Improved peripheral blood stem cell collection following plasma exchange in a patient with elevated viscosity and coagulopathy

We report a case of improved CD34+ cell yields from peripheral blood stem cell (PBSC) collection following therapeutic plasma exchange (TPE) in a patient with elevated viscosity and coagulopathy. The patient was a 46-year-old male diagnosed with IgM lambda multiple myeloma that was largely unresponsive to standard chemotherapy. He had coagulopathy due to lymphoproliferative disease-associated acquired von Willebrand Factor (vWF) deficiency. The patient underwent two rounds of PBSC collections over 3 consecutive weeks (five total collections) prior to planned tandem transplant for multiple myeloma. Both rounds resulted in poor collections due to processing difficulties. It was decided to perform three TPEs daily immediately prior to attempting additional PBSC collections, to treat the patient's elevated viscosity and thereby potentially improve the efficiency of collections. Immediately following the three TPEs, two additional PBSC collections resulted in sufficient CD34+ cells to proceed to transplant. Lower IgM and/or viscosity levels present after the three TPEs likely permitted successful collection of stem cells.