1
|
Kitamura W, Urata T, Fujii K, Fukumi T, Ikeuchi K, Seike K, Fujiwara H, Asada N, Ennishi D, Matsuoka KI, Otsuka F, Maeda Y, Fujii N. Collection efficiency and safety of large-volume leukapheresis for the manufacturing of tisagenlecleucel. Transfusion 2024; 64:674-684. [PMID: 38419458 DOI: 10.1111/trf.17765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In patients with relapsed or refractory B cell acute lymphoblastic leukemia or B cell non-Hodgkin lymphoma (r/r B-ALL/B-NHL) with low CD3+ cells in the peripheral blood (PB), sufficient CD3+ cell yield in a single day may not be obtained with normal-volume leukapheresis (NVL). Large-volume leukapheresis (LVL) refers to the processing of more than three times the total blood volume (TBV) in a single session for PB apheresis; however, the efficiency and safety of LVL for manufacturing of tisagenlecleucel (tisa-cel) remain unclear. This study aimed to investigate the tolerability of LVL. STUDY DESIGN AND METHODS We retrospectively collected data on LVL (≥3-fold TBV) and NVL (<3-fold TBV) performed for patients with r/r B-ALL/B-NHL in our institution during November 2019 and September 2023. All procedures were performed using a continuous mononuclear cell collection (cMNC) protocol with the Spectra Optia. RESULTS Although pre-apheresis CD3+ cells in the PB were significantly lower in LVL procedures (900 vs. 348/μL, p < .01), all patients could obtain sufficient CD3+ cell yield in a single day with a comparably successful rate of final products (including out-of-specification) between the two groups (97.2% vs. 100.0%, p = 1.00). The incidence and severity of citrate toxicity (no patients with grade ≥ 3) during procedures was not significantly different between the two groups (22.2% vs. 26.1%, p = .43) and no patient discontinued leukapheresis due to any complications. CONCLUSION LVL procedures using Spectra Optia cMNC protocol was well tolerated and did not affect the manufacturing of tisa-cel.
Collapse
Affiliation(s)
- Wataru Kitamura
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Urata
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Keiko Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Takuya Fukumi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Kazuhiro Ikeuchi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| | - Keisuke Seike
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Fumio Otsuka
- Division of Clinical Laboratory, Okayama University Hospital, Okayama, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
- Division of Blood Transfusion, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
2
|
Maitta RW. Apheresis collection of mononuclear cells for chimeric-antigen receptor therapies. Eur J Haematol 2024; 112:36-40. [PMID: 37525900 DOI: 10.1111/ejh.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
Collections of lymphocytes to be genetically modified to treat hematologic malignancies have seen a dramatic increase over the last few years as commercial products have been approved. Reports of new products in development that can possibly treat solid organ malignancies represent a massive change in the field. Apheresis is at the center of the collection of cells for the manufacture of these chimeric-antigen receptor therapy products. The expansion of these collections represents one of the areas of apheresis procedures growth. This review will summarize concepts important to this type of collection and variables that need to be optimized to obtain desired cell yields while increasing patients' safety.
Collapse
Affiliation(s)
- Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Jo T, Arai Y, Kitawaki T, Nishikori M, Mizumoto C, Kanda J, Yamashita K, Nagao M, Takaori-Kondo A. Risk analysis of fluctuating hypercalcemia after leukapheresis in cellular therapy. Sci Rep 2023; 13:14952. [PMID: 37696885 PMCID: PMC10495341 DOI: 10.1038/s41598-023-42159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
Optimized management of citrate-induced hypocalcemia is required to provide safe leukapheresis. We prospectively analyzed subjects who underwent leukapheresis for cytotherapy, and evaluated serum ionized (iCa) concentrations before, at the end of, and 1 h after leukapheresis. During leukapheresis, calcium gluconate solution was continuously supplemented intravenously with hourly measurement of iCa. 76 patients including 49 lymphapheresis for chimeric antigen receptor T-cell therapy and 27 stem cell collections were enrolled. Median processing blood volume was 10 L (range, 6-15 L). Fluctuating hypercalcemia, in which the iCa concentration rose above its upper limit 1 h after leukapheresis, was observed in 58 subjects (76.3%). Multivariate analysis revealed that higher ratios of processing blood volume to body weight, more rapid calcium supplementation, and lower iCa concentration at the end of leukapheresis significantly increased elevation of serum iCa concentration by 1 h after leukapheresis. Based on multivariate analyses, we developed a formula and a diagram that accurately estimates serum iCa concentration 1 h post-leukapheresis. This suggests optimal targets for iCa concentration and calcium supplementation rates. In cases with high ratios of processing blood volume to body weight, slowing the rate of blood processing, rather than increasing calcium supplementation should safely alleviate hypocalcemia during leukapheresis without inducing hypercalcemia thereafter.
Collapse
Affiliation(s)
- Tomoyasu Jo
- Center for Research and Application of Cellular Therapy, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Arai
- Center for Research and Application of Cellular Therapy, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Toshio Kitawaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chisaki Mizumoto
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miki Nagao
- Center for Research and Application of Cellular Therapy, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Center for Research and Application of Cellular Therapy, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
4
|
Benefits of plerixafor for mobilization of peripheral blood stem cells prior to autologous transplantation: a dual-center retrospective cohort study. Cytotherapy 2023:S1465-3249(23)00057-9. [PMID: 36914555 DOI: 10.1016/j.jcyt.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AIMS Before autologous stem cell transplantation (ASCT), hematopoietic stem cells must be stimulated to move from the bone marrow to the peripheral blood for harvesting. Plerixafor, a C-X-C chemokine receptor type 4 antagonist, is used to increase stem cell harvests. However, the effects of plerixafor on post-ASCT outcomes remain unclear. METHODS In a dual-center retrospective cohort study of 43 Japanese patients who received ASCT, the authors compared transplantation outcomes in patients who underwent stem cell mobilization with granulocyte colony-stimulating factor with (n = 25) or without (n = 18) plerixafor. RESULTS The number of days to neutrophil and platelet engraftment was significantly shorter with plerixafor than without plerixafor, as assessed by univariate (neutrophil, P = 0.004, platelet, P = 0.002), subgroup, propensity score matching and inverse probability weighting analyses. Although the cumulative incidence of fever was comparable with or without plerixafor (P = 0.31), that of sepsis was significantly lower with plerixafor than without (P < 0.01). Thus, the present data indicate that plerixafor leads to earlier neutrophil and platelet engraftment and a reduction of infectious risk. CONCLUSIONS The authors conclude that plerixafor may be safe to use and that it reduces the risk of infection in patients with a low CD34+ cell count the day before apheresis.
Collapse
|
5
|
Wang Y, Huan X, Jiao K, Jiang Q, Goh LY, Shi J, Lv Z, Xi J, Song J, Yan C, Lin J, Zhu W, Zhu X, Zhou Z, Xia R, Luo S, Zhao C. Plasma exchange versus intravenous immunoglobulin in AChR subtype myasthenic crisis: A prospective cohort study. Clin Immunol 2022; 241:109058. [PMID: 35690385 DOI: 10.1016/j.clim.2022.109058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/03/2022]
Abstract
Myasthenic crisis (MC) is a life-threatening state with respiratory failure in patients with myasthenia gravis (MG). The fast-acting immunomodulatory therapies for treating MC included plasma exchange (PE) and intravenous immunoglobulin (IVIG). However, the efficacy and the impact on antibody changes remained unknown. We prospectively followed 40 anti-acetylcholine receptors (AChR) antibody-positive MC patients who received either PE (n = 12) or IVIG (n = 28) at crisis. PE was associated with a reduced ICU stay length (p = 0.018) and an early response by the average changes in MGFA-QMG (p = 0.003), MMT (p = 0.020), and ADL (p = 0.011) at one-week off-ventilation. However, the clinical efficacy was equally comparable in both groups after 1 month. Post-treatment hemoglobin drop was significant in both groups, while IVIG was associated with a significant reduction in anti-AChR antibody titers (p < 0.001). This analysis provides real-world evidence in supporting the use of PE as a fast-acting therapy for shortening the ICU stay in AChR-associated MC.
Collapse
Affiliation(s)
- Yuan Wang
- Department of Blood Transfusion, Huashan Hospital Fudan University, Shanghai 200040, China
| | - Xiao Huan
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Kexin Jiao
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Qilong Jiang
- First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Ying Goh
- Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianquan Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhiguo Lv
- Changchun University of Chinese Medicine Department of Neurology, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130000, China
| | - Jianying Xi
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Jie Song
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Chong Yan
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Jie Lin
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Wenhua Zhu
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China
| | - Xinfang Zhu
- Department of Blood Transfusion, Huashan Hospital Fudan University, Shanghai 200040, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Xia
- Department of Blood Transfusion, Huashan Hospital Fudan University, Shanghai 200040, China.
| | - Sushan Luo
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China.
| | - Chongbo Zhao
- Huashan Rare disease centre, Department of Neurology, Huashan Hospital Fudan University, Shanghai 200040, China; National Center for Neurological Disorders, Shanghai 200040, China.
| | | |
Collapse
|