Allocord

Name: Allocord

Warnings

Included as part of the "PRECAUTIONS" Section

Overdose

Human Overdos Age Experience

There has been no experience with overdosage of HPC, Cord Blood, in human clinical trials. Single doses of ALLOCORD up to 67.0 x 107 TNC/kg have been administered. HPC, Cord Blood, prepared for infusion may contain dimethyl sulfoxide (DMSO). The maximum tolerated dose of DMSO has not been established, but it is customary not to exceed a DMSO dose of 1 gm/kg/day when given intravenously. Several cases of altered mental status and coma have been reported with higher doses of DMSO.

Management Of Overdose

For DMSO overdosage, general supportive care is indicated. The role of other interventions to treat DMSO overdosage has not been established.

Patient information

Discuss the following with patients receiving ALLOCORD:

  • Report immediately any signs and symptoms of acute infusion reactions, such as fever, chills, fatigue, breathing problems, dizziness, nausea, vomiting, headache, or muscle aches.
  • Report immediately any signs or symptoms suggestive of graft-vs.-host disease, including rash, diarrhea, or yellowing of the eyes.

Instructions For Preparation For Infusion

  1. Equipment, Reagents, And Supplies

    Equipment:
    Biologic safety cabinet
    Waterbath, 37°C
    Heat sealer
    Scale
    Automated cell counter
    Flow cytometer
    Microscope

    Reagents:
    25% Albumin (Human), USP
    Dextran 40 in Sodium Chloride Injection, USP or Dextran 40 in Dextrose Injection, USP

    Supplies:
    Sterile sealable zip lock bag
    Syringes - 1 mL, 3 mL, 5 mL, 30 mL, 60 mL
    18 gauge safety needles
    Blunt plastic cannulas
    Sterile syringe caps (dual end: male/female)
    Alcohol wipes
    Plasma transfer sets (2 inch tubing, female luer adapter) – included with product shipment
    Transfer packs – 150 mL, 300 mL
    Blood culture vials
    Blood culture device
    Hemostat
    2 mL cryovial

  2. Receipt Instructions

    ALLOCORD is shipped frozen in a steel canister that is contained in an insulating foam sleeve. ALLOCORD must be stored at or below -150 °C, either inside the container used for shipping (dryshipper) or in a liquid nitrogen (LN2)-cooled storage device at the Transplant Center (recommended).

    Upon receiving the shipment, perform the following steps:

    1. Confirm receipt of the shipment and the identity of the expected unit.
    2. Inspect the shipper for tampering or damage prior to opening.
    3. Weigh the shipper and document the weight on the Unit Receipt Form.
    4. Note the temperature displayed on the data logger and document the temperature on the Unit Receipt Form.
    5. Using cryoprotective gloves, remove the product from the canister and place in a reservoir with LN 2or in the vapor phase of aLN2 freezer.
    6. Carefully open the cassette. Inspect the integrity of the unit(s) received and document its conditions on the Unit Receipt Form.
    7. Confirm the identity of the cord blood unit. Include this check on the Unit Receipt Form.
    8. Store the product in an LN2 storage vessel that maintains a temperature below -150°C.
    9. Reserve the samples that accompany the unit as a DNA source for confirmatory testing or post engraftment studies:
      1. a segment remains on the unit; reserve it prior to thawing the unit
      2. an aliquot containing the material remaining from the red blood cell/plasma reduction
      3. an aliquot containing unmanipulated cord blood collected in Citrate Phosphate Dextrose (CPD)
      4. a spot card containing unmanipulated cord blood collected in CPD (in envelope)

      10. NOTE: Aside from the segment, ancillary samples are not intended to represent the cell count or potency of the cryopreserved product.

    10. Replace data logger temperature probe wire inside the inner dry shipper container if necessary, and reassemble the shipper for return.
    11. Fax the completed Unit Receipt Form to St. Louis Cord Blood Bank of the SSM Cardinal Glennon Children's Medical Center at 314-268-4186.

    NOTE: If there is any error or ambiguity with regard to the product documentation, close the canister and keep the product at LN2 temperature. Immediately advise the staff of the St. Louis Cord Blood Bank and the transplant physician. Do not proceed until the problem is resolved. If your LN2 storage tanks have no space to store the product in its canister and insulated sleeve, add LN2 to the St. Louis Cord Blood Bank dry-shipper to keep the product frozen until a completely satisfactory determination is made.

  3. Preparation
    1. Coordination with the clinical team
      1. Confirm the infusion time in advance, adjusting the start time for thaw so the unit is available for infusion when the recipient is ready.
      2. Consult with the clinicians about final product volume based on the recipient's weight and possible fluid restrictions.
    2. General Information
      1. Use aseptic technique in a biological safety cabinet for all processing steps, including all opencontainer processing and all spiking of container ports.
      2. Use only sterile materials when processing the cellular product.
      3. Record the manufacturer information, lot number and expiration date (if applicable) of all reagents and disposables.
      4. Prepare the water bath and verify that the temperature is 37°C.
    3. Prepare the reconstitution solution
      1. Combine 250 mL Dextran 40 and 50 mL 25% albumin in a 300 mL transfer pack. Clamp the tubing with a hemostat.
      2. Using appropriate sized syringes, withdraw the following and cap the syringes with blunt plastic cannula:
        1. 50 mL of reconstitution solution. If the total frozen volume (product + DMSO volume) exceeds the standard 50mL reconstitution solution, use a volume of reconstitution solution equal to the total frozen volume so the dilution ratio is at least 1:1
        2. 30 mL of reconstitution solution to be used as a container rinse for microbial culturing
    4. Obtain product
      1. Prepare a portable canister with LN2 using appropriate personal protective equipment (gloves, gowns, face shield).
      2. Product verification requires two members of the laboratory staff. With product and recipient files at hand, locate and remove the product from its location in the freezer, but maintaining in vapor phase. Expeditiously verify product identity, labeling, accuracy of information, and container integrity.
      3. Remove any segment attached to the unit, place into a 2 mL cryovial and store in either vapor or liquid phase of nitrogen (<-150°C).
      4. Immediately transfer the product from LN2 storage tank into the portable canister containing LN2.
  4. Procedure

    Reconstitution or simple dilution of ALLOCORD with dextran/human serum albumin (HSA) solution, using the Thawing and Diluting procedures described below, is recommended. The Alternate Procedure – Washing may be considered if the infusion volume and/or DMSO dose are contraindicated (>1 mL/kg).

    NOTE: Minimize the time from initiation of thaw to completion of infusion.

    Thawing:

    1. Verify the identity of the product being thawed.

    2. Remove the ALLOCORD unit from the cassette. Examine the cryobag for breaks or cracks.

    3. Carefully place the unit inside a sterile sealable zip-lock bag, and submerge in the 37°C water bath, keeping port(s) dry and above water.

    4. Document the thaw start time.
    5. To accelerate thawing, gently knead contents of bag.
      NOTE: Inspect for leaks ! If container integrity is observed to be compromised, position the cryobag and/or clamp with hemostats to prevent further escape of blood.
    6. When the contents of the cryobag become slushy, remove the bag from the 37°C water bath.

    7. Note the thaw stop time. Product expiration time is four hours from this step.
    8. Gently wipe the outside surface of the cryobag with alcohol, and place the cryobag into the biologic safety cabinet.
      DILUTING:
    9. Insert a plasma transfer set into the cryobag.
    10. Attach the syringe containing the 50mL reconstitution solution to the transfer set on the cryobag.
    11. Slowly introduce approximately half the volume of the reconstitution solution to the thawed product while mixing the fluids in the bag.

    12. Insert the spike of a correctly labeled appropriate volume capacity transfer pack into the second access port of the cryobag.
    13. Weigh the empty transfer pack to determine the tare weight of the bag.

    14. Drain the contents from the cryobag into transfer pack.

    15. Clamp the tubing between the bags with a hemostat.
    16. Add the remaining reconstitution solution to the cryobag.
    17. Mix well to rinse the cells from the bag and drain into transfer pack.
    18. Clamp the tubing between the bags.
    19. Weigh the transfer pack subtracting the tare weight to get product volume.
    20. Insert a transfer set into the product transfer pack.
    21. Aseptically attach a 3 mL syringe and aspirate a 1 mL aliquot for quality control testing.
    22. Deliver the 1mL testing aliquot into a labeled aliquot tube.
    23. Subtract the 1mL (testing aliquot) from product volume to determine infus ion volume. Record the infusion volume which will be used for calculating cell numbers.
    24. Heat seal the tubing between the cryobag and the transfer pack.
    25. Cut tubing at the seals and separate the bags.
      NOTE: At this point, it is approximately 30 minutes from infusion. Notify the clinical transplant team to pre-medicate the patient as ordered.
    26. Aseptically introduce the 30 mL of reconstitution solution from the syringe prepared in step 3.c.ii.2) into the (now empty) original product cryobag.
    27. Immediately transport the product to the clinical transplant site per the facility's SOP.

    Alternative Procedure - Washing:

    Perform steps a. through r. of the Thawing Procedure and Diluting Procedure as outlined above, then complete the following:

    1. Place the transfer pack into a sterile overwrap bag ready for centrifugation.
    2. Support bag in centrifuge bucket insert to prevent the formation of creases during centrifugation.

    3. Balance carriers and centrifuge at 650 x g (1500 rpm) for 20 minutes at 10°C (no brake).
    4. Carefully remove the transfer pack from the centrifuge into the biologic safety cabinet, placing the transfer pack into a plasma expresser.
    5. Using the original cryobag to collect the waste volume, express 75% of the volume of reconstitution solution originally added to the thawed product pre-centrifugation. Avoid accidental passage of cells with the supernatant.

    6. Allow the cells to rest for five minutes. Resuspend the sedimented cell pellet by gentle agitation.
    7. Obtain quality control samples as described in steps s. through aa. above.
  5. Quality Control:

    Perform quality control assays per transplant center policies and procedures using the aliquot of thawed product obtained in step u above. Recommended assays include:

    1. Nucleated Cell count
    2. Viability test
    3. Viable CD34+ cell count
    4. Colony Forming Unit
    5. Microbial cultures (aerobic, anaerobic and fungal)

    Calculations:

    Infusion TNC [x109] = (WBC/mL + NRBC/mL [x106]) x infusion 9 6 volume (mL)

    TNC dose [x107 /kg] = Infusion TNC [x109]
    Recipient wt (kg)

    Post-thaw TNC recovery [%] = TNC of thawed product [x109]
    TNC of original frozen product [x109]    		 x 100

    Total CD34+ cells [x106] = CD34+ cells/mL x dilution factor x 1000 mL x product volume (mL)

    CD34+ cell dose [x105/kg] = Absolute CD34+ cell cells (x106) ÷ Recipient weight (kg)

    Product RBC volume [mL] = product hematocrit x product volume (mL)

    RBC dose [mL/kg] = Product RBC volume [mL] ÷ Recipient weight (kg)

    Product CFU count [x105] = Colonies scored per 105NC x product TNC [x109]
    105

    CFU dose [x104/kg] = Product CFU count [x105] ÷ Recipient weight (kg)

  6. Contact Information

    SSM Cardinal Glennon Children's Medical Center
    St. Louis Cord Blood Bank (SLCBB)
    3662 Park Avenue
    St. Louis, MO 63110

    SLCBB Hours:     Monday-Friday, 7:00am – 5:00pm, Central Time

    SLCBB Phone Number:     314-268-2787 or 888-453-CORD (888-453-2673)

    SLCBB Fax Number:     314-268-4186

    After Hours Numbers:
    Director:     314-486-2488
    Distribution:     314-277-1638

Share
(web3)