title: Safety and efficacy of autologous hemopoietic progenitor cell collection in tandem with hemodialysis in multiple myeloma with myeloma cast nephropathy.
abstract: Autologous hemopoietic progenitor cell (HPC) collection is the most frequent indication for an apheresis procedure in patients with multiple myeloma, up to 10% of whom may also require hemodialysis because of myeloma kidney. We investigated whether HPC collection could be performed in tandem with hemodialysis, to avoid extra outpatient visits for extracorporeal procedures, without compromising the efficacy of the hemodialysis, the HPC collection efficiency (CE) or patient safety. Four dialysis-dependent patients with multiple myeloma underwent 5 large volume leukapheresis HPC collections in tandem with hemodialysis. Under our protocol, all of the blood processed through the apheresis instrument was dialyzed against a standard calcium-rich bath prior to being returned to the patient, therefore no supplemental calcium was needed. No significant changes in pulse rate (P = 0.625) or mean arterial pressure (P = 0.188) were noted between the start and end of the procedures. The patients exhibited no signs or symptoms of hypocalcemia or other adverse effects. Calculated urea reduction ratios ranged between 62.5 and 73.9%, and HPC CE was between 53 and 84% for 4 of the 5 procedures, indicating that there was no compromise of either procedure when performed in tandem. Ionized calcium measured at the beginning, midpoint and end of every procedure did not change (P = 0.954). The two patients who proceeded to autologous HPC transplant engrafted on Days 11 and 10, respectively. We conclude that autologous HPC collection can safely be performed in tandem with hemodialysis without compromising the efficacy of dialysis, HPC CE, or patient safety.
authors: Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts; Division of Transfusion Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts.
authors: Robert
authors: R
authors: Weinstein
authors: Glen
authors: G
authors: Kershaw
authors: Jeff
authors: J
authors: Bailey
authors: Mindy
authors: M
authors: Greene
authors: Vishesh
authors: V
authors: Chhibber
authors: Michelle
authors: M
authors: Vauthrin
authors: Rajneesh
authors: R
authors: Nath
authors: Eileen
authors: E
authors: Galvin Karr
mesh_terms: D000368:Aged; D001781:Blood Component Removal / Q000379:methods*; D002118:Calcium / Q000378:metabolism; D002469:Cell Separation / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis; D014182:Transplantation, Autologous; D014882:Water-Electrolyte Balance
chemical_list: D002118:Calcium
keywords: apheresis; autologous transplant; hypocalcemia; renal impairment