Leukapheresis
Leukapheresis is a medical procedure that involves filtering whole blood to separate and remove white blood cells or stem cells. It is primarily used in the treatment of various hematological cancers, including different forms of leukemia, lymphoma, and myeloma. The procedure is vital for patients undergoing high-dose chemotherapy, as it helps restore the blood cell production that is often compromised during treatment. There are two main types of stem cell transplants associated with leukapheresis: autologous transplants, where patients donate their own cells, and allogeneic transplants, where cells are sourced from a donor.
Before the procedure, thorough preparation is needed, including blood tests to assess cell levels. The process typically occurs on an outpatient basis, utilizing a cell separator machine to extract the needed cells while returning the remaining blood to the donor. Following leukapheresis, donors may leave the clinic shortly after, while patients remain until their bone marrow is producing adequate blood cells. Although generally safe, leukapheresis does carry some risks, such as light-headedness, bleeding, and potential infections, which should be considered by patients and donors alike. Overall, leukapheresis plays a crucial role in supporting cancer treatments by enabling the infusion of healthy stem cells that aid in rebuilding the patient’s immune system.
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Subject Terms
Leukapheresis
ALSO KNOWN AS: Apheresis, (hem)apheresis
DEFINITION: Leukapheresis is a process of filtering whole blood to remove stem cells or white blood cells.
Cancers treated: Most forms of leukemia, lymphoma, and myeloma, including acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or chronic lymphocytic leukemia (CLL)
Why performed: Because high-dose chemotherapy destroys normal blood-producing stem cells in the bone marrow, these cells must be replaced to restore blood cell production. Stem cell transplantation is often performed to support high-dose chemotherapy as a treatment option for many forms of leukemia, lymphoma, and myeloma. This procedure, like Car T-cell therapy, is essential if cancer treatment requires healthy white blood cells.
Autologous transplant means that a patient donates their blood cells for reinfusion after chemotherapy. In allogeneic transplants, a donor supplies blood cells for infusion into another person. Both the recipient and donor receive leukapheresis.
Patient preparation: Donors and patients undergo a complete blood count to determine the number of platelets, red and white blood cells, and hemoglobin levels. The collection of stem cells and white blood cells is usually performed on an outpatient basis. For the treatment of some blood and lymphatic cancers, a donor may be injected for five days with a drug to stimulate the production and release of large numbers of stem cells and white blood cells from the marrow into the bloodstream.
Steps of the procedure: An intravenous catheter is inserted into the donor. Blood passes out of the patient and circulates through a cell separator machine. The fraction of the blood containing stem cells or white cells is separated via centrifugation from the blood, which is not required for the transplant. The latter blood fraction is then remixed and returned to the donor through the catheter. When a patient’s own stem cells are used, they may be frozen and stored until needed. Stem cells from a donor can be collected when needed.
After the procedure: Donors are generally free to leave the clinic afterward. Patients receiving treatment may leave after their marrow begins producing sufficient new blood cells and treatment complications have been addressed.
Risks: Patients may experience temporary light-headedness and numbness or tingling of the nose, lips, or fingers. Possible complications include bleeding at the needle site, clotting in blood vessels, and similar complications. Because the procedure involves skin penetration and open access to blood vessels, infection is a risk. Some experience anemia, thrombocytopenia, or hypocalcemia, meaning the patients have lower-than-normal red blood cells, platelets, or calcium in their blood, respectively.
Results: Stem cells infused into the bloodstream of a patient receiving chemotherapy will travel to the marrow of certain bones and stimulate the production of cells that eventually mature into healthy blood cells, replacing the normal cells lost during high-dose chemotherapy.
Bibliography
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