Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children34910.24287/1726-1708-2020-19-2-152-159ORIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИApheresis of peripheral blood stem cells in children with very low body weight: a single centre experienceАферез гемопоэтических стволовых клеток крови у детей с экстремально низкой массой тела, как это делаем мы: опыт НМИЦ ДГОИ им. Дмитрия Рогачеваhttps://orcid.org/0000-0003-4767-5382KurnikovaE. E.КурниковаЕ. Е.
Russian Federation

Hematologist Department of Pediatric Hematology, Oncology,

Russia, 117997, Moscow, Samory Mashela st., 1

врач-трансфузиолог отделения трансфузиологии, заготовки и процессинга гемопоэтических стволовых клеток,

117997, Москва, ГСП-7, ул. Саморы Машела, 1

elena.kurnikova@fccho-moscow.ruhttps://orcid.org/0000-0001-8264-2258KhaminI. G.ХаминИ. Г.
Russian Federation
https://orcid.org/0000-0002-7945-2565ShchukinV. V.ЩукинВ. В.
Russian Federation
https://orcid.org/0000-0002-3767-4477ShamanskayaT. V.ШаманскаяТ. В.
Russian Federation
https://orcid.org/0000-0002-6553-2505FadeevaM. S.ФадееваМ. С.
Russian Federation
https://orcid.org/0000-0002-6148-7209PershiD. E.ПершинД. Е.
Russian Federation
https://orcid.org/0000-0002-0231-1617TrakhtmanP. E.ТрахтманП. Е.
Russian Federation
Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian FederationФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава России020720201921521590207202002072020Copyright ©; 2020, «D. Rogachev NMRCPHOI»Copyright ©; 2020, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2020«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/349

Polychemotherapy, accompanied by autologous hematopoietic stem cell transplantation, can improve the results of long-term survival of patients with cancer and some non-cancer diseases. Mobilizing and collecting hematopoietic stem cells in children with very low body weight can be a difficult task. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. 19 children with extremely low body weight was included in the current study. The median age was 8 (5–14) months, the median of body weight 7.5 (5.8–8.8) kg. Apheresis was performed in an ICU, using sedative therapy and in compliance with the conditions for the prevention of anemia, hypovolemia, hypothermia. 19 hematopoietic stem cell apheresis were performed using the Spectra Optia MNC separator program. Mobilization of CD34+ cells was performed with filgrastim; three children were additionally given plerixaphor. All 19 hematopoietic stem cell apheresis were successful: the median of collected CD34+ cells was 18.7 × 106/kg (8.6– 60.6 × 106/kg), the median apheresis duration was 204 (161–351) min. Serious side effects during apheresis were not recorded, however, in 6 children (31%) we encountered difficulties in the process of installing central venous access. The collection of hematopoietic stem cells for the future high-dose chemotherapy with autologous hematopoietic stem cells is a feasible task even for very young children with extremely low body weight. Correct preparation for manipulation, taking into account all possible risk factors and technical features, can avoid serious complications.

Полихимиотерапия, сопровождающаяся аутологичной трансплантацией гемопоэтических стволовых клеток (ауто-ТГСК), способна улучшить результаты долгосрочной выживаемости пациентов с онкологическими и некоторыми неонкологическими заболеваниями. Осуществление мобилизации и сбора гемопоэтических стволовых клеток у детей с очень низкой массой тела может оказаться сложновыполнимой задачей. Данное исследование одобрено независимым этическим комитетом и утверждено решением ученого совета ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России. В исследование включены 19 детей с экстремально низкой массой тела. Медиана возраста составила 8 (5–14) мес, медиана массы тела – 7,5 (5,8–8,8) кг. Аферезы выполняли в условиях отделения реанимации и интенсивной терапии с применением седативных препаратов и с соблюдением условий профилактики анемии, гиповолемии, гипотермии. Было выполнено 19 аферезов гемопоэтических стволовых клеток с применением программы MNC сепаратора Spectra Optia. Проводили мобилизацию CD34+-клеток филграстимом, 3 детям дополнительно назначали плериксафор. Все 19 аферезов гемопоэтических стволовых клеток были успешны: медиана полученных доз клеток CD34+-клеток составила 18,7 × 106/кг (8,6– 60,6 × 106/кг), медиана продолжительности афереза – 204 (161–351) мин. Случаев развития серьезных побочных явлений во время афереза не зафиксировано, однако у 6 (31%) детей мы столкнулись со сложностями в процессе установки венозного доступа. Осуществление сбора гемопоэтических стволовых клеток для проведения в дальнейшем высокодозной химиотерапии с ауто-ТГСК является выполнимой задачей даже для очень маленьких детей с экстремально низкой массой тела. Правильная подготовка к манипуляции, учет всех возможных факторов риска и технических особенностей позволяют избежать серьезных осложнений.

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