Comparison of prediction models for two different peripheral stem cell collection protocols in autologous patients. How to avoid errors in calculating total blood volume to process?
Abstract
Introduction: Calculating accurate blood volume to process is a critical practice in apheresis planning; therefore, researchers try to develop dedicated prediction models. In this analysis, we have attempted to compare three algorithms for two different apheresis collection protocols.
Methods: In a retrospective study, we have analyzed 137 apheresis procedures performed on 100 autologous patients. Apheresis procedures were performed with the Spectra Optia apheresis device with two protocols: mononuclear cell collection (MNC) and continuous mononuclear cell collection (cMNC). Three algorithms: a model based on mean collection efficiency (CE2), a linear regression model, and a power regression model were validated by plotting collected CD34+ cell dose versus predicted CD34+ cell dose.
Results: All models showed high predictability for MNC procedure, a high correlation of predicted CD34+ yield and actual CD34+ yield (R2 = 0.9547; 0.9487; 0.9474 for CE2-based model, linear and power regression model, respectively). In contrast, alteration between models for the cMNC procedure was greater (R2 = 0.8049, 0.7970, and 0.8169) with a higher number of overpredictions. Further analysis revealed that for low CD34+ precounts blood volume to process, calculated with the three models, differ significantly up to fivefold times.
Conclusions: Utilizing regression models may lead to calculation errors, which can affect undercollection, repetition of apheresis, or even mobilization failure. Contrary to regression models, the model based on mean CE2 gave the most accurate prediction both for MNC and cMNC procedures. Although new prediction algorithms are created, this simple formula remains a reliable tool that promotes careful planning of apheresis, thus improving patient safety.
Keywords: algorithmapheresiscMNCMNCOptiaperipheral blood progenitor cells
References
- Morgan G. Optimising strategies for the Spectra Optia. Transfus Apher Sci. 2013; 49(3): 688–691.
- Pusic I, Jiang SY, Landua S, et al. Impact of mobilization and remobilization strategies on achieving sufficient stem cell yields for autologous transplantation. Biol Blood Marrow Transplant. 2008; 14(9): 1045–1056.
- Ford CD, Chan KJ, Reilly WF, et al. An evaluation of predictive factors for CD34+ cell harvest yields from patients mobilized with chemotherapy and growth factors. Transfusion. 2003; 43(5): 622–625.
- Hequet O. Hematopoietic stem and progenitor cell harvesting: technical advances and clinical utility. J Blood Med. 2015; 6: 55–67.
- Moog R, Moog R, Uppenkamp M, et al. Technical aspects and performance in collecting peripheral blood progenitor cells. Ann Hematol. 1998; 77(4): 143–147.
- Armitage S, Hargreaves R, Samson D, et al. CD34 counts to predict the adequate collection of peripheral blood progenitor cells. Bone Marrow Transplant. 1997; 20(7): 587–591.
- Chen JP, Burns K, Kennedy M, et al. A method to predict the yield of peripheral blood stem cells collected by large volume leukapheresis. J Blood Lymph. 2017; 7(1).
- Mohty M, Hübel K, Kröger N, et al. Autologous haematopoietic stem cell mobilisation in multiple myeloma and lymphoma patients: a position statement from the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2014; 49(7): 865–872.
- Trickett AE, Smith S, Kwan YL. Accurate calculation of blood volume to be processed by apheresis to achieve target CD34+ cell numbers for PBPC transplantation. Cytotherapy. 2001; 3(1): 5–10.
- Pierelli L, Maresca M, Piccirillo N, et al. Accurate prediction of autologous stem cell apheresis yields using a double variable-dependent method assures systematic efficiency control of continuous flow collection procedures. Vox Sang. 2006; 91(2): 126–134.
- Pandey S, Cottler-Fox M. Optia® continuous mononuclear collection (CMNC) system is a safe and efficient system for hematopoietic progenitor cells-apheresis (HPC-a) collection and yields a lower product hematocrit (HCT%) than the COBE® spectra system: a retrospective study. J Clin Apher. 2018; 33(4): 505–513.
- Cousins AF, Sinclair JE, Alcorn MJ, et al. HPC-A dose prediction on the optia® cell separator based on a benchmark CE2 collection efficiency: Promoting clinical efficiency, minimizing toxicity, and allowing quality control. J Clin Apher. 2015; 30(6): 321–328.
- Douglas K, McGarvey M, Robertson S, et al. “Will I have enough cells for a transplant, doctor?” Validation of a CD34+ dose prediction formula using patient weight, peripheral CD34+ count and predicted end-run results in a series of 440 consecutive PBSC collection procedures using the MNC program on COBE Spectra. (Abstract). JClin Apheresis. 2008; 23: 21–2.
- Rosenbaum ER, O'Connell B, Cottler-Fox M. Validation of a formula for predicting daily CD34(+) cell collection by leukapheresis. Cytotherapy. 2012; 14(4): 461–466.
- Lisenko K, Pavel P, Bruckner T, et al. Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection. J Clin Apher. 2017; 32(1): 27–34.
- Mitterer M, Hirber J, Gentilini I, et al. Target value tailored (TVT) apheresis approach for blood progenitor cell collection after high-dose chemotherapy and rh-G-CSF. Bone Marrow Transplant. 1996; 18(3): 611–617.
- Leberfinger DL, Badman KL, Roig JM, et al. Improved planning of leukapheresis endpoint with customized prediction algorithm: minimizing collection days, volume of blood processed, procedure time, and citrate toxicity. Transfusion. 2017; 57(3): 685–693.
- Sheppard D, Tay J, Palmer D, et al. Improved prediction of CD34+ cell yield before peripheral blood hematopoietic progenitor cell collection using a modified target value-tailored approach. Biol Blood Marrow Transplant. 2016; 22(4): 763–767.
- Reinhardt P, Brauninger S, Bialleck H, et al. Automatic interface-controlled apheresis collection of stem/progenitor cells: results from an autologous donor validation trial of a novel stem cell apheresis device. Transfusion. 2011; 51(6): 1321–1330.
- Moog R. Adverse events in peripheral progenitor cell collection: a 7-year experience. J Hematother Stem Cell Res. 2001; 10(5): 675–680.
- Sanderson F, Poullin P, Smith R, et al. Peripheral blood stem cells collection on spectra optia apheresis system using the continuous mononuclear cell collection protocol: A single center report of 39 procedures. J Clin Apher. 2017; 32(3): 182–190.
- Schlenke P, Frohn C, Steinhardt MM, et al. Clinically relevant hypokalaemia, hypocalcaemia, and loss of hemoglobin and platelets during stem cell apheresis. J Clin Apher. 2000; 15(4): 230–235, doi: 10.1002/1098-1101(2000)15:4<230::aid-jca3>3.0.co;2-b.
- Cordoba R, Arrieta R, Kerguelen A, et al. The occurrence of adverse events during the infusion of autologous peripheral blood stem cells is related to the number of granulocytes in the leukapheresis product. Bone Marrow Transplant. 2007; 40(11): 1063–1067.
- Accorsi P, Passeri C, Iacone A. A multiple regression analysis on factors influencing haematopoietic progenitor cell collection for autologous transplantation. Transfus Apher Sci. 2012; 47(2): 223–227.
- Besson N, Topholm Bruun M, Stauffer Larsen T, et al. Impact of apheresis automation on procedure quality and predictability of CD34 cell yield. J Clin Apher. 2018; 33(4): 494–504.
- Spoerl S, Wäscher D, Nagel S, et al. Evaluation of the new continuous mononuclear cell collection protocol versus an older version on two different apheresis machines. Transfusion. 2018; 58(7): 1772–1780.
- Chepovetsky J, Yoon SC, Blouin AG, et al. Roles of peripheral blood CD34+ cell count and midpoint collection CD34+ cell yield for peripheral blood stem cell collections from autologous patients mobilized by G-CSF and plerixafor. NAJ Med Sci. 2013; 6(2): 63–70.
