From the Guidelines
For peripheral blood apheresis mononuclear cell collection for CAR-T therapy, the minimum hemoglobin required is >80 g/l, as recommended by the European Society for Blood and Marrow Transplantation (EBMT) and the European Haematology Association (EHA) 1.
Key Considerations
- The recommended hemoglobin level is crucial to help establish a good interface during leukapheresis, ensuring the safety and efficacy of the procedure.
- Patients with hemoglobin levels below this threshold may be at risk of complications during apheresis, such as reduced oxygen-carrying capacity, which could lead to adverse effects like dizziness, fatigue, or hypotension.
- The EBMT/EHA recommendations also emphasize the importance of other parameters, including performance status, interval following exposure to chemotherapy, and standard electrolytes and renal function, to ensure the patient's overall suitability for the procedure.
Clinical Implications
- Clinicians should carefully evaluate patients' hemoglobin levels before proceeding with peripheral blood apheresis mononuclear cell collection for CAR-T therapy.
- For patients with hemoglobin levels below the recommended threshold, red blood cell transfusions may be considered to raise hemoglobin to acceptable levels, minimizing the risk of adverse effects during the procedure.
- The specific requirements may vary slightly between institutions, but adhering to the EBMT/EHA recommendations can help standardize practice and ensure optimal patient outcomes.
From the Research
Minimum Hemoglobin or Hematocrit Requirements
- The minimum hemoglobin or hematocrit required to perform a peripheral blood apheresis mononuclear cell collection for CAR-T therapy is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 5 suggests that maintaining hemoglobin or hematocrit values around 11 g/dl or 33%, respectively, is one part of therapeutic interventions to improve the chances of survival in critically ill patients.
- Study 6 discusses the "10/30" (hemoglobin/hematocrit) rule as a threshold for transfusion in the perioperative setting, but notes that this decision should be based on an assessment of the overall clinical picture presented by the patient.
- Study 3 found that hematocrit values decreased by 7% in adults and 9% in children during apheresis procedures, but does not provide a minimum threshold for hemoglobin or hematocrit levels.
Considerations for Apheresis Procedures
- Establishing and maintaining adequate vascular access is critical for a successful apheresis procedure 2.
- The use of intravascular access devices should be considered only after it is determined that peripheral access is not feasible or desirable 2.
- Continuous monitoring of hematocrit values during apheresis may be useful in managing the procedure and minimizing risks to the patient 3.