzalez-Bautista y col. Incompatibilidad ABO en el trasplante de células progenitoras hematopoyeticas y sus complicaciones. Rev Med Inst Merx Seguro Soc 2023;93:12-18.
Nicola Daniele, Maria Cristina Scerpa, Cecilia Rossi y col. The processing of stem cell concentrates from the bone marrow in ABO-incompatible trasplants:how and when. Blood Transfus 2014; 12:150-158. https://doi.org/10.2450/2013.0127-13
Robert Sheppard Nickel, Muna Qayed, Diana Worthington-White y col. Infusion Hemolysis after Pediatric Major ABO Mismatched BMT:Comparison of Two Red Blood Cell Depletion Tecniques. Pediatr Blood Cancer 2018, 65-68. https://doi.org/10.1002/pbc.26883
Resolución INCUCAI 119/2012. Anexo I: Normas para las buenas prácticas de elaboración y laboratorio para preparaciones celulares.
Anne M. Brocklebank, Rosemary L. Sparrow. Enumeration of CD34+ Cells in Cord Blood:A Variation on a Single-Platform Flow Cytometric Method Based on the ISAGHE Gating Strategy. Cytometry 2001; 46:254-261. https://doi.org/10.1002/cyto.1136
Carreras E, Rovira M, Valcárcel D.Fallo de injerto.Complicaciones sistemicas del TCPH. Manual de trasplante hematopoyético y terapia celular 2022. 6ta Edición.
Patrick K,Lau W,Gassas A y col.Major ABO incompatible BMT in children:determining what residual volume of donor red cells can safely be infused following red cell depletion. Bone Marrow Transplant 2015; 50:536-539. https://doi.org/10.1038/bmt.2014.309
Cushing MM, Hendrickson JE. Transfusion support for hematopoietic stem cell transplant recipient. AABB Technical manual.19na. edición.
Mohamed A. Kharfan-Dabaja, Ambuj Kumar, Ernesto Ayala y col. Standardizing Definitions of Hematopoietic Recovery, Graft Rejection, Graft Failure, Poor Graft Function, and Donor Chimerism in Allogeneic Hematopoietic Cell Transplantation: A Report on Behalf of the American Society for Transplantation and Cellular Therapy. Transplantation and Cellular Therapy 2021; 27: 642-649. https://doi.org/10.1016/j.jtct.2021.04.007
All material published in the journal HEMATOLOGÍA (electronic and print version) is transferred to the Argentinean Society of Hematology. In accordance with the copyright Act (Act 11 723), a copyright transfer form will be sent to the authors of approved works, which has to be signed by all the authors before its publication. Authors should keep a copy of the original since the journal is not responsible for damages or losses of the material that was submitted. Authors should send an electronic version to the email: revista@sah.org.ar