BETA - What is apheresis? What happens in the apheresis room?

What is apheresis? What happens in the apheresis room? So apheresis just means a word that means that collecting something from the blood. So when a patient has to collect stem cells from their blood or in the case of CAR T cells, T cells from their blood, they go through apheresis. So when we collect stem cells or T cells, we call it leukophoresis because we're collecting white blood cells from the blood. So any patient with myeloma should actually be prepared for apheresis if they're going to have a stem cell transplant or if they're going to have CAR T cells made from their own immune cells or T cells. So apheresis is an important kind of marker or it's like something that you have to do if these highly advanced cellular therapies are going to be used in your case. For an apheresis, we use a machine called a cell sorter or a cell separator. It's a machine that collects blood from the veins into a chamber and then spins it around, centrifugation and then returns the blood back to you after centrifugation to another vein. So basically you have to have two veins that are punctured with needles and blood flow, good flow of blood from each one vein into the machine and then from the return blood comes back from the machine to the other vein. Sometimes it can be done with what we call a double lumen line. The machine itself separates the blood and using a laser, basically when the blood is spun in the machine or centrifuged in the machine, the white blood cells separate and move up to the top and then the white blood cells can be, the desired amount of white blood cells can be taken off with a laser which basically sucks out only the layer of blood that you need. You know, we can actually tune it to take plasma if you want from the same machine. You can take platelets off the blood. You can take white cells off the blood. So when we are collecting for stem cells, they are in the white blood compartment. When you are collecting for T cells, for CAR T, they are also in the white blood compartment. So in those cases, we just take the white cells off and the machine comes back. For peripheral blood stem cell transplantation or auto transplantation, you need a lot of cells because the number of stem cells in the blood is actually very low. Even if you use agents such as Neupogen or GCSF or Plerixaphor or Mozavel to boost the stem cells, even then the number of stem cells is very low. It's usually in the 5 to 10 percent even after using these medicines. In the resting states, it's actually even less than 1 percent. So you have to collect a lot of white cells to get the enough, the amount of stem cells that are enough for doing a transplant. So therefore the procedure can take sometimes two or three days and we always collect for more than one transplant, which is the ideal thing to do because these stem cells can come in handy later in the course of disease. Sometimes you do need it for a dual transplant. Sometimes you need it for a later second transplant. Sometimes you need it as a rainy day cell collection because you can use it if some treatment causes the bone marrow to get too suppressed. So in all these cases, I would advise that you need as many cells as you can collect in the first go, at least very minimum for two transplants. So it could take two or three days. In the case of CAR T cells, there are a lot of T cells in our blood typically, so the procedure itself is almost always just one day and most of the time it's about three hours or so. So it's actually a very light procedure. The most important complication I would think would be that a person has difficult venous access, which means that to get a good flow from a vein, it's very difficult in that person. So they may need a venipuncture or a tube going into a big blood vessel in the neck, which then goes down into another bigger blood vessel in the chest. And that again is a temporary thing. You can get that tube taken out the day after the collection is complete. So typically for T cells, the same day, and for stem cells, two or three days from keeping that tube in. That would be the single most annoying thing about this. The second most annoying thing is that you need to stay still and find some entertainment while this is all going on. The third thing is that sometimes it can drop your blood counts a little bit. Sometimes it can take out calcium from the blood and cause some problems because the blood needs to be kept in a non-clotting situation. So for that they add a chemical that can take out the calcium. So that is another complication that can happen. But these are all relatively minor complications. You can take some Tums or get some IV calcium and the calcium problem is immediately fixed. So these are some of the complications. But this is an important thing to do. The need for apheresis should by itself not deter anyone from pursuing a stem cell transplant or a CAR T procedure.