{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:47Z","timestamp":1787721647020,"version":"build-2784847793"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Citrate anticoagulation during peripheral blood stem cell (PBSC) collection frequently causes hypocalcemia. Conventional fixed-ratio protocols frequently employ prophylactic calcium supplementation in many centers; however, they are associated with a high citrate burden and have been linked to platelet aggregation in some reports. This randomized controlled study evaluated a two-phase low-dose Acid Citrate Dextrose formula A (ACD-A) strategy designed to reduce hypocalcemia without compromising collection efficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive donors undergoing PBSC collection were randomly assigned to two groups. The Control group (n=22) received a blood-to-ACD-A ratio of 10-12:1 with prophylactic intravenous calcium. The Low ACD-A group (n=21) received initial loading phase at a ratio of 10-12:1 until 1 mL\/kg of ACD-A was infused, followed by maintenance at 25:1 without prophylactic calcium. The primary outcome was the incidence of hypocalcemia-related symptoms. Secondary outcomes included collection time, ACD-A intake, CD34+ cell yield, and platelet aggregation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of hypocalcemia-related symptoms was significantly lower in the Low ACD-A group than in the Control group (14% vs. 73%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0002). Collection time was shorter (170.8 vs. 199.3\u00a0min,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0029), and ACD-A intake was substantially reduced (6.10 vs. 12.96 mL\/kg,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.0001). No significant differences were observed in CD34+ cell yield, enrichment ratio, yield per liter processed, or changes in ionized calcium levels between groups. Mild platelet aggregation occurred less frequently in the Low ACD-A group (9.5% vs. 41%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0339).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A two-phase low-dose ACD-A strategy significantly reduces hypocalcemia-related symptoms, shortens collection time, and decreases platelet aggregation without compromising stem cell yield or product quality. This simple modification represents a meaningful improvement over conventional citrate protocols for PBSC collection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1909033","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:48:19Z","timestamp":1787719699000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A two-phase low-dose ACD-A strategy overcomes hypocalcemia during peripheral blood stem cell collection: a randomized controlled study"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhangbiao","family":"Long","sequence":"first","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutong","family":"Jin","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinghui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengfeng","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jifei","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglin","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingsheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Anhui Medical University","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beha.2023.101467","article-title":"Take a spin: Apheresis in the care of adult leukaemia patients","volume":"36","author":"Ai","year":"2023","journal-title":"Best Pract Res Clin Haematol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/tme.13144","article-title":"Apheresis procedures for the treatment of patients and for the collection of cellular therapy products: a British Society for Haematology guideline","volume":"35","author":"Howell","year":"2025","journal-title":"Transfusion Med (Oxford 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