Discordant CD34+ cell results in peripheral blood and hematopoietic progenitor cell-apheresis product: Implications for clinical decisions and impact on patient treatment

Courtney J. Liwski, Douglas J. Padley, Michael Gustafson, Jeffrey L. Winters, Dennis A. Gastineau, Eapen K. Jacob

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Case Report A 50-year-old male with T-cell lymphoma presented for autologous peripheral blood stem cell transplantation. After granulocyte-colony-stimulating factor (G-CSF) mobilization, his peripheral blood CD34+ cell count was 166 × 106/L on the day before collection, which predicted a high yield of CD34+ cells in the apheresis product. The first two collections had yields much lower than expected, triggering an investigation and changes to the apheresis collection methods since mobilization appeared adequate from the peripheral CD34+ values. Results Changes to the apheresis collection variables and instrumentation did not improve the yields in the next three collections. The laboratory investigation demonstrated that there was an interfering substance in the patient's plasma that was causing falsely high peripheral blood CD34+ cell values and that the low CD34+ cell yields in the collections were consistent with the actual peripheral blood CD34+ cell value. Based on this finding and after discussion with the clinical service, the patient then received plerixafor to increase the number of circulating CD34+ cells before Collections 6 and 7. The patient went on to achieve the target CD34+ cell dose and subsequently underwent a successful autologous transplant with full hematopoietic engraftment. Conclusion This case demonstrates the importance of timely and critical review of laboratory results in the context of the specific patient. This case exemplifies how diligent review of laboratory results and open communication among the various teams can positively affect patient outcomes.

Original languageEnglish (US)
Pages (from-to)541-544
Number of pages4
JournalTransfusion
Volume54
Issue number3
DOIs
StatePublished - Jan 1 2014

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Blood Component Removal
Hematopoietic Stem Cells
Blood Cells
Therapeutics
Peripheral Blood Stem Cell Transplantation
Blood Cell Count
T-Cell Lymphoma
Autografts
Granulocyte Colony-Stimulating Factor
Communication

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Discordant CD34+ cell results in peripheral blood and hematopoietic progenitor cell-apheresis product : Implications for clinical decisions and impact on patient treatment. / Liwski, Courtney J.; Padley, Douglas J.; Gustafson, Michael; Winters, Jeffrey L.; Gastineau, Dennis A.; Jacob, Eapen K.

In: Transfusion, Vol. 54, No. 3, 01.01.2014, p. 541-544.

Research output: Contribution to journalArticle

Liwski, Courtney J. ; Padley, Douglas J. ; Gustafson, Michael ; Winters, Jeffrey L. ; Gastineau, Dennis A. ; Jacob, Eapen K. / Discordant CD34+ cell results in peripheral blood and hematopoietic progenitor cell-apheresis product : Implications for clinical decisions and impact on patient treatment. In: Transfusion. 2014 ; Vol. 54, No. 3. pp. 541-544.
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abstract = "Case Report A 50-year-old male with T-cell lymphoma presented for autologous peripheral blood stem cell transplantation. After granulocyte-colony-stimulating factor (G-CSF) mobilization, his peripheral blood CD34+ cell count was 166 × 106/L on the day before collection, which predicted a high yield of CD34+ cells in the apheresis product. The first two collections had yields much lower than expected, triggering an investigation and changes to the apheresis collection methods since mobilization appeared adequate from the peripheral CD34+ values. Results Changes to the apheresis collection variables and instrumentation did not improve the yields in the next three collections. The laboratory investigation demonstrated that there was an interfering substance in the patient's plasma that was causing falsely high peripheral blood CD34+ cell values and that the low CD34+ cell yields in the collections were consistent with the actual peripheral blood CD34+ cell value. Based on this finding and after discussion with the clinical service, the patient then received plerixafor to increase the number of circulating CD34+ cells before Collections 6 and 7. The patient went on to achieve the target CD34+ cell dose and subsequently underwent a successful autologous transplant with full hematopoietic engraftment. Conclusion This case demonstrates the importance of timely and critical review of laboratory results in the context of the specific patient. This case exemplifies how diligent review of laboratory results and open communication among the various teams can positively affect patient outcomes.",
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