Autologous Haematopoietic Stem Cell Harvest – Peripheral Blood and Bone Marrow
- Following the initial patient assessment, a decision will be made regarding the timing and nature of the stem cell harvest.
- Choices include autologous bone marrow and peripheral blood stem cells (PBSC).
- PBSC is the stem cell material of choice. Advantages of PBSC over marrow include more rapid haemopoietic engraftment, reduced supportive care costs, applicability to a greater number of patients, reduced potential for tumour contamination, and reduced morbidity for the donor.
- Depending on the individual patient, they may be managed as an inpatient on the Haematology, Oncology, or Paediatric wards.
Bone Marrow Harvests
The harvest material should preferably contain minimal or no contaminating residual disease.
- If the marrow has never been involved there is no reason to do a bone marrow examination pre harvest.
- If the marrow is almost certain to be involved, e.g., myeloma, then a bone marrow does not need to be repeated unless there is reason to suppose it has changed since the previous examination.
- In other patients, a bone marrow aspirate and trephine should be done if a significant time has elapsed since the previous examination, e.g., 1 to 2 months.
- All patients with cytopenias pre harvest need a bone marrow aspirate and trephine.
Peripheral Blood Stem Cell Harvests
In general follow the above advice for bone marrow harvests. Bone marrow examination is essential if cytopenias are present.
Note: Consider flow cytometry and cytogenetics in all patients who have a bone marrow performed in these circumstances.
- At the time of the harvest, patients must have adequate marrow function as defined by a neutrophil count of > 2.0 x 109/L, platelets of > 100 x 109/L and >25% marrow cellularity.
- Harvest material is assessed by total nucleated cell count/kg body weight and CD34 counts may also be recorded.
- PBSC harvests are assessed by MNC, CD34+ cells.
Note: If red cells are required two weeks prior to or during harvest they must be irradiated. Two units of blood must be cross-matched prior to a marrow harvest and be irradiated.
Topic Code: 9006
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