Richa, Elie M.

Abstract Anti-AnWj (Anton) has been associated with clinically significant hemolytic transfusion reactions. More than 99 percent of studied populations have RBCs that express the antigen. Reported here is a patient with anti-AnWj who was transfused with antigen-positive RBCs without adverse reaction. Immunohematology 2007; 23:55–58.

Abstract Introduction: Peripheral blood hematopoietic progenitor cell collection is a more popular source of stem cells for transplantation than bone marrow harvest. A number of automated cell separators exist which can be used to perform mononuclear cell collections. These separators collect varying amounts of other cells during the collection process, including them in the mononuclear cell product. Because of this, collection of mononuclear cells can result in significant reductions in platelet count and loss of red blood cells during the procedure. In order to minimize platelet transfusion support, we developed an algorithm to optimize mononuclear cell collections while minimizing platelet losses using the Gambro COBE Spectra and the Baxter Amicus Methods: Previously, patients were assigned randomly to any available apheresis machine. Starting August 2nd 2002, patients with a WBC count higher than 35×10 (9)/L were preferably assigned to Amicus for 5 hour collection with processing 1000 ml/cycle or as second choice Spectra for 5 hours run with maximum draw rate 65 ml/Min., for both instruments. If the WBC was lower than 35×10 (9)/L, the preferred machine would be Amicus for 5 hours run at 1400 ml/cycle with maximum draw rate 90ml/Min. or Spectra for 5 hours run with maximum draw 100 ml/Min. We reviewed the difference of pre and post procedure platelet counts of non Hodgkin’s Lymphoma patients undergoing stem cells collection for 6 months before and after the implementation of the above protocol from February 2002 till February 2003. All CBC were performed on the same Coulter analyzer. Results: 14 patients (2 on Amicus and 12 on Spectra) underwent stem cells collection before August 2nd, 2002. 13 patients (8 on Amicus and 5 on Spectra) were collected after this date. The Fisher’s exact test was used for this study. The median and mean differences in the first group were 141.5 ×10(9)/L and 135 ×10 (9)/L respectively (95% CI, p 0.0183). The second group had a median and mean of 45 ×10 (9)/L and 51 × 10(9)/L (95% I, p 0.0183). The minimum and maximum differences were 36 × 10(9)/L and 200 × 10(9)/L respectively in the first group and −19 ×10(9)/L and 121×10(9)/L for the second group. There was no difference in the numbers of the collections days in both groups in regard to the type of automated cell collector. Discussion: The implemented algorithm showed a net advantage. Even though none of the patients required blood transfusions, there was lesser drop of platelets counts with the new settings.

Abstract Autologous stem cells transplant in tandem is considered the standard therapy for patients with Multiple Myeloma (MM) and Primary Amyloidosis. The collection as well as the infusion of stem cells, which are preserved in dimethyl sulfoxide (DMSO), may cause serious side effects including renal failure. We reviewed the charts of MM patients undergoing stem cell transplant from 2001 through the end of 2005. Patients were grouped into one of 3 categories: Amylodosis, MM with Immunoglobulin G (IgG) and MM with non IgG. Creatinine and creatinine clearance values were collected 14 days prior to, the day of, 3 days post, and 28 days post infusion. The volume of the transplant as well as the number of CD 34+ stem cells reflect the dose of DMSO infused since all the cryopreservation of cells were done with 105 DMSO solution. We also collected data about the administration of nephrotoxic agents such as Aminoglycoside antibiotics, Vancomycin and Amphotercin B because these patients are at increased risk of developing infections. We also reviewed the dose of consolidation chemotherapy (Melphalen) as a potential nephrotoxic agent. Chi-square analysis was used. 645 patients were included [380 (58.82%) males and 265 females (41.18%)]. 384 received Vancomycin, 7 received Gentamycin and 8 received Amphotericin B with total of 146 missing data. 191 (29.57%) had Amyloidosis, 285 (44.12%) IgG MM and 169 (26.32%) non IgG MM. Only 6 transplants were allogeneic. The dose of Melphalen ranged between 0–200 mg/m2 over 2 days at the discretion of the physician. The mean weight was 82.25 Kg and median weight was 81.8 Kg. The mean age 57.12 years and median age was 58 years. 608 patients (94.12%) had one transplant, 35 (5.42%) had 2 transplants and 3 (0.46%) had 3 transplants. The mean volume was 289.20 ml and median volume was 245 ml. The mean number of CD34+ cells was 5.39 × 10(6)/kg with a median of 4.74 × 10(6). The mean and median Creatinine levels were 1.26 mg/dl and 1 mg/dl respectively at 2 weeks prior to transplant, 1.23mg/dl and 1mg/dl on the day of transplant, 1.18 mg/dl and 1mg/dl at 3 days after transplant and finally 1.16mg/dl and 0.9mg/dl at 4 weeks interval. 67 males as well 50 females had renal failure prior to transplant but there was no statistical difference due to gender (p 0.001). Creatinine clearance levels were 83.96 ml/min at 2 weeks prior, 83.84 ml/min at day zero, 88.57 ml/min and 91.89 ml/min respectively. The median were 83.37 ml/min, 82.77 ml/min, 86.43 ml/min and 91.29 ml/min respectively. Even though 35 creatinine values were missing within the first 3 days period, there was no acute renal failure (ARF) (0.5 mg/dl increase) noted with a 95% C.I. 95% in 494 patients with normal creatinine. The creatinine level improved in 93 patients with an abnormal level and only 24 were left with abnormal levels. This might represent a dilutional effect due to fluid administration during the transplant. Concerning the incidence of chronic renal failure (CRF) at 4 weeks interval, considering that only 47 laboratory values were missing the results was as follows: 4 patients had > 0.5 mg/dl creatinine increase from the 485 normal patients with C.I. 95%. CRF was still observed in 38 patients of the 72 patients with baseline renal failure. Even though 9 had very poor creatinine clearance <10ml/min (p 0.01) only 5 were left with severe creatinine clearance after transplant (p 0.05) We found that DMSO does not induce ARF or an exacerbation of CRF in transplants patients for Amyloidosis and Multiple Myeloma.