Increasing the economic efficacy of peripheral blood progenitor cell collections by monitoring peripheral blood CD34+ concentrations.
BACKGROUND
After mobilization, the collection of peripheral blood progenitor cells (PBPCs) can either be started a fixed number of days after having passed the white blood cell nadir (fixed-day scheme) or be based on monitoring of CD34+ cells. This study was conducted to compare both approaches and to assess possible financial consequences.


METHODS
For 29 patients daily enumeration of CD34+ cells was used to guide leukapheresis timing. In a retrospective analysis for the same group of patients, application of a fixed-day scheme was assumed. For scenarios of beginning apheresis 2, 3, 4, or 5 days after WBC nadir, the number of apheresis days and granulocyte-colony-stimulating factor (G-CSF) application days that could be saved was calculated.


RESULTS
A total of 44 apheresis procedures were performed resulting in a mean CD34+ cell content per apheresis product of 10.4 x 10(6) (range, 0.1 x 10(6)-49.5 x 10(6))/kg of body weight. The smallest number of deviation days compared to a fixed-day scheme was found for beginning an apheresis on Day 3. In comparison to this, CD34+ monitoring reduced the number of G-CSF days by 9 and the number of apheresis procedures by 11 overall, resulting in savings of euro;19,965 (US$28,788) in comparison to expenses of euro826 (US$1191) for CD34+ monitoring.


CONCLUSIONS
Measurement of CD34+ cells has reached a precision enabling a prediction of the harvest success. In comparison to a fixed-day scheme, daily CD34+ monitoring reduces the donor's exposition to G-CSF, enables collection of a sufficient number of PBPCs in the least possible number of apheresis sessions, and improves the economic efficacy of the institution.
Gutensohn
Kai
K
Department of Transfusion Medicine, University Hospital Hamburg Eppendorf; and AescuLabor Hamburg, Hamburg, Germany. email@kai-gutensohn.de
Magens
Mirko M
MM
Kuehnl
Peter
P
Zeller
Wolfgang
W
D000328:Adult; D018952:Antigens, CD34; D001781:Blood Component Removal / Q000191:economics* / Q000379:methods; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000191:economics; D019650:Hematopoietic Stem Cell Mobilization / Q000191:economics* / Q000379:methods; D006412:Hematopoietic Stem Cells; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics* / Q000379:methods; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics*; D011994:Recombinant Proteins; D013997:Time Factors; D014182:Transplantation, Autologous
D018952:Antigens, CD34; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor