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How to decrease bone marrow collection volume and risk contaminations via the operating room cell concentration?

Bone Marrow Transplantation volume 59, pages 711–713 (2024)Cite this article

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Hematopoietic stem cell transplantation remains the only curative treatment in several hematological disorders [1]. Bone marrow is the preferred source of cells in non-malignant hematological diseases such as aplastic anemia or sickle cell disease [2,3,4], as well as in the pediatric population and haploidentical grafts with myeloablative conditioning. As already demonstrated, bone marrow engraftment depends on the cell content of the graft. Bone marrow quantity and quality are therefore of critical importance [5, 6]. However, bone marrow yield is difficult to predict as it seems mainly dictated by donor characteristics (age, weight …) and depends on the experience and training of physicians [7].

Although there is an extensive literature on the bone marrow harvesting procedure, only few data are related to the prediction of the quantity of cells collected throughout the procedure. To improve the harvesting procedure and collect the requested number of cells, intra operative total nucleated cell (ioTNC) concentration measurement is classically performed [8]. However, practical contingencies and utility of the ioTNC are often questioned. During January 2017 to March 2022 at Saint-Louis Hospital, Paris, France, we investigated the impact of the different clinical and paraclinical elements (including the ioTNC concentration) on the TNC concentration of the graft on 83 donors with a median age of 35 [25.0–43.5]. Finally, as prolonged collection may risk donor complications, we investigated the impact of the number of bags collected on the final graft quantity and quality (each bag collecting 450 mL of graft). Patient, donor and graft characteristics are summarized in Supplemental Table 1. Data collected included: donor age, weight and height, donor blood volume; recipient age and weight; graft characteristics with: ioTNC concentration, graft volume, number of bags collected, graft TNC concentration and quantity, graft CD34+ cells concentration and quantity of viable CD45+/CD34+ cells. All statistical analysis were performed using StatAid software. Univariate and multivariate analysis were performed using a linear regression model; p-values were adjusted with the FDR (Benjamini-Hochberg) method.

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Fig. 1: Graft harvesting undergoes progressive hemodilution throughout the procedure with a contamination risk increasing with the number of collected bags.

Data availability

All data are available by request from the corresponding author.

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Acknowledgements

The authors would like to thank all cell therapy unit technician operators for all cell quantifications.

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Authors and Affiliations

  1. Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Saint-Louis Hospital, Cell Therapy Unit, Paris, France

    Yoann Grimaud, Aude Desnoyer, Jérôme Larghero, Justine Nasone & Lionel Faivre

  2. Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France

    Flore Sicre de Fontbrune, David Michonneau & Régis Peffault de Latour

  3. INSERM U976, Paris, France

    David Michonneau

  4. INSERM CICBT, Saint Louis Hospital, Paris, France

    Jérôme Larghero, Justine Nasone & Lionel Faivre

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  1. Yoann Grimaud
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Contributions

All authors read and approved the final manuscript. YG and LF wrote the manuscript. YG, AD, FSF, JN and LF conceived and planned the project and analysis. JL, DM, FSF, and RPL contributed to the revision of the manuscript. YG and LF performed data collection and analysed the data.

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Correspondence to Lionel Faivre.

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Grimaud, Y., Sicre de Fontbrune, F., Michonneau, D. et al. How to decrease bone marrow collection volume and risk contaminations via the operating room cell concentration?. Bone Marrow Transplant 59, 711–713 (2024). https://doi.org/10.1038/s41409-024-02253-y

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