Challenges in Autologous Peripheral Blood Stem Cell Collection in a Patient With IgM Myeloma and Cryoglobulinaemia.

Cold agglutinins are well recognized to complicate stem cell harvests. There is recognition that in both the collection, the processing, and reinfusion of the stem cells to the patient, the product could be exposed to lower temperatures, and this could affect the cold agglutinins within. There is little published evidence on peripheral blood stem cell (PBSC) collection in patients with cryoglobulinaemia. We would like to present a gentleman who has IgM myeloma and Type 1 cryoglobulinaemia. The patient was young and fit, and the plan was to consolidate his induction chemotherapy with an autologous stem cell transplant (ASCT). We would like to discuss the challenges that we faced in this gentleman in trying to harvest stem cells to utilize for the purposes of performing an ASCT. These challenges occurred because of 1. progressive disease, causing an inevitable rise in cryoglobulin levels that prevented therapeutic plasma exchange and stem cell collection and 2. the myelosuppressive effects of the chemotherapeutic agent prohibiting an adequate stem cell dose required to proceed to transplant. We would like to describe the measures that we put in place in trying to collect PBSC in this patient, to utilize for the purposes of performing an ASCT.