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Safety and efficacy of autologous hemopoietic progenitor cell collection in tandem with hemodialysis in multiple myeloma with myeloma cast nephropathy

Authors

  • Robert Weinstein,

    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Division of Transfusion Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    4. Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Glen Kershaw,

    1. Hemodialysis Unit, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Division of Nephrology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Jeff Bailey,

    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Division of Transfusion Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Mindy Greene,

    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Vishesh Chhibber,

    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Division of Transfusion Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    4. Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Michelle Vauthrin,

    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Rajneesh Nath,

    1. Bone Marrow Transplant Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    2. Division of Hematology/Oncology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    3. Department of Medicine, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Eileen Galvin Karr

    Corresponding author
    1. Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
    • Correspondence to: Robert Weinstein, Division of Transfusion Medicine, UMass Memorial Medical Center, LA-113, 55 Lake Avenue North, Worcester, MA 01655-0002. E-mail: Robert.Weinstein@umassmemorial.org

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Abstract

Autologous hemopoietic progenitor cell (HPC) collection is the most frequent indication for an apheresis procedure in patients with multiple myeloma, up to 10% of whom may also require hemodialysis because of myeloma kidney. We investigated whether HPC collection could be performed in tandem with hemodialysis, to avoid extra outpatient visits for extracorporeal procedures, without compromising the efficacy of the hemodialysis, the HPC collection efficiency (CE) or patient safety. Four dialysis-dependent patients with multiple myeloma underwent 5 large volume leukapheresis HPC collections in tandem with hemodialysis. Under our protocol, all of the blood processed through the apheresis instrument was dialyzed against a standard calcium-rich bath prior to being returned to the patient, therefore no supplemental calcium was needed. No significant changes in pulse rate (P = 0.625) or mean arterial pressure (P = 0.188) were noted between the start and end of the procedures. The patients exhibited no signs or symptoms of hypocalcemia or other adverse effects. Calculated urea reduction ratios ranged between 62.5 and 73.9%, and HPC CE was between 53 and 84% for 4 of the 5 procedures, indicating that there was no compromise of either procedure when performed in tandem. Ionized calcium measured at the beginning, midpoint and end of every procedure did not change (P = 0.954). The two patients who proceeded to autologous HPC transplant engrafted on Days 11 and 10, respectively. We conclude that autologous HPC collection can safely be performed in tandem with hemodialysis without compromising the efficacy of dialysis, HPC CE, or patient safety. J. Clin. Apheresis 29:83–89, 2014. © 2013 Wiley Periodicals, Inc.

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