title: Large-volume leukapheresis using regional citrate anticoagulation to collect peripheral blood progenitor cells.
abstract: The use of peripheral blood progenitor cells (PBPC) for hematopoietic rescue after high-dose chemotherapy is limited by the number of leukaphereses required to collect an adequate number of hematopoietic progenitors. To optimize the collection of PBPC, we evaluated a single large-volume leukapheresis protocol with citrate anticoagulation. A group of 23 patients received cyclophosphamide (4 g/m2) and GM-CSF (5 micrograms/kg/day for 15 days) as PBPC mobilization, with a single outpatient 6 h leukapheresis performed on the COBE Spectra 15 days later. Citrate (0.190 mmol/ml) was infused at 1.2 ml/L of blood/minute with a whole blood to citrate ratio between 17:1 and 25:1. Calcium chloride (50 mM) was administered at a citrate to calcium molar ratio between 10:1 and 5:1 to prevent hypocalcemia. A median 36.6 L (range 24.4-46.4) blood was processed using 338 mM citrate (269-473) and 50 mM calcium (25-75). A median 5 x 10(6) CD34+ cells/kg (< 0.3-24) and 6.2 x 10(5) CFU-GM/kg (< 0.001-29) were collected, representing 5.6 and 5.9 more PBPC, respectively, than were in circulation at the initiation of leukapheresis. We conclude that a 6 h large-volume leukapheresis following cyclophosphamide and GM-CSF mobilization is safe, can recruit hematopoietic progenitors into the circulatory compartment, and allows the collection of high numbers of PBPC in a single procedure.
authors.affiliation: Johns Hopkins Oncology Center, Baltimore, MD 21287, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Passos-Coelho
authors.forename: H G
authors.initials: HG
authors.lastname: Braine
authors.forename: S K
authors.initials: SK
authors.lastname: Wright
authors.forename: J M
authors.initials: JM
authors.lastname: Davis
authors.forename: K G
authors.initials: KG
authors.lastname: Schepers
authors.forename: A M
authors.initials: AM
authors.lastname: Huelskamp
authors.forename: B
authors.initials: B
authors.lastname: Clarke
authors.forename: S J
authors.initials: SJ
authors.lastname: Noga
authors.forename: M J
authors.initials: MJ
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants; D001773:Blood Cells / Q000473:pathology*; D001943:Breast Neoplasms / Q000628:therapy; D002469:Cell Separation; D002951:Citrates; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D008875:Middle Aged
chemical_list: D000925:Anticoagulants; D002951:Citrates