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PubMed · 1687956

Bone marrow processing for transplantation.

E M Areman·R A Sacher
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Abstract

As indications for BMT increase, so do variations in bone marrow processing and manipulation techniques. Many centers have their own unique methods of mononuclear cell purification, concentration and storage. This is particularly evident in the processing of bone marrow for autologous BMT to allow dose intensification as salvage therapy for malignant disease. Unique procedures have been developed to maximize yields, concentrate mononuclear cells necessary for engraftment, and reduce the likelihood of GVH disease. Graft rejection and disease relapse still remain a problem in some of these "manipulated" marrows. Newer procedures may allow titration of the optimum numbers of immune reconstituting cells; however, at this time, these techniques are not precise and the balance between preventing GVH disease at the expense of graft failure or relapse may still jeopardize disease-free survival. Innovative purging techniques that include pharmacologic and immunologic methods, continue to evolve, necessitating standards for bone marrow processing that are flexible yet practical. Quality control and viability assays are essential to verify the biologic proliferative potential of progenitor cells capable of marrow reconstitution. Although no standards are yet established, all centers should have criteria to monitor the quality of the processed marrow. Blood banks and transfusion services are well versed in regulations governing processing, labeling, storage, and quality control of blood components. Bone marrow is the ultimate blood component, and it stands to reason that methods outlined in this article be integrated into transfusion medicine.

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Blood Component TransfusionBlood Transfusion, AutologousBone MarrowBone Marrow PurgingBone Marrow TransplantationHematopoietic Stem Cell TransplantationHematopoietic Stem CellsHumansLeukapheresisLymphocyte DepletionQuality Assurance, Health CareTissue PreservationTissue and Organ ProcurementTransplantation, AutologousTransplantation, HomologousJournal ArticleReview

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E M Areman, R A Sacher. 1991. Bone marrow processing for transplantation.. https://doi.org/10.1016/s0887-7963(91)70210-1

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PubMed1995

[The extent of transfusion-associated HIV infections in Switzerland until 1994: an updated estimate].

OBJECTIVE: The first report on transfusion-associated HIV infections was published in the USA in 1982. The first case reports in Switzerland were published in 1986. So far there has never been a methodologically sound answer to the question of how many persons were infected with HIV by receiving transfusions in Switzerland before the introduction of universal HIV blood donor screening. METHODS: The following available data sources were analyzed simultaneously: firstly, the results of the look-back study conducted in 1993, secondly, the reports of HIV infections and AIDS cases in the national surveillance system, and, thirdly, the claims for compensation for HIV-infected transfusion recipients and hemophiliacs. Two methodologically different and independent estimates were obtained. Firstly, the coverage of the look-back study was estimated, which made it possible to calculate the total number of documentable transfusion-associated HIV infections in Switzerland. Secondly, matching was performed on the cases in the look-back study and the reports in the national surveillance system. Applying formulas of capture-recapture designs provided a second estimate of the total number of documentable transfusion-associated HIV infections. The claims for compensation were used to corroborate the estimates obtained. RESULTS: The two methods produced almost identical figures which were corroborated by the number of claims for compensation. It is therefore estimated that 80 to 100 persons in Switzerland may have been diagnosed as having HIV infection because of transfusions in Switzerland in the years after 1980. The last five known infections occurred in 1986 (four) and, after termination of the look-back study, in 1994 (one). However, the estimate of 80 to 100 does not include individuals who were infected before 1986 and died soon--within weeks or a few months--after the transfusion without diagnosis of HIV infection being possible. CONCLUSION: This estimate of the total number of transfusion-associated HIV infections in Switzerland is approximately half earlier published ones. In addition, the present study will probably reduce the remaining uncertainties about the size of these iatrogenic HIV infections in the 1980s.

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