Journal of Clinical Apheresis最新文献

Lipoprotein apheresis is a well-established therapy for patients with dyslipidemia unresponsive to conventional lipid-lowering strategies. However, its impact on systemic inflammation remains uncertain. This systematic review and meta-analysis evaluated the effect of apheresis on circulating inflammatory markers, including C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Following PRISMA guidelines, a systematic search of PubMed, Scopus, and ISI Web of Science was conducted up to June 2025. Studies reporting pre- and post-apheresis values for inflammatory markers were included. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Thirteen publications met inclusion criteria. Meta-analysis demonstrated that apheresis significantly reduced CRP levels (SMD = −0.31; 95% CI: −0.44 to −0.18; p < 0.001), particularly in long-term interventions. No significant changes were observed for IL-6, TNF-α, or hs-CRP. In conclusion, apheresis significantly reduces CRP levels, especially with long-term treatment, suggesting a modest anti-inflammatory benefit. However, its effects on other markers remain unclear. Larger and high-quality trials are warranted.

The American Society for Apheresis recommends leukapheresis as a category II recommendation for symptomatic hyperleukocytosis. Mortality in these patients varies between 8%–29%. However, no tool is currently available to assess the mortality risk following the procedure. This study aims to assess the factors associated with in-hospital mortality and develop a risk stratification tool consisting of clinically relevant variables to categorize patients based on their mortality risk following the procedure. The National Inpatient Sample Database (2016–2021) and ICD-10 coding were utilized to identify adults with leukemia who underwent leukapheresis. Multivariate logistic regression models were constructed to identify independent factors of mortality. A scoring system was constructed to identify the risks of mortality using the variables in the model and their associated odds ratio (OR). The cumulative risk score was divided into three strata: low (mortality < 20%), intermediate (20%–50%), and high risk (> 50%). Of the estimated 3555 patients who underwent leukapheresis, 40.1% also received chemotherapy. Most patients who underwent leukapheresis had myeloid leukemia (52.2%), followed by lymphoid leukemia (14.2%), monocytic leukemia (6.2%), and the remaining were other types of leukemia. Variables incorporated into the scoring system include: monocytic leukemia, age over 50, morbid obesity, and interventions performed before leukapheresis, such as mechanical ventilation and blood transfusions. The cumulative mortality score ranged from 0 to 30, categorizing patients into high risk (score > 13), intermediate risk (6–13), and low risk (0–5). The risk score demonstrated a performance with an area under the curve of 0.82. A novel simplified scoring tool to predict in-hospital mortality in leukemia patients requiring leukapheresis is presented here. This tool can assist in preprocedural risk assessment, help guide management planning, and consideration of other treatment modalities.

A major challenge in hematopoietic progenitor cell apheresis is determining the whole blood (WB) volume to process to achieve a CD34+ cell collection goal. We developed a web-based calculator app that uses the Collection Efficiency 2 (CE2) model to estimate personalized WB processing volumes needed to reach a prescribed CD34+ cell collection goal. Retrospective evaluation of the app using collection data from two academic medical centers showed that actual processed WB volumes were frequently higher than the app's recommendations. The frequency of potential under-collection events is predicted to be low had the app-calculated volumes been utilized. Our findings suggest that using the app's recommendations may lower total WB processing volumes, reducing over-collection and time spent on the apheresis machine, while maintaining a low under-collection risk profile.

Calculating the collection efficiency (CE) of CD34+ cells in leukocytapheresis (LVL) is critical to understanding the performance of cell collection. Traditional CE values are typically based on both pre- and post-apheresis calculations of the pooled cells (CE1), or they may be based only on the pre-procedure pool calculation (CE2) and total blood volume (TBV) processed. However, determining the actual CD34+ concentration in peripheral blood (PB) during LVL is more problematic. New crude CE (CruCE) takes into account the recruitment and extraction of CD34+ cells during LVL. This study aims to retrospectively compare traditional (CE2, CE1) and CruCE and to assess the variables that influence new CruCE—including donor characteristics, procedure characteristics, and device setting parameters—in both large-volume LVL and non-LVL. Data from adult donors who underwent autologous and allogeneic collections of PB stem cells between January 2020 and April 2023 were retrospectively included. Our series comprises 123 autologous and 37 allogeneic LVL procedures. The median of CD34+ CE2, CE1, and CruCE was 51%, 65%, and 74% in autologous donors and 58%, 69%, and 76% in allogeneic donors. In multivariate analysis, TBV processed and prior CD34+ cell count in PB showed a positive and a negative correlation with CruCE in autologous and allogeneic settings, respectively. In conclusion, CruCE may be closer to actual CE in comparison to CE2 and CE1. LVL and low CD34+/μL prior to the procedure may enhance CD34+ cell CE.