Journal of Clinical Apheresis最新文献

Initial hematopoietic stem cell (HSC) mobilization failure remains a critical barrier to autologous stem cell transplantation (ASCT) in patients with lymphoma or multiple myeloma (MM). This retrospective cohort study (August 2015 to March 2023) evaluated the efficacy, safety, and cost-effectiveness of a novel salvage regimen—split-dose cyclophosphamide (CTX: 1.5 g/m² for 2 days) + Mecapegfilgrastim (PEG-rhG-CSF) + on-demand plerixafor (PXF)—compared to conventional strategies (CTX + granulocyte colony-stimulating factor [G-CSF] or G-CSF + PXF) in 118 patients with initial mobilization failure. Patients were stratified into three groups: CTX + PEG-rhG-CSF + on-demand PXF (n = 46), CTX + G-CSF (n = 34), and G-CSF + PXF (n = 38). The CTX + PEG-rhG-CSF + on-demand PXF group achieved superior mobilization efficacy: median CD34⁺ cell yield was 9.2 × 10⁶/kg, which is significantly higher than that of CTX + G-CSF group (4.1 × 10⁶/kg; p < 0.05) and G-CSF + PXF group (4.6 × 10⁶/kg; p < 0.05). Rates of achieving the thresholds of ≥ 2 × 10⁶ CD34⁺ cells/kg and ≥ 5 × 10⁶ CD34⁺ cells/kg were significantly higher in the CTX + PEG-rhG-CSF + on-demand PXF group. This superior mobilization efficacy also brought fewer apheresis sessions: only 15.2% of patients in the CTX + PEG-rhG-CSF + on-demand PXF cohort required ≥ 2 sessions, compared to 70.5% in CTX + G-CSF group and 57.9% in G-CSF + PXF group (p < 0.001). Safety profiles were comparable across cohorts: febrile neutropenia occurred in 13% of patients in CTX + PEG-rhG-CSF + on-demand PXF group (vs. 26.5% in CTX + G-CSF; p = 0.33). Severe neutropenia (Grade 3–5) was common in CTX-containing groups (91.3% vs. 90.2%; p = 0.88) but mostly being transient, with no treatment-related mortality. Neutrophil engraftment times were similar (median 10–11 days; p = 0.406) in all groups. Cost analysis revealed that the CTX + PEG-rhG-CSF + on-demand PXF regimen was more cost-effective than G-CSF + PXF regimen (5511 vs. 8761; p < 0.05) but more expensive than CTX + G-CSF regimen ($3012; p < 0.05). In conclusion, CTX + PEG-rhG-CSF + on-demand PXF is a highly effective salvage mobilization strategy for patients with initial HSC mobilization failure, yielding higher CD34⁺ cell counts with fewer aphereses and acceptable safety. With balanced advantages in efficacy, safety, and cost-effectiveness, the CTX + PEG-rhG-CSF + on-demand PXF regimen can be a preferred salvage option for ASCT candidates with prior mobilization failure.

The postpartum period represents a high-risk interval for presentation with a pregnancy-associated thrombotic microangiopathy (TMA). Given the possibility of immune thrombotic thrombocytopenic purpura, postpartum TMA is typically treated with initiation of therapeutic plasma exchange (TPE). Yet, TPE use in postpartum TMA and its impact on maternal outcomes are poorly understood. Therefore, this study sought to determine the incidence of TPE-treated postpartum TMA and its impacts on maternal outcomes. In a retrospective cohort analysis of the Nationwide Readmission Database, we first identified patients with an index delivery hospitalization and then identified any readmissions within 30 days. Readmissions were categorized according to TMA status (no TMA vs. postpartum TMA). Postpartum TMA readmissions were identified using validated International Classification of Diseases codes for TMA (M31.1) and TPE (6A550Z3 and 6A551Z3). We then estimated the national incidence of postpartum TMA readmissions and the risk of the primary composite outcome of mortality, thrombosis, and major bleeding. Among 11 378 671 delivery hospitalizations, we identified 41 postpartum TMA readmissions (incidence 3.6/1 000 000 deliveries). Compared to non-TMA readmissions, postpartum TMA readmissions were associated with higher rates of the composite outcome (26.8% vs. 4.7%; p < 0.001). Postpartum TMA readmissions were also associated with higher rates of thrombosis (p = 0.03), major bleeding (p < 0.001), and mortality (p = 0.001). Although rare, postpartum TMA is associated with poor maternal outcomes. Future studies should explore strategies to improve outcomes in this high-risk population.

Hematopoietic progenitor cell collection (HPC-C) by apheresis after granulocyte-colony stimulating factor (G-CSF) stimulation is a routine worldwide procedure. The first apheresis procedure is typically performed on Day 5 of G-CSF administration. We aimed to evaluate whether initiating the apheresis procedure on Day 4, with 1 day shorter G-CSF exposure for the donor, affects collection outcomes. This study included healthy, unrelated donors who underwent HPC-C by apheresis after G-CSF administration between April 2022 and February 2024 at our center. Of 182 unrelated donors, 34.6% underwent apheresis on Day 4 of G-CSF treatment and 65.4% on Day 5. There was no significant difference between the two groups in terms of collected CD34⁺ cell yield (p = 0.369) or the need for a second apheresis procedure (p = 0.74). Successful mobilization was achieved in 93.7% of donors who underwent a single apheresis procedure on Day 4 and in 95% of those who underwent a single apheresis procedure on Day 5 (p = 0.477). In donors requiring two consecutive apheresis procedures, the collected CD34⁺ cell yield was higher in those who initiated apheresis on Day 4, although this difference was not statistically significant (p = 0.067). This is the first study comparing HPC-C outcomes on Days 4 and 5 of G-CSF administration exclusively in unrelated donors. Our data indicate no difference in the collected CD34⁺ cell yield or the need for a second apheresis procedure between the two groups. Initiating apheresis on Day 4 may allow for 1 day less G-CSF exposure without compromising collection outcomes.

Advances in the understanding of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) pathophysiology have expanded the application of plasma exchange (PE) in severe cases; however, robust evidence on its efficacy, safety, and long-term outcomes remains scarce. This retrospective study evaluated the short-term efficacy, safety, and long-term prognosis of PE in patients with severe AAV. A total of 24 patients receiving PE alongside standard induction therapy (glucocorticoids plus cyclophosphamide or rituximab) were analyzed. Clinical and laboratory parameters—including ANCA titers, Birmingham Vasculitis Activity Score (BVAS), C-reactive protein (CRP), and hemoglobin (Hb)—were assessed before and after treatment, together with adverse events and survival. The cohort comprised 10 males and 14 females, mean age 62.5 ± 16.1 years (range 29–84). PE was associated with significant reductions in ANCA levels, BVAS, and CRP, alongside increased Hb. Over long-term follow-up, mortality rose progressively, mainly attributable to severe infections, respiratory failure, and heart failure. In conclusion, PE exhibits short-term effectiveness and a tolerable safety profile in severe AAV, yet long-term survival outcomes warrant further attention.

This report describes an unusual case of an apheresis platelet (AP) unit in platelet additive solution (PAS) exhibiting marked icteric discoloration and bag staining, despite sterile cultures and initially preserved platelet morphology. Donor evaluation revealed mild unconjugated hyperbilirubinemia, implicating donor-derived pigments as the source of discoloration. By Day 5, reduced platelet function was observed. This case underscores that icteric appearance in PAS-suspended platelets, though rare, may signal donor-related pigment transfer and warrants reevaluation of current visual inspection and acceptance for blood components.

People are increasingly using artificial intelligence (AI)-based chatbots to provide health-related information. However, concerns remain regarding the quality, accuracy, and readability of the information they produce. This study aimed to evaluate and compare the responses of five widely used AI chatbots to the most frequently searched keywords about apheresis. On May 1, 2025, the 25 most searched apheresis-related keywords were identified using Google Trends. Two keywords were excluded due to irrelevance. The remaining 23 queries were submitted to five chatbots: GPT-4o, Gemini 2.5, Grok 3, DeepSeek v3, and Copilot. Responses were assessed using the EQIP tool for content quality, the DISCERN questionnaire for information reliability, and the Flesch–Kincaid grade level (FKGL) and reading ease (FKRE) metrics for readability. Statistical analysis was performed using the Kruskal–Wallis test and Bonferroni correction. Significant differences were found among chatbots in EQIP, DISCERN, FKGL, and FKRE scores (p = 0.001). DeepSeek v3 demonstrated the highest quality and accuracy (EQIP: 95.7%, DISCERN: 71.8), while GPT-4o had the best readability (FKRE: 43.1, FKGL: 9.1). Copilot showed the poorest readability. Overall, chatbot responses were generally written at a college reading level. AI chatbots vary substantially in the quality and comprehensibility of their health information about apheresis. While newer models like DeepSeek offer improved informational accuracy, readability remains a concern across all platforms. Future chatbot development should prioritize plain-language communication to enhance accessibility and health literacy for diverse patient populations.

With hematopoietic progenitor cell (HPC) collections by apheresis, it is not clear whether CD34+ cells inhabit a specific density within the mononuclear cell (MNC) interface. This study was undertaken to see whether this could be determined by targeting a specific depth in the interface as determined by the colorgram level. In 90 National Marrow Donor Program HPC collections using the continuous MNC procedure of the Spectra Optia device, the level of the MNC layer targeted for collection was systematically rotated between three different colorgram levels. Relevant collection characteristics, collection efficiencies (CE), and a novel measure, the CD34+ enrichment ratio, were compared between the three colorgram levels using one-way ANOVA. Validating the colorgram level targeting, the product Hct was significantly different between the three colorgram levels. CD34+ CE2 and the CD34+ enrichment ratio trended higher with a lower Hct level. Lymphocyte CE1 trended higher with a higher Hct level. Our results are consistent with the hypothesis that CD34+ cells layer higher than lymphocytes in the collection interface, and that CD34+ cells may perhaps be more precisely targeted by collecting lighter in the collection interface. Our results pave the groundwork for further study with a more precise CD34+ CE1 calculation.