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Risk analysis of fluctuating hypercalcemia after leukapheresis in cellular therapy

Jo, Tomoyasu Arai, Yasuyuki Kitawaki, Toshio Nishikori, Momoko Mizumoto, Chisaki Kanda, Junya Yamashita, Kouhei Nagao, Miki Takaori-Kondo, Akifumi 京都大学 DOI:10.1038/s41598-023-42159-1

2023.09.11

概要

Optimized management of citrate-induced hypocalcemia is required to provide safe leukapheresis. We prospectively analyzed subjects who underwent leukapheresis for cytotherapy, and evaluated serum ionized (iCa) concentrations before, at the end of, and 1 h after leukapheresis. During leukapheresis, calcium gluconate solution was continuously supplemented intravenously with hourly measurement of iCa. 76 patients including 49 lymphapheresis for chimeric antigen receptor T-cell therapy and 27 stem cell collections were enrolled. Median processing blood volume was 10 L (range, 6–15 L). Fluctuating hypercalcemia, in which the iCa concentration rose above its upper limit 1 h after leukapheresis, was observed in 58 subjects (76.3%). Multivariate analysis revealed that higher ratios of processing blood volume to body weight, more rapid calcium supplementation, and lower iCa concentration at the end of leukapheresis significantly increased elevation of serum iCa concentration by 1 h after leukapheresis. Based on multivariate analyses, we developed a formula and a diagram that accurately estimates serum iCa concentration 1 h post-leukapheresis. This suggests optimal targets for iCa concentration and calcium supplementation rates. In cases with high ratios of processing blood volume to body weight, slowing the rate of blood processing, rather than increasing calcium supplementation should safely alleviate hypocalcemia during leukapheresis without inducing hypercalcemia thereafter.

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Acknowledgements

We are grateful to Dr. Shinya Yamamoto (Department of Nephrology, Graduate School of Medicine, Kyoto

University) and Ms. Asuka Hada (Department of Human Health Sciences, Graduate School of Medicine, Kyoto

University) for helpful discussion, and to clinical engineers and nurses at the leukapheresis sites, transplant

coordinators, and all clinicians in Kyoto University Hospital for their support, as well as patients who contributed

to this research. This work was supported, in part, by the Program for Development of Next-generation Leading

Scientists with Global Insight (L-INSIGHT), sponsored by the Ministry of Education, Culture, Sports, Science

and Technology (MEXT), Japan to YA.

Author contributions

T.J. and Y.A. designed the study, reviewed, and analyzed data. T.J. and Y.A. wrote the paper; T.K., M.N., C.M.,

J.K., K.Y., M.N., and A.T.-K. interpreted data and revised the manuscript. All authors critiqued the manuscript.

Competing interests The authors declare no competing interests.

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Supplementary Information The online version contains supplementary material available at https://​doi.​org/​

10.​1038/​s41598-​023-​42159-1.

Correspondence and requests for materials should be addressed to Y.A.

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