Journal of Clinical Apheresis最新文献

Therapeutic plasma exchange (TPE) in pediatric patients presents many challenges, including management of a large extracorporeal volume (ECV) and calcium replacement for patients who may not be able to express signs of hypocalcemia or other associated adverse events with a large ECV. Pediatric patients who are critically ill on continuous renal replacement therapy (CRRT) and/or extracorporeal membrane oxygenation (ECMO) may have indications for TPE, such as sepsis or liver failure anticipating transplant. It may be difficult or clinically detrimental to take the patient off the CRRT or ECMO circuit to perform TPE. Connecting the TPE device into the preexisting circuit is feasible with the understanding of the principles of the circuit flow set up and monitoring to mitigate adverse events. Effective communication among clinical teams managing distinct extracorporeal circuits is critical to ensuring coordinated patient care.

Few studies have explored the outcomes of patients with optic neuritis (ON) who undergo treatment with therapeutic plasma exchange (TPE). We hypothesized that patients with detectable antibodies may respond more favorably to TPE than those without. Data were retrospectively collected from the electronic medical record on patients ≥ 18 years old with a diagnosis of ON that our apheresis service consulted on between October 2022 and July 2024. A total of 288 admissions for ON occurred, and the apheresis service was consulted on 66 (23%); all patients were on high-dose steroids at the time of the consult. Fifty-four patients were diagnosed with neuromyelitis optica spectrum disorder (n = 24, 44%), myelin oligodendrocyte glycoprotein antibody-associated disease (n = 13, 24%), multiple sclerosis (n = 6, 11%), or ON not otherwise specified (n = 11, 20%). The mean age was 44 years, 74% were female, and 63% were Black. The average duration of visual symptoms prior to the initiation of TPE was 23 days; most patients underwent five TPE treatments, and the average improvement after the TPE course on a scale of 1–5 was 2.9. No relationship was observed between the duration of symptom onset prior to TPE and outcome, regardless of ON cause. Despite a long duration of symptoms prior to TPE, most patients showed moderate clinical improvement. The cause of ON or the presence of detectable antibodies did not impact the outcome, suggesting that removal by TPE of cytokines, complement, or other substances may be important.

In order to reflect patient needs given new treatment options for hematopoietic malignancies, autologous hematopoietic progenitor cell (HPC) collection goals were changed to 10 or 15 × 10⁶ CD34+/kg (previously 20 × 10⁶ CD34+/kg) for myeloma patients and to 5 × 10⁶ CD34+/kg (previously 10 × 10⁶ CD34+/kg) for lymphoma patients in March 2023. The minimum number of large volume leukapheresis (LVL) procedures required decreased from two to one. We analyzed the impact of these changes on apheresis and cell therapy laboratory (CTL) services. Data from the post-implementation period of April through December in 2023 were compared to those from the same 9-month periods in 2022 and 2021 as controls. The number of patients undergoing autologous HPC collection per month were examined. The numbers of LVL procedures, numbers of cryopreserved bags, and apheresis and CTL staffing hours and costs were determined retrospectively on a per patient and monthly basis. One-way ANOVA with Tukey's multiple comparison was performed. The per patient averages for LVL procedures, cryopreserved bags, staff hours, and costs in apheresis and CTL services were decreased significantly in 2023 compared to both control periods. However, for monthly analyses, differences were significant between 2023 and 2021; but not between 2023 and 2022. No differences were seen between the two control periods. The changes in autologous HPC collection goals led to a significant decrease in LVL procedures and cryopreserved bags required per patient to meet collection goals, reducing costs and workload for apheresis and CTL.

Estimating total blood volume (TBV) in obese individuals remains a critical yet unresolved challenge in apheresis medicine. Our prior work demonstrated that commonly used TBV formulas exhibit significant variability, particularly at higher BMI ranges. This study builds on those findings to test modified algorithms that produce mid-spectrum apheresis parameters and mitigate extreme over- or underestimation. Using a standardized artificial dataset and retrospective clinical data from obese patients, we evaluated the performance of modified versions of the Lemmens-Bernstein formula and Gilcher's Rule. We assessed output consistency, alignment with empirically defined expected ranges, and potential clinical impact on apheresis parameters. A modified Lemmens-Bernstein formula (LB-60) yielded TBV estimates within an expected range for obese women and resolved extreme overshooting of an empiric expected range at higher BMIs. For obese men, both the LB-60 and a modified Gilcher's Rule (Gilchers-65) performed comparably. These formulas produced mid-spectrum apheresis parameters and mitigated extreme over- or underestimation. We recommend using a modified Lemmens-Bernstein formula for obese women, and either it or a modified Gilcher's Rule for obese men. These represent practical interim solutions while the field moves toward direct TBV measurement.

This case report presents a previously unreported grade 4 adverse event in a 23-year-old male with sickle cell disease (SCD) undergoing autologous stem cell collection for gene therapy. About 8 h after the collection of stem cells, the patient experienced a generalized tonic–clonic seizure. Imaging revealed a right temporal infarct, newly identified but determined to be subacute. Common causes such as electrolyte imbalance, a thromboembolic event, and posterior reversible encephalopathy syndrome (PRES) were excluded. Given the temporal relation of seizure occurrence after the apheresis procedure, an adverse event due to apheresis cannot be excluded. Seizure due to apheresis has not been reported before and would be categorized as grade 4 according to the common terminology criteria for adverse events (CTCAE). This case highlights the need to report and collect all adverse events that occur during or after apheresis procedures in SCD patients undergoing gene therapy to better counsel patients on the potential risks and prevention strategies.

The hematopoietic progenitor cell apheresis [HPC(A)] is a cornerstone of stem cell transplantation. While multiple apheresis sessions are common in clinical practice, few studies have examined the procedural variability within the same donor across consecutive collections. This study aims to compare changes in the efficiency metrics between the first and second HPC(A) procedures. A retrospective analysis was conducted on paired HPC(A) procedures performed on the same donor between January 2023 and May 2025 at the Abu Dhabi Stem Cells Center. The predefined parameters, including the collection efficiencies (CE₁, CE₂, cruCE), performance ratio (PR), and total volume processed (TVP), were compared using the Wilcoxon signed-rank tests. Effect sizes were calculated using Cohen's r, and associations between variables were assessed using the Spearman correlation. Of the 215 procedures screened, 90 met the inclusion criteria. Despite similar preapheresis CD34⁺ cell counts and flow rates, second-day procedures demonstrated significantly improved CE₁, CE₂, and PR, with lower TVP. A large effect size was observed for the TVP/total blood volume (TBV) ratio (r = 0.63), and moderate-to-large effect sizes for CE₂ (r = 0.41), PR (r = 0.47), and CE₁ (r = 0.47). CE₁ and CE₂ correlated strongly with PR across both sessions, while CE₂ correlated positively with TVP/TBV on day 1 (ρ = 0.47) and negatively on day 2 (ρ = −0.40). Second-day HPC(A) sessions yielded superior efficiency despite reduced volume, supporting the value of individualized collection planning. These “day two advantages” may inform refinements in yield prediction and highlight the need for prospective studies to optimize apheresis strategies.

Focal segmental glomerulosclerosis (FSGS) is one of the causes of end-stage kidney disease. The etiology is not fully understood, and standardized treatments are not established. We created a registry on apheresis for post-transplant FSGS through the Renal Subcommittee in the Research Committee in the American Society for Apheresis (ASFA), and here is our first report. Members of the renal subcommittee from seven centers in the United States contributed data collection on demographic, clinical course, and overall outcomes of patients with post-transplant recurrence of FSGS treated with therapeutic plasma exchange (TPE) between 2015 and 2020. The TPE data, including frequency and replacement fluid for TPE, are also investigated. The median age at diagnosis of FSGS and first transplantation among 26 patients was 12.7 and 21 years, respectively. The FSGS recurred at a median of 1 day after transplantation, and TPE was performed daily or every other day in the first month and continued at some frequency beyond a year in some cases. Most procedures used albumin as a replacement fluid and citrate anticoagulation, with 1–1.5 plasma volumes exchange. Twelve patients had complete/partial remission by 6 months. The median urine protein/creatinine ratio improved from 4.47 to 1.4 mg/mg within 3 months, and eGFR improved from 26 to 78 mL/min/1.73 m² in a year after TPE started. The study revealed some uniformity in the prescription of TPE, primarily using albumin as replacement fluid and performing 1–1.5 plasma volume exchanges. Observed complication rates were minimal. TPE can be one of the treatments to consider in this condition.

We report the case of a 50-year-old male with peripheral T-cell lymphoma who underwent allogeneic hematopoietic stem cell transplantation and developed overlap chronic graft-versus-host disease (ocGvHD) requiring extracorporeal photopheresis (ECP). His clinical presentation included a maculopapular rash with jaundice, hepatosplenomegaly, hyperbilirubinemia, and elevated liver enzymes. Liver biopsy findings were not consistent with GvHD or lymphoma but were suggestive of drug-induced hepatitis. ECP was initiated using the Therakos CellEx Photopheresis System. During the initial sessions, dark green plasma discoloration was observed, accompanied by multiple plasma/red blood cell interface-related procedural alarms. These challenges were managed through various operator adjustments, and the procedures remained safe and effective. Over four ECP sessions, both the discoloration and opacity of the plasma progressively improved, in parallel with declining liver enzyme levels and a reduction in procedural alarms. This temporal association between hepatic recovery and improved interface stability during ECP has not been previously described in the context of ocGvHD. Although dark green plasma is an uncommon finding in this setting, it should prompt evaluation for underlying hepatic dysfunction and timely management of plasma/red blood cell interface issues to ensure safe and effective ECP delivery.