Streamlining Apheresis: A Dual-Intervention Quality Improvement Initiative to Increase the Efficiency in Stem Cell Collection

Autologous stem cell transplantation (ASCT) requires efficient collection of peripheral blood stem cells. At London Health Sciences Centre (LHSC), patients are routinely booked for three-day apheresis collections leading to resource inefficiencies. Each extra day impacts patients, apheresis costs, staffing, and resources. The standard total blood volume (TBV) processed prior to the intervention was 3 times with the CD34 target for a single graft being 3 × 10^6 CD34 cells/kg, and double graft being 6 × 10^6 CD34 cells/kg. The aim statement was to identify Quality Improvement strategies to reduce apheresis procedures by 30% by March 4, 2025. Baseline data on 20 patients was collected. Ishikawa Fishbone Diagram (Figure 1) was used as a Root Cause Analysis (RCT) tool. Based on the RCT, higher CD34 cell target and less TBV processed were determined to be the primary root causes as change ideas for improvement. A quality improvement initiative was implemented to reduce unnecessary apheresis sessions through two interventions: (1) lowering CD34+ target thresholds (from 6 × 10⁶ to 5 × 10⁶ cells/kg for tandem collections and from 3 × 10⁶ to 2.5 × 10⁶ for single collections), and (2) increasing TBV processed from 3 × to 4 × for patients calculated to collect below target thresholds. Two Plan-Do-Study-Act (PDSA) cycles were conducted between March 2024 and March 2025 involving 76 patients. Outcome measures included collection days saved and cost savings, and post-transplant engraftment times served as a balancing measure. A total of 30 of 72 patients (39%) avoided at least one collection day due to these interventions. Third-day collection usage in high-risk myeloma patients decreased from 25% to 5.9%. Mean number of collection days reduced significantly in this group (2.21 to 1.8; p = 0.0015) (Figure 2), with total cost savings of CAD $72,734.97 (Figure 3). No significant differences were observed in neutrophil or platelet engraftment times, confirming maintained clinical efficacy. Two small changes at the level of the Apheresis Unit (reducing the CD34 collection targets and increasing TBV processed) had a sustainable impact in reducing Apheresis collection days, processing time, with overall cost reductions. This change has now become the standard process at our centre and such an approach may be of benefit at other centres.