Technique for PBSC harvesting in children of weight under 10 kg

Abstract

Peripheral blood stem cell (PBSC) harvesting in the smallest children (weight <10 kg) using separators is complicated by specific problems. The volume of the separation set exceeds 25% of the total blood volume and the vascular access is generally not sufficient. Therefore, a simple manual technique for PBSC harvesting was developed. Three children (6-9 kg), with newly diagnosed tumours were scheduled to be treated with three to six sequential courses of high-dose chemotherapy, each followed by PBSC support. PBSC harvests were started after mobilization using cyclophosphamide and G-CSF when the peripheral blood CD34+ cell count exceeded 50/microl. About 50 ml of blood was drawn from a venous catheter, injected into a transfer bag containing ACD-A, and centrifuged. The buffy coat obtained was pooled in a collection bag, remaining plasma and erythrocytes were immediately reinfused and a subsequent cycle started. From three to 13 cycles were performed in 1-3 days and 18.0-32.2 x 10(6) CD34+cells/kg were collected. We did not detect any bacterial contamination or any notable complications. Fifteen PBSC reinfusions have been performed to date, each with rapid engraftment taking between 7 and 13 days. Patients are in very good PR (18 months from diagnosis) or in CR (6 and 8 months). We can conclude that this procedure is feasible and safe.