Journal of Clinical Apheresis最新文献

{"title":"Hemodynamic Effect of Different Replacement Fluid Protocols During Therapeutic Apheresis Evaluated With CRIT-LINE","authors":"Hajar Elassas,&nbsp;Olivier Moranne","doi":"10.1002/jca.70047","DOIUrl":"https://doi.org/10.1002/jca.70047","url":null,"abstract":"<p>In therapeutic apheresis (TA) procedures, it is essential to administrate human albumin solution (HAS) to prevent hypotensive episodes. The CRIT-LINE monitor is used in hemodialysis to estimate changes in relative blood volume (RBV) to prevent such hypotensive episodes. The aim of this study was to evaluate the change in RBV during therapeutic plasma exchange (TPE) and double filtration plasmapheresis (DFPP) according to different fluid replacement protocols in order to identify the best protocol. A retrospective case series study was conducted on three patients with CIDP at a tertiary center. Each patient's TA sessions were evaluated with the CRIT-LINE monitor to compare fluid replacement protocols. The following protocols were evaluated for TPE: (TPE1) 100% volume replacement with 4% albumin supplementation; (TPE2) a combination of a 70% volume with 4% albumin and 30% normal saline in the initial phase of the session; and (TPE3) the same combination with normal saline in the final phase of the session. With regard to DFPP, the following protocols were evaluated: DFPP1: continuous infusion of 4% albumin throughout the entire session, and DFPP2: 4% albumin the last 20 min of the session. For the three patients, during the TPE sessions, the nadir for RBV was −10% to −13%, −11% to −17%, and −17% to −20% for TPE1, TPE2, and TPE3 protocols, respectively. Hypotensive episodes were observed in three patients with a combination of fluid replacement with normal saline infused at the end of the session (TPE3). In the DFPP sessions, the nadir for the change in RBV was −7% to −15% and −10% to −20% for DFPP1 and DFPP2 protocols, respectively. The nadir for RBV was higher with albumin infusion at the end of the session. Our results suggest a potentially crucial role of continuous RBV monitoring during TA to identify the better substitution fluid protocol and prevent hypotension during sessions.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869826","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":"Hematopoietic Stem Cell Donors' Experiences of Information and Side-Effects During the First Year After Donation—A Swedish National Study","authors":"Annika M. Kisch,&nbsp;Jeanette Winterling,&nbsp;Hans Hägglund,&nbsp;Gunnar Larfors,&nbsp;Stig Lenhoff,&nbsp;Simon Pahnke","doi":"10.1002/jca.70050","DOIUrl":"https://doi.org/10.1002/jca.70050","url":null,"abstract":"<p>The aim was to describe hematopoietic stem cell (HSC) donors' experiences focusing on information and side effects during the first year after donation. Our prospective Swedish cohort study with adult HSC donors was performed from 2019 to 2022, with questionnaires at four time points from before until 12 months after donation. 173 unrelated and 68 related donors participated, and the majority donated peripheral blood stem cells. All but one rated their donation experience as good or very good. At least one side effect was reported by 83% of participants. Six donors (2.5%) experienced either numerous side effects, at least one severe side effect, or prolonged side effects. Satisfaction with information was lower among donors having severe side effects and bone marrow donors. Overall satisfaction with the donation was lower among donors having severe side effects and unrelated donors. Donors were generally satisfied with the pre-donation information. Most experienced side effects that resolved within 2 weeks, which strengthens the case for unchanged donor follow-up 1 month after donation, with individualized follow-up for donors with persistent symptoms. Enhanced information regarding the risk of more severe or prolonged side effects appears warranted, and its effect on donor satisfaction should be evaluated.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144853778","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":"Impact of New Hematopoietic Progenitor Cell Collection Goals on Apheresis and Cell Therapy Laboratory Services","authors":"Aaron J. Wyble,&nbsp;V. Rakesh Sethapati,&nbsp;Steven R. Post,&nbsp;Haley McAloon,&nbsp;Nancy Green,&nbsp;Mayumi Nakagawa,&nbsp;Michele Cottler-Fox,&nbsp;Gina Drobena","doi":"10.1002/jca.70048","DOIUrl":"https://doi.org/10.1002/jca.70048","url":null,"abstract":"<div>\u0000 \u0000 <p>In order to reflect patient needs given new treatment options for hematopoietic malignancies, autologous hematopoietic progenitor cell (HPC) collection goals were changed to 10 or 15 × 10⁶ CD34+/kg (previously 20 × 10⁶ CD34+/kg) for myeloma patients and to 5 × 10⁶ CD34+/kg (previously 10 × 10⁶ CD34+/kg) for lymphoma patients in March 2023. The minimum number of large volume leukapheresis (LVL) procedures required decreased from two to one. We analyzed the impact of these changes on apheresis and cell therapy laboratory (CTL) services. Data from the post-implementation period of April through December in 2023 were compared to those from the same 9-month periods in 2022 and 2021 as controls. The number of patients undergoing autologous HPC collection per month were examined. The numbers of LVL procedures, numbers of cryopreserved bags, and apheresis and CTL staffing hours and costs were determined retrospectively on a per patient and monthly basis. One-way ANOVA with Tukey's multiple comparison was performed. The per patient averages for LVL procedures, cryopreserved bags, staff hours, and costs in apheresis and CTL services were decreased significantly in 2023 compared to both control periods. However, for monthly analyses, differences were significant between 2023 and 2021; but not between 2023 and 2022. No differences were seen between the two control periods. The changes in autologous HPC collection goals led to a significant decrease in LVL procedures and cryopreserved bags required per patient to meet collection goals, reducing costs and workload for apheresis and CTL.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144782442","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":"Toward Better Estimation of Total Blood Volume in Obese Patients Undergoing Apheresis","authors":"Caitlin Raymond,&nbsp;Sinaii Ninet,&nbsp;Kamille West-Mitchell","doi":"10.1002/jca.70049","DOIUrl":"https://doi.org/10.1002/jca.70049","url":null,"abstract":"<div>\u0000 \u0000 <p>Estimating total blood volume (TBV) in obese individuals remains a critical yet unresolved challenge in apheresis medicine. Our prior work demonstrated that commonly used TBV formulas exhibit significant variability, particularly at higher BMI ranges. This study builds on those findings to test modified algorithms that produce mid-spectrum apheresis parameters and mitigate extreme over- or underestimation. Using a standardized artificial dataset and retrospective clinical data from obese patients, we evaluated the performance of modified versions of the Lemmens-Bernstein formula and Gilcher's Rule. We assessed output consistency, alignment with empirically defined expected ranges, and potential clinical impact on apheresis parameters. A modified Lemmens-Bernstein formula (LB-60) yielded TBV estimates within an expected range for obese women and resolved extreme overshooting of an empiric expected range at higher BMIs. For obese men, both the LB-60 and a modified Gilcher's Rule (Gilchers-65) performed comparably. These formulas produced mid-spectrum apheresis parameters and mitigated extreme over- or underestimation. We recommend using a modified Lemmens-Bernstein formula for obese women, and either it or a modified Gilcher's Rule for obese men. These represent practical interim solutions while the field moves toward direct TBV measurement.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740482","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":"Unexpected Seizure Complication Post-Apheresis in a Young Adult With Sickle Cell Disease: A Case Report","authors":"Joshua Glass,&nbsp;HyoJeong Han,&nbsp;Jennifer Webb","doi":"10.1002/jca.70044","DOIUrl":"https://doi.org/10.1002/jca.70044","url":null,"abstract":"<div>\u0000 \u0000 <p>This case report presents a previously unreported grade 4 adverse event in a 23-year-old male with sickle cell disease (SCD) undergoing autologous stem cell collection for gene therapy. About 8 h after the collection of stem cells, the patient experienced a generalized tonic–clonic seizure. Imaging revealed a right temporal infarct, newly identified but determined to be subacute. Common causes such as electrolyte imbalance, a thromboembolic event, and posterior reversible encephalopathy syndrome (PRES) were excluded. Given the temporal relation of seizure occurrence after the apheresis procedure, an adverse event due to apheresis cannot be excluded. Seizure due to apheresis has not been reported before and would be categorized as grade 4 according to the common terminology criteria for adverse events (CTCAE). This case highlights the need to report and collect all adverse events that occur during or after apheresis procedures in SCD patients undergoing gene therapy to better counsel patients on the potential risks and prevention strategies.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695780","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":"The Day Two Advantage: A Retrospective Paired Analysis of Consecutive HPC(A) Collections","authors":"Yandy Marx Castillo-Aleman,&nbsp;Carlos Agustin Villegas-Valverde,&nbsp;Antonio Alfonso Bencomo-Hernandez,&nbsp;Shinnette Lumame,&nbsp;Charisma Castelo,&nbsp;Jay Mary Rose-Roque,&nbsp;Marlene Cato,&nbsp;Nameer Al-Saadawi,&nbsp;Mohamed Ibrahim Abu-Haleeqa,&nbsp;Inas El-Najjar,&nbsp;Yendry Ventura-Carmenate,&nbsp;Fatema Mohammed Al-Kaabi","doi":"10.1002/jca.70046","DOIUrl":"https://doi.org/10.1002/jca.70046","url":null,"abstract":"<div>\u0000 \u0000 <p>The hematopoietic progenitor cell apheresis [HPC(A)] is a cornerstone of stem cell transplantation. While multiple apheresis sessions are common in clinical practice, few studies have examined the procedural variability within the same donor across consecutive collections. This study aims to compare changes in the efficiency metrics between the first and second HPC(A) procedures. A retrospective analysis was conducted on paired HPC(A) procedures performed on the same donor between January 2023 and May 2025 at the Abu Dhabi Stem Cells Center. The predefined parameters, including the collection efficiencies (CE₁, CE₂, cruCE), performance ratio (PR), and total volume processed (TVP), were compared using the Wilcoxon signed-rank tests. Effect sizes were calculated using Cohen's <i>r</i>, and associations between variables were assessed using the Spearman correlation. Of the 215 procedures screened, 90 met the inclusion criteria. Despite similar preapheresis CD34⁺ cell counts and flow rates, second-day procedures demonstrated significantly improved CE₁, CE₂, and PR, with lower TVP. A large effect size was observed for the TVP/total blood volume (TBV) ratio (<i>r</i> = 0.63), and moderate-to-large effect sizes for CE₂ (<i>r</i> = 0.41), PR (<i>r</i> = 0.47), and CE₁ (<i>r</i> = 0.47). CE₁ and CE₂ correlated strongly with PR across both sessions, while CE₂ correlated positively with TVP/TBV on day 1 (<i>ρ</i> = 0.47) and negatively on day 2 (<i>ρ</i> = −0.40). Second-day HPC(A) sessions yielded superior efficiency despite reduced volume, supporting the value of individualized collection planning. These “<i>day two advantages</i>” may inform refinements in yield prediction and highlight the need for prospective studies to optimize apheresis strategies.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666454","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":"Report of the ASFA Apheresis Registry Study on Focal Segmental Glomerulosclerosis","authors":"Poyyapakkam Srivaths,&nbsp;Grace F. Monis,&nbsp;Leonor P. Fernando,&nbsp;Jeanne E. Hendrickson,&nbsp;Jay S. Raval,&nbsp;Cyril Jacquot,&nbsp;Keefe Davis,&nbsp;Edward Wong,&nbsp;Chisa Yamada","doi":"10.1002/jca.70041","DOIUrl":"https://doi.org/10.1002/jca.70041","url":null,"abstract":"<div>\u0000 \u0000 <p>Focal segmental glomerulosclerosis (FSGS) is one of the causes of end-stage kidney disease. The etiology is not fully understood, and standardized treatments are not established. We created a registry on apheresis for post-transplant FSGS through the Renal Subcommittee in the Research Committee in the American Society for Apheresis (ASFA), and here is our first report. Members of the renal subcommittee from seven centers in the United States contributed data collection on demographic, clinical course, and overall outcomes of patients with post-transplant recurrence of FSGS treated with therapeutic plasma exchange (TPE) between 2015 and 2020. The TPE data, including frequency and replacement fluid for TPE, are also investigated. The median age at diagnosis of FSGS and first transplantation among 26 patients was 12.7 and 21 years, respectively. The FSGS recurred at a median of 1 day after transplantation, and TPE was performed daily or every other day in the first month and continued at some frequency beyond a year in some cases. Most procedures used albumin as a replacement fluid and citrate anticoagulation, with 1–1.5 plasma volumes exchange. Twelve patients had complete/partial remission by 6 months. The median urine protein/creatinine ratio improved from 4.47 to 1.4 mg/mg within 3 months, and eGFR improved from 26 to 78 mL/min/1.73 m² in a year after TPE started. The study revealed some uniformity in the prescription of TPE, primarily using albumin as replacement fluid and performing 1–1.5 plasma volume exchanges. Observed complication rates were minimal. TPE can be one of the treatments to consider in this condition.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598428","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":"Green Plasma in Extracorporeal Photopheresis: A Case Report in Overlap Chronic GvHD","authors":"Yandy Marx Castillo-Aleman,&nbsp;Aseel Suleiman Alsaid,&nbsp;Shinnette Lumame,&nbsp;Charisma Castelo,&nbsp;Jay Mary Rose Roque,&nbsp;Marlene Cato,&nbsp;Yara Khaled Afifi,&nbsp;Sheima Ali,&nbsp;Mohamed Ibrahim Abu-Haleeqa,&nbsp;Inas El-Najjar,&nbsp;Nameer Al-Saadawi","doi":"10.1002/jca.70045","DOIUrl":"https://doi.org/10.1002/jca.70045","url":null,"abstract":"<div>\u0000 \u0000 <p>We report the case of a 50-year-old male with peripheral T-cell lymphoma who underwent allogeneic hematopoietic stem cell transplantation and developed overlap chronic graft-versus-host disease (ocGvHD) requiring extracorporeal photopheresis (ECP). His clinical presentation included a maculopapular rash with jaundice, hepatosplenomegaly, hyperbilirubinemia, and elevated liver enzymes. Liver biopsy findings were not consistent with GvHD or lymphoma but were suggestive of drug-induced hepatitis. ECP was initiated using the Therakos CellEx Photopheresis System. During the initial sessions, dark green plasma discoloration was observed, accompanied by multiple plasma/red blood cell interface-related procedural alarms. These challenges were managed through various operator adjustments, and the procedures remained safe and effective. Over four ECP sessions, both the discoloration and opacity of the plasma progressively improved, in parallel with declining liver enzyme levels and a reduction in procedural alarms. This temporal association between hepatic recovery and improved interface stability during ECP has not been previously described in the context of ocGvHD. Although dark green plasma is an uncommon finding in this setting, it should prompt evaluation for underlying hepatic dysfunction and timely management of plasma/red blood cell interface issues to ensure safe and effective ECP delivery.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598225","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":"In Response to a Letter to the Editor on Our Recent Publication “Performance of Total Blood Volume Algorithms in Obesity and Severe Obesity”","authors":"Caitlin Raymond","doi":"10.1002/jca.70043","DOIUrl":"https://doi.org/10.1002/jca.70043","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589664","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":"Constructive Reflections on Total Blood Volume Estimation in Obesity: Comment on Raymond et al.","authors":"Radheshyam Meher","doi":"10.1002/jca.70042","DOIUrl":"https://doi.org/10.1002/jca.70042","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589663","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}