ABSTRACT Therapeutic plasma exchange (TPE) is a costly procedure and is commonly used as an effective treatment modality for a range of life‐threatening neurological, hematological, and autoimmune disorders. In this study, both the clinical and economic aspects of TPE were evaluated in hospitalized patients at a tertiary teaching hospital. This cost‐consequence analysis was conducted for 246 patients who received TPE during the hospitalization course. Data were extracted from patients' medical records and the hospital information system. Indications were categorized according to the ASFA 2023 guideline, which classifies indications from Category I to IV based on the strength of supporting evidence. Direct medical costs were estimated using a micro‐costing approach. A binary outcome measure was applied. A favorable outcome was defined as partial or complete recovery, and an unfavorable outcome as no recovery or death. Neurologic disorders and TTP were the predominant indications, with most procedures undertaken for ASFA Category I‐II indications. The median direct cost was 987 million IRR (USD 3464) per patient and 197 million IRR (USD 690) per session, with albumin and apheresis sets together contributing more than three‐quarters of total expenditure. Costs were greater among patients who achieved a favorable clinical outcome. Adverse events were infrequent. TPE is an effective and costly intervention. Optimizing resource utilization may reduce the economic burden, particularly in resource‐limited settings. These findings can inform future planning, cost‐effectiveness and cost‐minimization analyses, managerial decision‐making, and optimization of clinical protocols in line with the ASFA 2023 guideline.
ABSTRACT Autologous peripheral blood stem cell (APBSC) collection is a standard procedure for patients with multiple myeloma (MM) undergoing hematopoietic stem cell transplantation. Hypokalemia is a frequently observed but underappreciated complication during apheresis, with limited evidence on its incidence and risk factors. To determine the incidence of hypokalemia following APBSC collection in MM patients and to identify independent risk factors. This retrospective cohort study consecutively enrolled 109 MM patients who underwent their first APBSC collection at Union Hospital, Fujian Medical University, between January 2018 and December 2022. All patients received prophylactic potassium supplementation during collection. Patients were stratified by serum potassium measured 2 h postprocedure: hypokalemia (< 3.5 mmol/L; n = 59) and normokalemia (3.5–5.0 mmol/L; n = 50). Variables with p < 0.10 in univariate analysis were entered into multivariable logistic regression with backward elimination. Post‐APBSC serum potassium was significantly lower than baseline (3.46 ± 0.43 vs. 3.85 ± 0.22 mmol/L; p < 0.001). Hypokalemia developed in 59 patients (54.1%): 48 mild (81.4%), nine moderate (15.3%), and two severe (3.4%). Three independent predictors were identified by multivariable analysis: higher body mass index (BMI) (OR 1.217; 95% CI 1.030–1.439; p = 0.021), higher hematocrit (OR 1.119; 95% CI 1.032–1.213; p = 0.006), and lower preprocedure serum potassium (OR 1.43 per 0.1 mmol/L decrease; 95% CI 1.15–1.78; p = 0.001). The model demonstrated adequate calibration (Hosmer–Lemeshow p = 0.635) and explained 24.6% of variance (Nagelkerke R 2 = 0.246). Hypokalemia affects over half of MM patients undergoing APBSC collection. Preprocedure risk factors (BMI, hematocrit, baseline potassium) may help identify high‐risk patients for whom intensified electrolyte monitoring and individualized supplementation strategies are warranted.
ABSTRACT Hematopoietic stem cell transplantation is a standard treatment for hematologic malignancies, and peripheral blood stem cell (PBSC) collection by leukapheresis is the preferred harvesting method. Platelet loss is a common procedure‐related complication. This study compared platelet loss and product characteristics between two PBSC apheresis systems and evaluated the pre‐collection platelet baseline needed to avoid procedure‐related thrombocytopenia. This retrospective cohort study was conducted at a tertiary care hospital from March 2024 to October 2025. We reviewed 158 autologous PBSC collections in 110 patients using Spectra Optia in continuous mononuclear cell mode and 63 collections in 55 patients using Amicus in Mononuclear Cell mode. Platelet loss, hemoglobin, hematocrit, white blood cell count, granulocyte percentage, and CD34 + product characteristics were evaluated. Platelet loss was lower with Amicus than with Spectra Optia (median [IQR] 19.28% [10.94%–31.43%] vs. 33.33% [24.40%–42.50%]; p < 0.001). Spectra Optia had higher collection efficiency (48.30% [37.03%–63.64%] vs. 37.23% [27.26%–48.58%]; p < 0.001), higher product volume (257 [238–283] vs. 177 [155–202] mL; p < 0.001), and higher platelet concentration (515 [390–680] vs. 340 [240–480] × 10 3 /μL; p < 0.001). A pre‐collection platelet threshold of 35 000/μL was proposed to maintain post‐collection counts ≥ 20 000/μL. Both systems were effective for autologous PBSC collection. Spectra Optia provided higher collection efficiency, whereas Amicus was associated with lower platelet loss. Appropriate pre‐apheresis assessment of CD34 + cells and platelet count may help optimize collection and reduce procedure‐related thrombocytopenia.
ABSTRACT Immune checkpoint inhibitors (ICIs) have revolutionized the management of patients with cancer. However, they can induce breakdowns in immunologic tolerance, leading to autoimmune diseases, or immune related adverse events (irAEs). These irAEs can sometimes be life threatening, requiring aggressive management, such as immunosuppressant (IS) or even therapeutic apheresis (TA). TA, an extracorporeal circulation technique, may represent a therapeutic option for severe irAEs, reducing their severity and duration by removing ICIs, pathogenic antibodies or inflammatory cytokines, although its role in this situation remains underreported. We made scoping review to better identify the use of TA for managing severe irAEs. From January 2022 to August 2025, three databases were reviewed, for articles mentioning the use of TA in the event of immunotoxicity. Only case reports or case series were retained. A descriptive summary was produced in table forms. Between 2022 and 2025, 162 articles were identified, 34 articles concerning 42 patients treated for severe irAE via TA were included. The underlying cancers were mainly non‐small cell lung cancer and melanoma, and 78% of patients were treated with monotherapy anti‐PD(L)1. The main indications for TA were neurological (40.6%), overlap manifestations (23.8%), and hepatitis (21.4%), mainly highly severe. TA was most often used in rescue situations, that is, after failure of several lines of IS. Complications of TA were rare. Clinical improvement was reported in most patients, usually within days of TA, with 24% complete resolution, and 45% partial resolution. Despite revolutionizing cancer treatment, ICIs induce severe irAEs, with poorly defined therapeutic options. TA may be a therapeutic option for life threatening irAEs, with data in the literature assuming its effectiveness. However, details on its use remain poorly defined. Further studies are required to emphasize its use as in irAEs.
Lipoprotein apheresis is an adjunctive treatment for severe peripheral artery disease (PAD) and is a Category II indication for peripheral vascular diseases in the American Society for Apheresis guidelines. Rheocarna, a direct hemoperfusion adsorption device used in Japan for severe PAD and chronic limb-threatening ischemia (CLTI), is designed to remove LDL cholesterol (LDL-C) and fibrinogen (Fib). Device performance is often summarized by pre-/post-treatment values or a single-point extraction ratio (ER), which may not capture time-dependent changes in adsorption efficiency. We therefore characterized serial ER profiles during Rheocarna treatment in maintenance hemodialysis patients with severe CLTI (5 patients, 10 sessions) and in a closed-loop ex vivo system using pooled plasma. Inlet and outlet samples were obtained serially, and ER was calculated as (C-in - C-out)/C-in & times; 100. In clinical sessions, median LDL-C ER declined from 73.7% (IQR 70.9-76.2) at baseline to 12.3% (10.3-14.6) at 60 min and 5.2% (3.1-8.2) at 120 min (p < 0.0001). Fib ER similarly declined from 63.3% (59.9-69.9) at baseline to 7.9% (6.2-10.1) at 60 min and 6.5% (5.1-7.5) at 120 min (p < 0.0001). In the ex vivo system, LDL-C ER also decreased over time (p = 0.0274), whereas Fib ER showed a more variable pattern (p = 0.1877). These findings show that extraction efficiency changes substantially during a treatment session and may not be fully captured by a single-point ER. Serial ER profiling may provide a more detailed assessment of the time-dependent performance of adsorption-based apheresis devices.
