[28] CHAPTER XII LESSON 1 Flashcards
is “the administration of products with the intent of providing effector cells in the treatment of disease or support of other therapy.
Cellular therapy
This broad definition can apply to applications ranging from injecting cells with reparative potential into a damaged joint to engineering a person’s immune cells to kill cancer.
Cellular therapy
The most common cellular therapy encountered in blood banking and transfusion medicine relates to the [?] as part of a bone marrow or peripheral blood stem cell transplant.
transplantation of hematopoietic progenitor cells (HPCs)
o The first standards publication for cellular therapy was published in 1996.
AABB
o Accreditation is renewable every 2 years.
AABB
o Internationally, 21 countries hold accreditation for cellular therapy
AABB
was established in 1996 by the American Society for Blood and Marrow Transplantation (ASBMT) and the ISCT with their first edition of Standards published.
FACT
published standards that are described as evidence-based requirements for quality practice of cellular therapies.
FACT
Their accreditation cycle is 3 years.
FACT
o Transplant centers may be accredited under the guidance of international standards established by JACIE.
JACIE
o FACT collaborates with JACIE to develop and maintain standards for quality and medical laboratory practice in cellular therapies. o
JACIE
Accreditation is on a 4-year cycle with the first transplant center accredited in 2004.
JACIE
can be used for a wide variety of indications that include both malignant and nonmalignant disorders.
HPC transplantation
- use of one’s own HPCs for transplantation
- Autologous HPC transplantation
- HPC transplantation using HPCs from another individual
- Allogeneic HPC transplantation
- donor is an identical twin
- Syngeneic HPC transplantation
Nonmalignant disease processes can also be treated with [?] because donor HPCs can be selected that have the missing trait.
allogeneic HPC transplantation
Mismatches in HLA types between the donor and recipient can lead to failure of the allogeneic HPC to engraft or result in the donor cells recognizing the recipient as “foreign” and inducing a potentially lethal immune attack on the recipient, which is called
graft-versus-host disease (GVHD).
SOURCES OF HPC
collected from the placenta and umbilical cord at the time of delivery
- Umbilical cord blood (HPC-cord blood or HPC-C)
collections are performed under anesthesia in an operating room using sterile technique, using a needle to access the marrow space of the posterior iliac crest.
- Bone marrow (HPC-marrow or HPC-M)
collected employing apheresis technology that uses an automated device to process blood and collect peripherally circulating HPCs.
- Peripheral blood stem cells collected by apheresis (HPC-apheresis or HPC-A)
- nothing is done to the HPC product that could alter its relevant biological characteristics, which is to reconstitute bone marrow function.
Minimally manipulated
Examples of minimal manipulation include
sterilely sampling the product for microbial contamination or cell counts, volume reduction, washing, cryopreservation, and thawing.
Initial testing of the HPC product may consist of a
complete blood count, white blood cell (WBC) differential, CD34 enumeration, and viability studies.
are usually performed on automated instruments with the differential performed manually to confirm mononuclear cells that contain the HPCs
Cell counts
For allogeneic HPC transplantation, [?] can often be collected near the time of transplant to avoid cryopreservation, which is optimal because cryopreservation may result in increased cost and decreased yield.
HPC-apheresis and HPC-marrow products
are often collected and cryopreserved for infusion at a later date.
Autologous HPC-apheresis products and HPC-cord blood products
usually involves the addition of a cryoprotectant such as DMSO to the HPC product, followed by freezing in a controlled-rate freezer.
Cryopreservation
For cryopreserved HPC products, [?] is usually performed in a 37°C water bath with gentle kneading of the product and careful manipulation to prevent damage to the bag and potential loss of the product.
thawing
There are many different types of cellular therapies, with HPC transplantation the most commonly encountered by
transfusion services.
HPCs are derived from hematopoietic stem cells, express CD34 antigen, and can reconstitute the function of the
bone marrow.
HPCs can be obtained from cord blood, bone marrow aspirates, or the peripheral blood using
apheresis technology after pharmacological interventions.
HPCs can be collected from patients for self-use to recover bone marrow function after chemotherapy and/ or radiation in a process called
autologous HPC transplantation.
HPCs can be collected from donors and transplanted into patients to recover bone marrow function after chemotherapy and/or radiation in a process called
allogeneic HPC transplantation.
HPC products are highly regulated and undergo testing for safety, purity, and potency that includes
infectious disease testing, CD34 cell counts, viability, and sterility.
can be frozen and stored for later use.
HPCs
HPC products can be manipulated to reduce
contaminating RBCs, plasma, or the cryoprotectant DMSO.
HPC transplant recipients present unique challenges to the transfusion service. including
transfusiontransmitted infectious diseases, transfusion-associated graft-versus- host disease, ABO compatibility issues, passenger lymphocyte syndrome, and platelet refractoriness.
