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Biotherapies, Cellular Therapies, and Immunotherapies

(P-BT-28) Two Day Hematopoietic Progenitor Cell Infusion for Recipients Ineligible for One Day Infusions – A Three-Year Review 

Sunday, October 20, 2024
12:00 PM - 1:00 PM  
Background/Case Studies: Hematopoietic progenitor cells (HPCs) are used for immune reconstitution in patients with hereditary or acquired deficiencies in hematopoiesis or after marrow toxic chemotherapy in the setting of malignancy. Autologous HPCs are generally collected by apheresis, cryopreserved, and infused later. Cryopreservation is performed using a cryoprotectant, usually dimethyl sulfoxide (DMSO), and liquid nitrogen under conditions to preserve HPC viability. DMSO is relatively safe at low doses during transplant. Higher doses can result in side effects as mild as garlic odor to as significant as cardiovascular instability. Here we review three years of HPC infusions to evaluate the effectiveness of infusions split over 2 days compared to one day infusions.

Study

Design/Methods:

Autologous transplants from 2021-2024 were reviewed. Transplants not meeting the following release criteria were split over 2 days: 1. red blood cell content ≤ 30 mL, 2. DMSO content ≤ 1.0g/kg for recipients with estimated glomerular filtration rate ≥ 60 mL/min/BSA, or 3. DMSO content ≤ 0.5g/kg for recipients with estimated glomerular filtration rate ≤ 60 mL/min/BSA. 



The following data was gathered for each HPC infusion: DMSO content, red blood cell content, CD34 dose/kg, days to neutrophil & platelet engraftment, total days of collection to meet collection goal, and reported infusion toxicities (Table 1). Time to engraftment was determined by days to absolute neutrophil count of 0.5 x109/L and platelet count of >20,000 x109/L for 7 days without transfusion support. Cryopreservation was performed using 10% DMSO by volume.


Results/Findings: 365 autologous transplants were performed from 2021-2024. 11 transplants were split over 2 days. Results are shown in Table 1. The mean neutrophil engraftment is 11 days (SD±1.13), and platelet engraftment is 19 days (SD±2.61) for split infusions. The mean CD34+ cells x106/kg dose is 1.95 (SD ± 0.72) per split infusion. The adverse event rate for split infusions was 0 as compared to 2.62% for one day infusions. All but 1 recipient receiving 2-day infusions engrafted by time of this report.

Conclusions: Splitting HPC infusions across 2 days is a reasonable alternative to cell washing prior to transplant. Logistically this process shifts the burden of staffing onto infusion teams. However, it prevents manipulation of post thaw products reducing risk of product contamination, cell loss from washing to remove DMSO and free hemoglobin and reduces staffing needs for processing. 2-day infusions successfully resulted in patient engraft for 91% of patients with no reported adverse events. An ongoing program review is being performed to determine the feasibility of further lengthened infusion practices for those unable to accommodate 2-day infusions.