Journal of Clinical Apheresis最新文献

{"title":"Plerixafor and G-CSF Versus Placebo and G-CSF in Moderately Mobilizing Patients With Multiple Myeloma to Optimize Hematopoietic Stem Cell Collection Results (OPTIMIZE)","authors":"Worel Nina,&nbsp;Schreder Martin,&nbsp;Tanzmann Andreas,&nbsp;Kurz Martin,&nbsp;Huber-Kraßnitzer Bianca,&nbsp;Neumeister Peter,&nbsp;Rosskopf Konrad,&nbsp;Sareban Nazanin,&nbsp;Branka Manuela,&nbsp;Kolovratova Vera,&nbsp;Oesterreicher Sophia,&nbsp;Koerbler Beatrix,&nbsp;Kitzweger Elvira,&nbsp;Ruckser Reinhard,&nbsp;Rabitsch Werner,&nbsp;Agis Hermine,&nbsp;Krauth Maria,&nbsp;Greinix Hildegard T.","doi":"10.1002/jca.70188","DOIUrl":"10.1002/jca.70188","url":null,"abstract":"<p>Efficient collection of hematopoietic progenitor cells (HPCs) is essential for autologous stem cell transplantation (ASCT) in multiple myeloma (MM). Although plerixafor is routinely used in poor mobilizers, its role in patients with intermediate mobilization capacity remains unclear. In this randomized, double-blind, placebo-controlled phase IV trial, MM patients with peripheral blood (PB) CD34⁺ counts of 15–40 cells/μL after steady-state G-CSF mobilization were randomized to receive plerixafor or placebo. The primary endpoint was successful collection of ≥ 6.0 × 10⁶ CD34⁺ cells/kg, sufficient for two ASCTs, during a single apheresis session. Secondary endpoints included CD34⁺ kinetics, graft composition, colony-forming capacity, engraftment, immune reconstitution, and safety. Twenty-one patients were enrolled before premature study termination due to changes in first-line MM therapy and the COVID-19 pandemic. Plerixafor significantly increased PB CD34⁺ cell counts compared with placebo (<i>p</i> &lt; 0.001). All patients receiving plerixafor achieved the primary endpoint, whereas none in the placebo group achieved it (<i>p</i> &lt; 0.001). Mean CD34⁺ yield was significantly higher with plerixafor (10.4 ± 1.9 × 10⁶/kg vs. 2.9 ± 1.3 × 10⁶/kg; <i>p</i> &lt; 0.001). Plerixafor-mobilized grafts contained significantly higher numbers of primitive hematopoietic progenitor subsets and demonstrated increased CFU-GM formation, indicating enhanced clonogenic potential. Despite marked differences in graft quantity and quality, engraftment kinetics, graft sustainability, and immune reconstitution were comparable between groups. In MM patients with intermediate mobilization capacity, the addition of plerixafor markedly improved stem cell mobilization efficiency and enriched grafts with functionally robust progenitor cells. These findings suggest that selected patients beyond conventional poor mobilizers may benefit from plerixafor-assisted mobilization.</p><p><b>Trial Registration:</b> EudraCT nr.: 2016-004122-41</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Plasmapheresis on Serum Concentrations of Antiseizure Medications: A Systematic Review","authors":"Eman A. Makhlouf,&nbsp;Salma M. Abdel Fattah,&nbsp;Noha T. Abokrysha,&nbsp;Amani M. Ali","doi":"10.1002/jca.70193","DOIUrl":"10.1002/jca.70193","url":null,"abstract":"<div>\u0000 \u0000 <p>Seizures are an important neurological manifestation of several autoimmune and antibody-mediated disorders and often require treatment with antiseizure medications (ASMs). Therapeutic plasma exchange (TPE) is frequently used to treat these antibody-mediated conditions by removing circulating pathogenic factors. However, TPE is non-selective and may also remove protein-bound ASMs, particularly those with low volume of distribution. This unintended drug clearance may result in subtherapeutic concentrations and breakthrough seizures. This study aims to systematically assess the available evidence on the effects of TPE on ASM serum concentrations. It also seeks to determine whether drug removal is clinically significant and needs post-procedure supplemental dosing. A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library from April to May 2025 using predefined MeSH terms and keywords related to epilepsy, ASMs, and TPE. Randomized trials and case reports/series involving patients receiving ASMs concomitantly with TPE and reporting serum drug concentrations were included. Two independent reviewers performed study selection, data extraction, and quality assessment using the Joanna Briggs Institute checklist, in accordance with PRISMA guidelines. The primary outcome was the effect of TPE on ASM serum concentrations and the need for dose adjustment. Eighteen studies comprising 30 patients were included. Phenytoin was the most frequently evaluated ASM; although total serum concentrations often declined during TPE, overall drug removal was generally low, and free levels frequently remained therapeutic. Phenobarbital showed minimal change, while valproate and several newer ASMs demonstrated variable reductions in serum concentrations. Breakthrough seizures were reported in seven studies, ranging from transient events to refractory seizures requiring dose adjustments or treatment discontinuation. The effect of TPE on ASM pharmacokinetics was found to be drug-specific and largely influenced by protein binding and volume of distribution. Although overall drug removal is generally limited, peri-procedural serum fluctuations may contribute to breakthrough seizures in vulnerable patients. Routine supplemental dosing is not generally recommended; instead, individualized monitoring, and post-session dosing strategies are advised, particularly for ASMs with low volume of distribution or in high-risk patients.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single Center Retrospective Study: Efficacy and Platelet Preservation of Double Plasma Molecular Adsorption System Therapy by Membrane Separation Versus Centrifugal Separation in Acute-on-Chronic Liver Failure Patients With Hepatocellular Carcinoma","authors":"Guozhen Zhang,&nbsp;Yalin Wu,&nbsp;Xia Li,&nbsp;Hong Zheng,&nbsp;QingPei Guan,&nbsp;BoWei Hao,&nbsp;YueYang Deng,&nbsp;HaoXin Zhang,&nbsp;Jing Wang,&nbsp;Rui Xia","doi":"10.1002/jca.70192","DOIUrl":"10.1002/jca.70192","url":null,"abstract":"<div>\u0000 \u0000 <p>Hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC) and liver failure. The double plasma molecular adsorption system (DPMAS) reduces bilirubin and may create a therapeutic window for anti-tumor therapy in HCC patients. Two plasma separation techniques are used: membrane-based (MBS-DPMAS) and centrifugal (CPS-DPMAS), but no study has compared them specifically in HCC patients with acute-on-chronic liver failure (ACLF). This retrospective study included 203 HBV-related HCC patients who received DPMAS without plasma exchange (93 MBS-DPMAS, 110 CPS-DPMAS), with citrate anticoagulation used in all cases. Bilirubin, liver enzymes, INR, and platelet count were compared between groups and before versus after treatment. Baseline characteristics were comparable. CPS-DPMAS showed superior bilirubin reduction (TBIL: 184.60 vs. 220.05 μmol/L, <i>p</i> = 0.002; DBIL: 156.04 vs. 183.55 μmol/L, <i>p</i> = 0.004), whereas platelet count was significantly higher after MBS-DPMAS than after CPS-DPMAS (135.35 vs. 106.32 × 10⁹/L, <i>p</i> = 0.012). Both modalities decreased INR transiently, and only MBS-DPMAS significantly reduced ALT, AST, and creatinine. In conclusion, both techniques effectively reduce bilirubin and decrease INR, but CPS-DPMAS offers better bilirubin clearance while MBS-DPMAS provides better platelet protection, suggesting that technique selection should be individualized.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centrifugal Plasma Exchange Versus Double-Filtration Plasmapheresis in Chronic CIDP: A Randomized Crossover Study Comparing Clinical Outcomes, Biological Effects, Procedure Times, and Costs—The Lymphoapheresis Study","authors":"O. Moranne,&nbsp;S. Chkair,&nbsp;P. Ahmadapoor,&nbsp;C. Prelipcean,&nbsp;T. Chevallier,&nbsp;Ioana Ion,&nbsp;Z. Messikh","doi":"10.1002/jca.70191","DOIUrl":"10.1002/jca.70191","url":null,"abstract":"<p>Direct comparisons between centrifugal therapeutic plasma exchange (cTPE) and double-filtration plasmapheresis (DFPP) remain scarce. We compared cTPE and DFPP in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), regarding clinical outcomes, biological effects, tolerability, session times and hospital costs. Lymphoapheresis was a prospective, single-center, randomized, crossover ancillary study. At study entry, 5 patients with idiopathic CIDP on long-term therapeutic plasmapheresis were randomized to start with either cTPE or DFPP, then undergo 6 alternating sessions, for 30 sessions (15 cTPE, 15 DFPP) in all. Two patients had central venous access (CVA), and 3 had peripheral (PVA). Target treated plasma volume was identical for all patients. Clinical outcomes, intraprocedural tolerance, session-related biological changes, total session times, and procedure-related costs were compared using within-patient analyses and mixed-effects models. All 5 patients were men, median age 62 [56–68] years. The median treated plasma volume was similar for cTPE and DFPP sessions (4500 mL [4400–5000]). No difference was observed between modalities regarding short-term clinical outcomes or adverse events. Total session time differed insignificantly between modalities, but was longer with PVA than with CVA (201 [189–209] vs. 177 [163–192] minutes; <i>p</i> = 0.01). Compared with DFPP, cTPE induced greater per-session reductions in platelets, fibrinogen, prothrombin time, and IgG but not in IgM or Hb. Albumin use was markedly higher with cTPE than with DFPP (180 g vs. 20 g per session). By contrast, weight gain was greater with DFPP than with cTPE (1.0 [0.5–1.5] vs. 0.4 [0.0–0.5] kg; <i>p</i> = 0.04). Estimated hospital costs per session were higher with DFPP than with cTPE using HSA rather than FFP as fluid replacement, based on French blood product costs. The cost of DFPP is mainly due to material and platform costs and cTPE to blood products and staff requirements. In chronically treated CIDP patients, cTPE and DFPP showed similar short-term clinical efficacy and safety. Total session time depended on vascular access rather than the plasmapheresis modality. The cost of DFPP is mainly due to material and platform costs and cTPE to blood products and staff requirements.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Selective Plasma Exchange Versus Conventional Plasma Exchange in Pretransplant Desensitization of ABO-Incompatible Kidney Transplantation","authors":"Takahiro Inoue,&nbsp;Hajime Hirano,&nbsp;Yu Munakata,&nbsp;Yuki Kawaguchi,&nbsp;Ken Tsuchiya,&nbsp;Kohei Unagami,&nbsp;Junichi Hoshino,&nbsp;Hideki Ishida,&nbsp;Toshio Takagi,&nbsp;Norio Hanafusa","doi":"10.1002/jca.70186","DOIUrl":"10.1002/jca.70186","url":null,"abstract":"<div>\u0000 \u0000 <p>Selective plasma exchange (SePE) may reduce adverse events associated with fresh frozen plasma (FFP) use during pretransplant desensitization for ABO-incompatible kidney transplantation. We conducted a single-center retrospective cohort study of 75 patients who underwent ABO-incompatible kidney transplantation between January 2020 and April 2024. Of these, 48 received SePE and 27 received conventional plasma exchange (CPE) with FFP. We compared antibody titers at transplantation, perioperative outcomes, and procedure-related adverse events between the groups. Adverse events occurred in 5 patients (10.4%) in the SePE group and 17 patients (63.0%) in the CPE group (<i>p</i> &lt; 0.001). Anaphylactic shock occurred in no patients in the SePE group and 4 patients (14.8%) in the CPE group (<i>p</i> = 0.027). All patients in the SePE group and all but one patient in the CPE group achieved the prespecified preoperative antibody titer target of ≤ 1:32. Neither surgical operating time nor intraoperative blood loss differed significantly between the groups. In this cohort, SePE was associated with fewer procedure-related adverse events than CPE with FFP while achieving the preoperative antibody titer target in all SePE-treated patients.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Apheresis Inlet Flow With a Novel Double-Draw Vascular Access Technique","authors":"Amber P. Sanchez,&nbsp;Dan Norman Nicodemus Perez,&nbsp;Yeon Su Han,&nbsp;Janice Park,&nbsp;Marian Cabandong,&nbsp;Jerel Lee S. Malong","doi":"10.1002/jca.70190","DOIUrl":"10.1002/jca.70190","url":null,"abstract":"<div>\u0000 \u0000 <p>Peripheral intravenous catheters (PIVCs) are the preferred vascular access for apheresis; however, veins that initially appear suitable may develop venous spasms, resulting in poor inlet flow and frequent pressure alarms. Ports used for apheresis can also experience inlet pressure alarms due to catheter or venous occlusion. When conservative measures failed, we implemented a novel double-draw technique in which a second draw line was connected via a four-way stopcock and male-to-male adapter to the initial draw access (either a PIVC or port) to improve inlet flow. The double-draw technique was performed in 26 procedures (therapeutic plasma exchange [TPE], <i>n</i> = 10 and lipoprotein apheresis [LA], <i>n</i> = 16) in 8 patients. During TPE, median negative inlet pressure improved from −179 mmHg (IQR −218 to −69) with single-draw access to −71 mmHg (IQR −78 to −62) following placement of a second draw line (<i>p</i> = 0.0162). Inlet flow rate during TPE improved from median 47 mL/min (IQR, 40–58 mL/min) with single-draw access to 70 mL/min (IQR, 60–75 mL/min) (<i>p</i> = 0.008). During LA, median negative inlet pressure improved from −136 mmHg (IQR −193 to −109) to −59 mmHg (IQR −66 to −47) (<i>p</i> &lt; 0.0001). Median inlet flow rate during LA improved from 70 mL/min (IQR 59–71 mL/min) with single-draw access to median 80 mL/min (IQR 70–80 mL/min) (<i>p</i> = 0.023). Overall 25 of 26 procedures (96.2%) demonstrated an improvement in inlet pressure following implementation of the double-draw technique. All procedures were completed successfully without abandonment of the original access site. The double-draw technique is a novel option for managing inlet pressure alarms during apheresis when conservative measures fail.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron-Related Biomarkers and Red Cell Indices as Predictors of PBSC Collection Outcomes in Healthy Allogeneic Donors","authors":"Hatice Gizem Gunhan,&nbsp;Onur Direk,&nbsp;Ismail Mustafa Avci,&nbsp;Fatma Arikan,&nbsp;Tayfur Toptas,&nbsp;Isik Atagunduz,&nbsp;Ayse Tulin Tuglular","doi":"10.1002/jca.70189","DOIUrl":"10.1002/jca.70189","url":null,"abstract":"<div>\u0000 \u0000 <p>Efficient peripheral blood stem cell (PBSC) collection from healthy donors is essential for transplantation success and donor safety. While hemoglobin is routinely used in donor evaluation, the contribution of iron-related biomarkers and red cell indices to predicting collection outcomes remains incompletely defined. In this retrospective cohort study, 143 healthy PBSC donors undergoing granulocyte colony-stimulating factor-mediated mobilization and apheresis were evaluated. Baseline hematologic parameters and iron-related biomarkers were analyzed in relation to weight-adjusted total CD34⁺ cell yield using correlation, threshold-based analyses, and multivariable modeling. The median donor age was 32 years, and 70.6% were male. The overall median CD34⁺ yield was 5.41 × 10⁶/kg. Ferritin negatively correlated with CD34⁺ yield in male donors (<i>r</i> = −0.22, <i>p</i> = 0.027). In female donors, folate levels and red cell distribution width showed positive correlations with collection outcomes (<i>r</i> = 0.342, <i>p</i> = 0.027; <i>r</i> = 0.322, <i>p</i> = 0.037). The Mentzer index demonstrated an inverse association with CD34⁺ yield across both sexes. Transferrin saturation ≥ 18% in females was associated with higher target achievement rates (95.2% vs. 66.7%, <i>p</i> = 0.020). In males, ferritin ≥ 73 μg/L or hemoglobin &gt; 15.3 g/dL was associated with lower collection success. Readily available red cell indices and iron parameters are associated with clinically relevant PBSC collection outcomes and may serve as practical biomarkers for predicting PBSC collection performance and improving donor assessment. Incorporation of these markers into donor assessment may improve collection planning and procedural efficiency.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraprocedural Hemodynamics During Concomitant Rheocarna Therapy and Maintenance Hemodialysis: Effects of Dialyzer Membrane Type and Circuit Sequence","authors":"Yusuke Ishizuka,&nbsp;Genshin Sato,&nbsp;Shizuka Ishigaki,&nbsp;Ryo Enoki,&nbsp;Kako Kajiwara,&nbsp;Akihiko Nakasato,&nbsp;Sosuke Kinomura,&nbsp;Saori Kin,&nbsp;Yuji Noguchi,&nbsp;Daisuke Yoshizawa,&nbsp;Koichi Kikuchi,&nbsp;Michiaki Abe,&nbsp;Koki Kumagai,&nbsp;Tetsuhiro Tanaka,&nbsp;Koji Okamoto","doi":"10.1002/jca.70184","DOIUrl":"10.1002/jca.70184","url":null,"abstract":"<p>Chronic limb-threatening ischemia (CLTI), a severe manifestation of peripheral artery disease, is particularly prevalent among patients receiving maintenance hemodialysis (HD) and is associated with poor limb and survival outcomes. Low-density lipoprotein (LDL) apheresis, including Rheocarna, is used as adjunctive therapy for refractory CLTI; however, intraprocedural hypotension remains a major limitation, especially when combined with HD. We examined the effects of dialyzer membrane type and extracorporeal circuit sequence on hemodynamic stability during concomitant therapy. This case series comprised two patients with CLTI receiving maintenance HD. Each patient underwent four treatment sessions representing the four configurations defined by two dialyzer membranes (polysulfone [PS] and AN69) and two circuit sequences (Rheocarna → dialyzer vs. dialyzer → Rheocarna). Hemodynamic parameters, including systolic blood pressure, relative blood volume change (ΔBV), and peripheral microvascular perfusion assessed by laser Doppler flowmetry (ΔLDF), were assessed during each treatment session. In both cases, the Rheocarna → AN69 configuration showed the smallest early decrease in systolic blood pressure and the most favorable early ΔBV pattern among the four sessions. Toe ΔLDF was preserved or increased with this configuration. The other three configurations were associated with larger early decreases in systolic blood pressure in one or both patients, including a decrease to below 90 mmHg in Case B. These findings suggest that dialyzer membrane type and circuit sequence may influence intraprocedural hemodynamic stability during concomitant Rheocarna therapy and HD. Among the tested configurations, Rheocarna → AN69 showed better hemodynamic tolerance and preservation of peripheral perfusion. These hypothesis-generating findings warrant further evaluation in larger prospective studies.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Plasma Exchange in Pediatric Patients: A Multi-Institutional Landscape Analysis.","authors":"Caitlin Raymond","doi":"10.1002/jca.70198","DOIUrl":"https://doi.org/10.1002/jca.70198","url":null,"abstract":"<p><p>Pediatric evidence for therapeutic plasma exchange (TPE) is largely small, single-center cohorts; there is no prior large-scale age-stratified outcomes assessment. Using the TriNetX US Collaborative Network, we identified 3744 patients ≤ 17 years old undergoing an index TPE procedure, stratified into four age groups (≤ 1, 2-5, 6-12, and 13-17 years). ICD-10-CM diagnosis codes recorded 30 days prior to the index procedure were mapped to American Society for Apheresis Categories I-III indications; three high-prevalence nonspecific codes were tracked separately. All-cause mortality at 30 days, 90 days, and 1 year was assessed. All-cause mortality decreased with increasing age at every time window: 30-day mortality ranged from 16.8% (≤ 1 year) to 4.3% (13-17 years, p < 0.0001). Infant mortality risk was concentrated disproportionately in the first 90 days postprocedure. Sex distribution shifted from a slight male predominance in infancy and early childhood (55%-56% male) to a female predominance in adolescence (55% female, p < 0.0001). Leading specific indications were autoimmune encephalitis (10%), sepsis with multiorgan failure (9%), renal transplant rejection (6%), acute disseminated encephalomyelitis (5%), Guillain-Barré syndrome (5%), and myasthenia gravis (4%); nonspecific diagnosis codes were each individually more prevalent than any single ASFA-mapped indication. This is the first large-scale, age-stratified, multi-institutional characterization of pediatric TPE. We identified an inverse relationship between age and all-cause mortality, a sex-distribution shift in adolescence, and an indication landscape dominated by nonspecific diagnosis codes. These findings offer age-stratified benchmarks for clinical counseling and hypothesis generation.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":"e70198"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apheresis in Children of Weight Under 7 kg-A Single Center Experience.","authors":"Phassawan Rungsiprakarn, Bryan E Wilson, Natalie E Rintoul, K Taylor Wild, David F Friedman","doi":"10.1002/jca.70195","DOIUrl":"https://doi.org/10.1002/jca.70195","url":null,"abstract":"<p><p>Although apheresis techniques in children are well established, published experience with very low-weight children is limited. We reviewed 68 procedures performed in 19 children weighing less than 7 kg, including hematopoietic progenitor and T-cell collections and plasmapheresis. With significant modifications of standard techniques, all but one procedure was successfully and safely completed without serious citrate toxicity. Access was a major challenge. For plasmapheresis, the mean plasma volume removed was 1.2 × total plasma volume, but the mean total blood processed was 1.74 × total blood volume (TBV). For collections, the mean number of whole blood volumes processed was 4.1 × TBV. For T cell collections, the median CD3+ yield was 243.6 × 10⁶/kg. For HPC collections, the median CD34+ cell yield was 14.8 × 10⁶/kg. Mean durations for collections and plasmapheresis were 247.00 and 120.67 min, respectively. Of the CBC parameters, only platelet count was significantly lower after collections.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"41 5","pages":"e70195"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}