FIELD OF THE DISCLOSURE
The present disclosure is directed to the processing of blood components in the course of an extracorporeal photopheresis treatment. More specifically, the present disclosure is directed to a disposable fluid circuit and its use in extracorporeal photopheresis wherein the circuit includes an integrated source of the photoactive agent, allowing for combining a pre-determined amount of the agent and the collected component with a reduced risk of operator error during such combining.
Whole blood can be separated into its constituent components (cellular or liquid), and the desired component can be separated so that it can be administered to a patient in need of that particular component. For example, mononuclear cells (MNCs), primarily lymphocytes and monocytes, can be removed from the whole blood of a patient, collected, and subjected to photodynamic therapy in a procedure commonly referred to as extracorporeal photopheresis, or ECP. In ECP, MNCs are treated with a photoactivate or photosensitizing agent (e.g., 8-methoxypsoralen (8-MOP)) and subsequently irradiated with specified wavelengths of light to achieve a desired effect, and returned to the patient for the treatment of various blood diseases to, e.g., eliminate immunogenicity in cells, inactivate or kill selected cells, inactivate viruses or bacteria, or activate desirable immune responses.
In one example of an ECP procedure, blood is withdrawn from the patient and the mononuclear cells are separated (typically by centrifugation) from the remainder of the other whole blood components. The separated mononuclear cells are combined with a selected dose of 8-MOP and subjected to light (typically UV-A) to activate the 8-MOP molecules. The light crosslinks 8-MOP to DNA strands inside the cell and on the cell wall of the exposed mononuclear cells, eventually causing cell apoptosis. The fluid with the altered mononuclear cells is reinfused back into the patient to induce an immune system response. The procedure is carried out using a disposable fluid circuit, i.e., a “kit,” that includes devices for accessing the vascular system of the patient (e.g., venipuncture needles), tubing that defines flow paths for conveying fluid to and from the patient to a separation chamber and a treatment container, and solution or storage containers. Examples of a photopheresis methods and systems of the type described above are set forth in U.S. Pat. No. 9,399,093 and U.S. Patent Application Publication No. US2014/0370491, the contents of both incorporated herein by reference in their entireties.
In order to achieve the desired apoptotic response in the MNC, the correct dosage of 8-MOP must be mixed with the collected MNCs. Current ECP systems are designed with target 8-MOP concentrations of approximately 100-400 ng/mL in the collected (and diluted) cells, which can be achieved using existing 8-MOP formulations provided at a concentration of 20 μg/mL in 10 mL glass vials. If a lower 8-MOP dosage were to be injected, the therapy may be less effective. On the other hand, if a higher 8-MOP dosage is administered, certain patient side effects related to 8-MOP, such as irritation to the skin and eyes due to exposure to sunlight (and the further potential for erythema, cataracts, or skin carcinoma resulting from such exposure to UVA light) may occur and may be severe.
In current ECP systems, the operator uses a syringe to inject the photoactive agent (e.g., 8-MOP) into the container that holds the collected MNCs. Thus, the responsibility to prepare and correctly inject the 8-MOP with the correct concentration and volume lies with the operator. The operator may likewise be responsible for the correct storage and correct aseptic techniques when drawing and injecting, as well as the proper disposal of the drug. If the wrong agent were added or too much of the agent were added, there may be risk to the patient, as described above. In the event of the wrong agent being added, the consequences of such administration could be significant and even catastrophic.
Accordingly, if the treating agent were already incorporated into the disposable fluid circuit, many of these risks can be mitigated and the tasks performed by the operator would also be facilitated. Incorporating a pre-determined dose of the photoactive agent and (preferably) allowing for automated opening of the flow paths between the container that holds the 8-MOP and a treatment container would ensure that the correct dosage of this drug is used and reduces the risk of bacterial contamination, particularly in already immune-suppressed patients (e.g. GVHD patients).
There are several aspects of the subject matter described herein. In one aspect, the subject matter of this disclosure is directed to a disposable fluid circuit for combined association with a cell separator and a separate irradiation device. The fluid circuit includes at least one patient access device for establishing flow communication with a patient, a separation chamber in openable fluid communication with the patient access device and a treatment container including walls made of a material that is transparent to light of a selected wavelength. Tubing defining a sterile flow path between the separation chamber and the treatment container is provided and includes a length sufficient to allow for placement of the separation chamber within the separator, and placement of the treatment container in the separate irradiation device. A container of photoactive agent is integral with the fluid circuit, the container having an outlet in openable flow communication with an outlet flow path that includes at least one frangible cannula for preventing flow of photoactive agent from the container of photoactive agent to the treatment container.
In another aspect, the subject matter of this disclosure is directed to a system for performing a therapeutic cellular treatment wherein the system includes a reusable separator unit for separating blood into blood components, a reusable irradiation unit for treating a separated blood component, a controller configured to effect the separation of blood into blood components, effect the conveying of the separated blood components through a disposable fluid circuit and, optionally, effect the treatment of a separated component. The system includes a disposable fluid circuit for combined association with the separator and the separate irradiation unit.
The fluid circuit includes one or more patient access devices for establishing flow communication with a patient, a separation chamber in openable fluid communication with the one or more patient access devices, a treatment container made of walls that are transparent to light of a selected wavelength and tubing defining a sterile flow path between the separation chamber and the treatment container. The flow path preferably has a length sufficient to allow for placement of the separation chamber within the separator and allow for placement of said treatment container in the separate irradiation device. A container of photoactive agent integral with the fluid circuit has an outlet in openable flow communication with an outlet flow path. A frangible cannula for preventing flow of photoactive agent from the treating agent container with a photoactive agent to said treatment container is included at the outlet or in the outlet flow path. The system may further include an automated cannula breaker configured to receive the cannula.
In a further aspect, the subject matter described herein is directed to a method for combining a treating agent with a collected blood component. The method includes mounting an integral disposable fluid circuit including one or more vascular access devices, a separation chamber, a treatment container and a container of a treating agent on a separator unit and an irradiation unit wherein the separation chamber is mounted within the separator unit and the treatment container is mounted within the irradiation unit. The method includes introducing whole blood into the separation chamber and separating whole blood into blood components wherein one of the blood components comprises mononuclear cells. The mononuclear cells are removed from the separation chamber and conveyed from the separation chamber to the treatment container. A flow path between the treating agent container and the treatment container is opened to combine the treating agent with the mononuclear cell product.
The present disclosure is directed to disposable fluid circuits, methods, and systems for the processing of mononuclear cells in an ECP treatment. The circuits, methods, and systems of the present disclosure are described in connection with particular apheresis and irradiation/illumination devices for purposes of exemplification only. It will be understood that the methods and systems described and claimed herein may be carried out and provided in combination with other apheresis and/or irradiation/illumination devices that will be known to those of skill in the art.
Turning now to the Figures,
As generally shown in
The separated target cell population, e.g., mononuclear cells with residual red blood cells and plasma, is then prepared for treatment and irradiation in reusable treatment component or irradiation unit 20. In accordance with the present disclosure, effective treatment of the mononuclear cells with ultraviolet light requires that the collected mononuclear cells be provided in a suspension having a suitable hematocrit, i.e., a certain (low) concentration of red blood cells. Specifically, the hematocrit level in the MNC suspension to be treated affects the amount of UV light that the MNC are exposed to as the red blood cells in the MNC suspension will block at least a portion the UV light from reaching the targeted MNCs. The hematocrit level of the MNC product to be treated may be adjusted by diluting the collected MNC product with plasma and/or saline, as described in U.S. Pat. No. 9,399,093 and U.S. Patent Application Publication No. US2014/0370491, both previously incorporated by reference.
Turning now, more specifically, to one embodiment of the reusable hardware units and disposable fluid circuit components of the system, devices/separators 10 useful in the collection (and washing) of mononuclear cells include the Amicus® Separator made and sold by Fresenius-Kabi USA, of Lake Zurich, Ill. Mononuclear cell collections using a device such as the Amicus® are described in greater detail in U.S. Pat. No. 6,027,657, previously incorporated by reference herein in its entirety.
Briefly,
With reference to
The system described herein may, optionally, further include one or more automated cannula breaker(s) 250, as shown in
As further seen in
Container 68 may also serve as the illumination container, and is preferably pre-attached to the disposable circuit 200. Alternatively, container 68 may be attached to set 200 by known sterile connection techniques, such as sterile docking or the like. With reference to
Container 68 is suitable for irradiation by light of a selected wavelength. By “suitable for irradiation” it is meant that the walls of the container are sufficiently transparent to light of the selected wavelength to activate the photoactive agent. In treatments using UVA light, for example, container walls made of ethylene vinyl acetate (EVA) are suitable. Accordingly, as indicated above, container 68 in which the mononuclear cells are collected may serve both as the collection container and the irradiation container. Container 68 may be placed inside irradiation unit 20 by the operator or, more preferably, may be placed inside the irradiation chamber of irradiation device 20 at the beginning of the ECP procedure and prior to whole blood withdrawal (as shown by the broken lines representing device 20 in
Fluid flow through fluid circuit 200 is preferably driven, controlled and adjusted by a microprocessor-based controller in cooperation with the valves, pumps, weight scales and sensors of device 10, the details of which are described in the previously mentioned U.S. Pat. No. 6,027,657. As described below, the controller is programmed to activate rotation of pumps (and control the rotational speed thereof), associated with cassettes 23L, 23M and 23R, open and close valves, receive output signals from sensors and detectors, such as the interface detection system described below, and preferably, to commence and control treatment of the MNC in irradiation unit 20.
As is also illustrated in
The at least one input 302 may include a number of different devices according to the embodiments described herein. For example, the input 302 could include a keyboard or keypad by which a user may provide information and/or instructions to the controller 300. Alternatively, the input 302 may be a touch screen, such as may be used in conjunction with a video display 308 (
The method of using the
The method of using disposable fluid circuit 200′ is generally set forth in
As described in connection with the earlier embodiments, breaking of frangible cannula 71′ may be manually performed by the operator or automatically by an automated cannula breaker 250, either by an operator-entered instruction or under the command of controller 300 once the system has sensed that MNCs are being removed from separation chamber 12. For example, where an automated cannula breaker is used, breakage may be prompted by the optical sensor sensing the MNCs traveling through a predetermined portion of the disposable fluid circuit flow path.
A further alternative embodiment of a disposable fluid circuit 200″ with an integrated treating agent container 69″ is shown in
There are additional aspects to the methods and systems described herein including, without limitation, the following aspects.
Aspect 1. A disposable fluid circuit for combined association with a cell separator and a separate irradiation device including: a patient access device for establishing flow communication with a patient; a cell separation chamber in openable fluid communication with said patient access device; a treatment container comprising walls made of a material that is transparent to light of a selected wavelength; tubing defining a sterile flow path between the separation chamber and the treatment container, the flow path having length sufficient to allow for placement of the separation chamber within the separator and allow for placement of the treatment container in the separate irradiation device; a container of photoactive agent integral with the circuit, the container having an outlet in openable flow communication with an outlet flow path; and a frangible cannula for preventing flow of photoactive agent from the container of photoactive agent to the treatment container.
Aspect 2. The disposable fluid circuit of Aspect 1 further including a frangible cannula for preventing flow to the container of photoactive agent.
Aspect 3. The disposable fluid circuit of Aspect 2 wherein at least one of the frangible cannulas is disposed in at least the inlet or outlet.
Aspect 4. The disposable fluid circuit of any one of Aspect 1 through 3 wherein the container of photoactive agent is located between the separation chamber and the treatment container.
Aspect 5. The disposable fluid circuit of any one of Aspect 1 through 3 further comprising a plasma container in openable flow communication with the separation chamber and the treatment container.
Aspect 6. The disposable fluid circuit of Aspect 5 wherein the container of photoactive agent is located between the separation chamber and the plasma container.
Aspect 7. The disposable fluid circuit of Aspect 6 including a frangible cannula located in a flow path between the container of photoactive agent and the separation chamber and a frangible cannula located in a flow path between the container of photoactive agent and the treatment chamber.
Aspect 8. The disposable fluid circuit of claim 6 including a frangible cannula located in a flow path between the plasma container of photoactive agent and a frangible cannula located in a flow path between the container of photoactive agent and the treatment container.
Aspect 9. A system for performing a therapeutic cellular treatment including: a reusable separator unit for separating blood into blood components; a reusable irradiation unit for treating a separated blood component; a controller configured to effect the separation of blood into blood components, effect the conveying of the separated blood components through a disposable fluid circuit and, optionally, to effect the treatment of the separated component; a disposable fluid circuit for combined association with a cell separator and a separate irradiation device comprising: a patient access device for establishing flow communication with a patient; a cell separator comprising a separation chamber in openable fluid communication with the patient access device; a treatment container comprising walls made of a material that is transparent to light of a selected wavelength; tubing defining a sterile flow path between the separation chamber and said treatment container the flow path having length sufficient to allow for placement of the separation chamber within the separator and allow for placement of the treatment container is the separate irradiation device; a container of photoactive agent integral with said circuit, the container having an outlet in openable flow communication with an outlet flow path; and a frangible cannula for preventing flow of photoactive agent from the container of photoactive agent to the treatment container, an automated cannula breaker configured to receive the cannula.
Aspect 10. The system of Aspect 9 wherein the disposable fluid circuit further includes a frangible cannula for preventing flow to the container of photoactive agent.
Aspect 11. The system of Aspect 10 wherein the automated cannula breaker is configured to receive both cannulas.
Aspect 12. The system of any one of Aspects 9 through 11 wherein the automated cannula breaker is carried by said reusable separator unit.
Aspect 13. The system of any one of Aspects 9 through 11 wherein the automated cannula breaker is carried by the reusable irradiation unit.
Aspect 14. The system of any one of Aspects 9 through 13 wherein the controller is configured to effect breaking of one or more cannulas when a pre-determined volume of a target blood component has been collected in the treatment container.
Aspect 15. A method for combining a treating agent with a collected blood component including: mounting an integral disposable fluid circuit comprising a one or more vascular access devices, a separation chamber, a treatment container and a container of a treating agent on a separator unit and an irradiation unit wherein the separation chamber is mounted within the separator unit and said treatment container is mounted within the irradiation unit; introducing whole blood into the separation chamber; separating whole blood into blood components wherein one of the blood components comprises mononuclear cells; removing said mononuclear cells from the separation chamber; conveying said mononuclear cells from the separation chamber to the treatment container; and opening a flow path between the treating agent container and the treatment container.
Aspect 16. The method of Aspect 15 comprising opening a flow path between the separation chamber and the treating agent container.
Aspect 17. The method of Aspect 15 wherein the disposable fluid circuit further comprises a plasma collection container and the method comprises separating a plasma component within the separation chamber and conveying the separated plasma to the plasma container.
Aspect 18. The method of Aspect 17 including opening a flow path between the plasma container and the treating agent container.
Aspect 19. The method of any one of Aspects 17 through 18 including pumping a selected volume of the plasma component from the plasma container to the treatment container through the treating agent container.
Aspect 20. The method of any one of Aspects 16 through 19 including opening the frangible cannulas simultaneously.
It will be understood that the embodiments and examples described above are illustrative of some of the applications or principles of the present subject matter. Numerous modifications may be made by those skilled in the art without departing from the spirit and scope of the claimed subject matter, including those combinations of features that are individually disclosed or claimed herein. For these reasons, the scope hereof is not limited to the above description but is as set forth in the following claims, and it is understood that the claims may be directed to the features thereof, including as combinations of features that are individually disclosed or claimed herein.
Number | Date | Country | |
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62397744 | Sep 2016 | US |