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O'Reilly MA, Malhi A, Cheok KPL, Ings S, Balsa C, Keane H, Jalowiec K, Neill L, Peggs KS, Roddie C. A novel predictive algorithm to personalize autologous T-cell harvest for chimeric antigen receptor T-cell manufacture. Cytotherapy 2023; 25:323-329. [PMID: 36513573 DOI: 10.1016/j.jcyt.2022.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AIMS The most widely accepted starting materials for chimeric antigen receptor T-cell manufacture are autologous CD3+ T cells obtained via the process of leukapheresis, also known as T-cell harvest. As this treatment modality gains momentum and apheresis units struggle to meet demand for harvest slots, strategies to streamline this critical step are warranted. METHODS This retrospective review of 262 T-cell harvests, with a control cohort of healthy donors, analyzed the parameters impacting CD3+ T-cell yield in adults with B-cell malignancies. The overall aim was to design a novel predictive algorithm to guide the required processed blood volume (PBV) (L) on the apheresis machine to achieve a specific CD3+ target yield. RESULTS Factors associated with CD3+ T-cell yield on multivariate analysis included peripheral blood CD3+ count (natural log, ×109/L), hematocrit (HCT) and PBV with coefficients of 0.86 (95% confidence interval [CI], 0.80-0.92, P < 0.001), 1.30 (95% CI, 0.51-2.08, P = 0.001) and 0.09 (95% CI, 0.07-0.11, P < 0.001), respectively. The authors' model, incorporating CD3+ cell count, HCT and PBV (L), with an adjusted R2 of 0.87 and root-mean-square error of 0.26 in the training dataset, was highly predictive of CD3+ cell yield in the testing dataset. An online application to estimate PBV using this algorithm can be accessed at https://cd3yield.shinyapps.io/cd3yield/. CONCLUSIONS The authors propose a transferrable model that incorporates clinical and laboratory variables accessible pre-harvest for use across the field of T-cell therapy. Pending further validation, such a model may be used to generate an individual leukapheresis plan and streamline the process of cell harvest, a well-recognized bottleneck in the industry.
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Affiliation(s)
- Maeve A O'Reilly
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK. maeve.o'
| | - Aman Malhi
- Cancer Research UK & University College London Cancer Trials Center, University College London, London, UK
| | - Kathleen P L Cheok
- Department of Hematology, University College London Hospital, London, UK
| | - Stuart Ings
- Department of Hematology, University College London Hospital, London, UK
| | - Carmen Balsa
- Department of Hematology, University College London Hospital, London, UK
| | - Helen Keane
- Department of Hematology, University College London Hospital, London, UK
| | - Katarzyna Jalowiec
- Department of Hematology, University College London Hospital, London, UK
| | - Lorna Neill
- Department of Hematology, University College London Hospital, London, UK
| | - Karl S Peggs
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK
| | - Claire Roddie
- University College London Cancer Institute, London, UK; Department of Hematology, University College London Hospital, London, UK
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Pham HP, Dormesy S, Wolfe K, Budhai A, Sachais BS, Shi PA. Potentially modifiable predictors of cell collection efficiencies and product characteristics of allogeneic hematopoietic progenitor cell collections. Transfusion 2021; 61:1518-1524. [PMID: 33713454 DOI: 10.1111/trf.16370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hematopoietic progenitor cell (HPC) and immune effector cell (IEC) therapies often require high doses of mononuclear cells (MNCs), whether CD34+ cells, lymphocytes, or monocytes. Cells for IEC can be sourced from HPC products. We thus examined potentially modifiable variables affecting collection efficiencies (CEs) of MNC subsets in HPC collection and also of the typically undesired cell types of platelets, granulocytes, and red cells, which hinder downstream processing. Finally, we sought to confirm previously indeterminate studies of the effect of an adjusted collect flow rate (CFR) on CD34+ CE. STUDY DESIGN AND METHODS We performed univariate and multivariate regression analyses of all 135 National Marrow Donor Program (NMDP) HPC collections in 2019 and compared these fixed CFR procedures to previous NMDP collections using adjusted CFRs. RESULTS Target cell CEs decreased with increasing peripheral blood (PB) concentration and were associated with different cell type locations within the MNC layer. CEs of undesired cell types varied with standard procedural parameters (inlet flow rate, whole blood processed, etc.). Interestingly, some CEs increased with preapheresis hematocrit. Finally, adjusting the CFR by PB MNC count improved MNC CE but not CD34+ CE. CONCLUSION Correlation of target cell CEs with their PB concentration and different cell type locations by depth within the MNC layer indicates the importance of investigating the compensatory fine-tuning of procedure variables to improve CE. Correlation of CEs with PB hematocrit, and CFR adjustment by a modified PB MNC and/or PB CD34 algorithm should be further explored. Adjusting standard procedural parameters may reduce product contamination.
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Affiliation(s)
- Huy P Pham
- Be The Match Seatte Collection Center, National Marrow Donor Program, Seattle, Washington, USA
| | | | - Kurt Wolfe
- New York Blood Center, Clinical Services, New York, New York, USA
| | - Alexandra Budhai
- New York Blood Center, Clinical Services, New York, New York, USA
| | - Bruce S Sachais
- New York Blood Center, Clinical Services, New York, New York, USA
- New York Blood Center, Lindsley F. Kimball Research Institute, New York, New York, USA
| | - Patricia A Shi
- New York Blood Center, Clinical Services, New York, New York, USA
- New York Blood Center, Lindsley F. Kimball Research Institute, New York, New York, USA
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Cid J, Carbassé G, Suárez-Lledó M, Moreno DF, Martínez C, Gutiérrez-García G, Fernández-Avilés F, Rosiñol L, Giavedoni P, Mascaró JM, Agustí C, Marín P, Rovira M, Urbano-Ispizua Á, Lozano M. Efficacy and safety of one-day offline extracorporeal photopheresis schedule processing one total blood volume for treating patients with graft-versus-host disease. Transfusion 2019; 59:2636-2642. [PMID: 31135994 DOI: 10.1111/trf.15384] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has been increasingly used as a second-line therapy for graft-versus-host disease (GVHD) but there is no consensus regarding the best therapeutic schedule. STUDY DESIGN AND METHODS Our offline ECP schedule for treating patients with GVHD was retrospectively reviewed. Patients with acute GVHD were treated on 2 days per week for the first 2 weeks, followed by 1 day per week for 2 more weeks. After the first month of treatment, patients received treatment 1 day every 2 weeks for a minimum of 16 ECP procedures. Patients with chronic GVHD were treated on 1 day per week for 4 weeks followed by 1 day every 2 weeks for a minimum of 14 ECP procedures. RESULTS Our series comprises 21 (45%) patients with acute GVHD and 26 (55%) patients with chronic GVHD who received 667 ECP procedures. A median (interquartile range [IQR]) of 1.0 (1.0-1.12) total blood volume was processed. Patients with acute and chronic GVHD received ECP procedures during a median of 49 (IQR, 14-103) and 180 (IQR, 111-274) days, respectively. Mild citrate-induced symptoms were present in 98 (46%) and 232 (51%) procedures in patients with acute and chronic GVHD, respectively. Overall response rate (ORR) and overall survival (OS) were 57 and 38% (95% confidence interval [CI], 17%-59%), respectively, for patients with acute GVHD. For patients with chronic GVHD, ORR and OS were 77 and 61% (95% CI, 18%-87%), respectively. CONCLUSION Our new offline ECP schedule for treating patients with acute and chronic GVHD was efficacious and safe.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gloria Carbassé
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - David F Moreno
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Dermatology ICMiD, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José M Mascaró
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Dermatology ICMiD, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carles Agustí
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Pneumology and Respiratory Allergy, ICR, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Marín
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
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