From the Guidelines
The minimum hemoglobin required for peripheral blood apheresis mononuclear cell collection for CAR-T therapy is greater than 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 collection of sufficient mononuclear cells for CAR-T therapy while maintaining patient safety.
- The EBMT and EHA guidelines also recommend other pre-leukapheresis checks, including performance status, interval following exposure to chemotherapy, blood oxygen saturation, and standard electrolytes and renal function, to minimize the risk of complications during the procedure.
- Patients with hemoglobin levels below the recommended threshold may require red blood cell transfusion prior to the procedure to increase their hemoglobin to acceptable levels.
Hematocrit Considerations
- Although the guidelines do not specify a minimum hematocrit level, it is generally accepted that a hematocrit of at least 24% is required to ensure adequate blood viscosity and prevent complications during apheresis.
- However, the primary focus is on maintaining a hemoglobin level greater than 80 g/l, as recommended by the EBMT and EHA guidelines 1.
Clinical Implications
- The collection team should carefully evaluate each patient's individual needs and medical history to determine the best approach for peripheral blood apheresis mononuclear cell collection.
- By adhering to the recommended guidelines and considering individual patient factors, healthcare providers can minimize the risks associated with apheresis and ensure the successful collection of mononuclear cells for CAR-T therapy.
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 discusses the "10/30" (hemoglobin/hematocrit) rule, which has been recognized 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 6 examines the rate and timing of hemoglobin decline in cancer patients receiving chemotherapy, but does not provide a specific minimum hemoglobin or hematocrit requirement for apheresis procedures.
- Study 3 discusses the monitoring of hematocrit values during apheresis for allogeneic peripheral blood stem cell collection, but does not provide a specific minimum requirement.
- Study 4 reports on the performance of the Continuous Mononuclear Cell Collection protocol on the Spectra Optia Apheresis System, but does not provide information on minimum hemoglobin or hematocrit requirements.
Hematocrit and Hemoglobin Levels
- Study 3 found a marked contrast in hematocrit kinetics during apheresis in adult and pediatric donors, with a 7% decrease in hematocrit value in adults and a 9% decrease in children 3.
- Study 4 reports a cell product hematocrit of 2.4% in patients undergoing autologous peripheral blood stem cell collection using the Continuous Mononuclear Cell Collection protocol 4.
- Study 6 examines the rate and timing of hemoglobin decline in cancer patients receiving chemotherapy, with 40% of patients experiencing a decline from <10 g/dL to <9 g/dL at week 3 6.