Taiwan Unrelated Donor PBSC Harvest Experience Shu-Huey Chen Hualien Tzu-Chi General Hospital

Impact of donor characteristics and procedural settings in yield Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect Second donation MCV

Materials and Methods ( І) Jan 〜 Mar. 2008, 373 unrelated healthy donors. G-CSF sc, μg/kg, daily for 5 days, harvest on day 5 of G-CSF(Filgrastim)

Materials and Methods( Ⅱ ) CD34+ cell criteria : >5  10 6 CD34+ cells/ kg recipient BW, If the first apheresis(D1) failed, following day a second apheresis(D2) D1 apheresis volume: patient body weight <35 kg→12 liters; kg →15 liters; >45 kg →18 liters D2 apheresis volume: 6-12 liters( D1 + D2 ≤24 liters)

Materials and Methods( Ⅲ ) BMI (kg/m2) : body weight (kg) divided by the square of their height (m). CIC(circulating immature cell )= circulating myeloblasts, promyelocytes, and myelocytes, metamyelocytes and erythroblasts The number of CD34+ cells : resultant leukapheresis bag using a PE-conjugated anti-CD34+ cell antibody (HPCA2) and flow cytometry (Becton Dickinson, San Jose, Ca, USA).

Yield Convention outcome: CD34+ cells /donor BW (10 6 /kg ) CD34+ cells / recipient BW (10 6 /kg) This study outcome: CD34+ cell yield (10 6 /L of processed blood) Poor yield: <10 x 10 6 CD34+ cells per L of processed blood volume a maximum of two aphereses of 24 liters of processed blood volume yielding 4 x 10 6 CD34+ cells/ kg for a recipient with BW of 60 kg

Results Ⅰ

Results Ⅱ

Results Ⅲ Female: low BMI, high artery, low total CD34, CD34/recipi ent kg, and yield

Results Ⅳ female donors artery access did exhibit higher CD34+ cell yields

Results Ⅴ donor age↑, female, low BMI, low pre-harvest WBC and circulating immature cell count, venous access type and high flow rate correlated with low Day 1 yield

Results Ⅵ female gender, an older age, a higher flow rate and venous access a higher risk for poor yield

DISCUSSION Outcome of harvest: mobilization and harvest Harvest(procedural setting): less been studies Suzuya : flow rate negatively correlated with the outcome of stem cell harvest ; CD34+ cells were higher in the arterial group but the differences didn’t reach the significance Our study: the mean harvest stem cell counts were also not significantly different if data viewed as a whole, but in female donors venous access did exhibit lower CD34+ cell yields Difficult to explain: arterial access will have a lesser stem cells trapping in the pulmonary circulation; more obvious in low circulating stem cells.

Donor characteristics in G-CSF side effect and post G-CSF WBC in predicting side effect Jan./2008 to Dec./2009

Table 2 Incidences of adverse events Percentage of the side effect Bone pain64.9% Myalgia/arthralgia58.2% Fatigue44.1% Headache33.0% Insomnia16.6% Nausea/anorexia13.9% Sweats9.5% Fever9.5% Vomiting5.9% Chills5.3%

Female(all S/S), high BMI(fatigue, myalgia/arthralgia, sweat), High G-CSF dose(bone pain), High 3rd day WBC(fatigue)

Second Donation(May./1994 to May./2009) 63.6%(7/11) donor choose BM; Fixed experienced staff for vascular access, Routine concomitant calcium gluconate supplement, Reduce processing blood volume for low body weight donor

MCV ≥80 (n=731)MCV <80 (n=62)p value Gender (Male/Female)451/280 (61.7/38.3)40/22 (64.5/35.5)0.76 Age (year) Donor BW (Kg) Access (Artery/Vein)319/412 (43.6/56.4)25/37 (40.3/59.7)0.71 Process volume (L) Flow rate (ml/min) Recipient BW (Kg) CD34 count in PB (uL) Total CD34 cell (10 6 ) < CD34 dose (10 6 /RBW)8.24.9< CD34 yield (10 6 /L) <0.0001

Poor mobilizer 年度 Aug Total 總案例數 poor_mobil izer poor_mob ilizer(%)

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