Large-volume leukapheresis procedure for peripheral blood progenitor cell collection in children weighing 15 kg or less: Efficacy and safety evaluation

Background. We update our experience on large-volume leukapheresis (LVL) in very small patients with malignancies. LVLs were performed with the aim of reducing the psychological impact of leukaphereses by reducing the number of procedures while collecting large numbers of cells. Procedure. Seventeen LVLs were performed using a Cobe Spectra separator in 14 patients weighing less than or equal to 15 kg. A median of 3.8 patient's blood volumes corre sponding to 296 mL/kg (range, 202-565) of blood was processed per session o f 190 minutes (120-279) duration. A femoral catheter was installed speciall y for collection for 88% LVL (vs. 35% for standard leukaphereses). A median volume of 16.9 mL/kg was collected with 5.4 x 10(8) MNC/kg (range, 0.6-16. 3) and 8.2 x 10(6) CD34+ cells/kg (range, 1.3-31.7). Results. No signs of c omplications due to citrate toxicity were encountered. No hypotensive or hy pothermic episodes were observed. Platelet counts were significantly dimini shed after each procedure (median: -59%). When the extracorporal line was n ot primed with red blood cells (RBC), the difference between pre-LVL and po st-LVL hemoglobin levels was significant with a median 32 g/L decrease. Con clusions. The LVL approach for peripheral blood progenitor cells (PBPC) col lection in very small children may expose them to the risk of anemia and th rombocytopenia and an excess of special central line installation. The appl ication of this technique in these patients should be reserved for special cases when a very large number of cells must be collected and should be per formed by an experienced team. Med. Pediatr. Oncol. 32:7-10, 1999. (C) 1999 Wiley-Liss, Inc.