Erythrocyte antigen and reticulocyte engraftment after allogeneic hematopoietic stem cell transplantation

Abstract

Summary:The aim of this study was to study the usefulness of erythrocyte antigen (EA) measurement to study engraftment after allogeneic HSCT. In all, 31 consecutive patients receiving HLA-identical bone marrow (BM) (n ¼ 13) or peripheral blood stem cells (n ¼ 18) were investigated. Apart from the ABO group, 15 EAs representing six minor blood groups were followed by the simple tube agglutination technique. A total of 20 (64.5%) patients received ABOidentical, eight (25.8%) received ABO minor and three (9.7%) received ABO major mismatched grafts. In all, 29 patients were followed for a median of 12 (6-16) months; 65% of the patients expressed donor type EA 1 month and almost all did so 6 months after transplant. Reticulocyte engraftment was significantly shorter than EA engraftment (median 18 vs 35 days) (P ¼ 0.001). Patients who received PB stem cells showed significantly faster EA and reticulocyte engraftment than patients who received BM stem cells (P ¼ 0.038 and 0.025). ABO compatibility did not have an impact on reticulocyte and EA engraftment (P ¼ 0.4 and 0.55). The earliest donor type EA detected was from the Rh and Kidd system. These data suggest that EA and reticulocyte assays are useful in monitoring engraftment. 4 Flow cytometric analysis using monoclonal antibodies directed against blood group antigens enabled sensitive evaluation of dual RBC populations. 5 Our aim was to study a simple tube hemagglutination method for monitoring RBC repopulation following HSCT. In addition, we evaluated the disappearance of recipient-derived RBC antigens and appearance of donorderived antigens after transplantation, and correlated RBC antigen engraftment with reticulocyte counts after AHSCT. Patients and methods PatientsA total of 31 consecutive HSCT patients were studied. They consisted of 11 females and 20 males with a median age of 36 years (range 18-51). The underlying diseases were chronic myeloid leukemia in 18, acute leukemia in 11, severe aplastic anemia in one and renal cell carcinoma in one patient. In all, 13 of the patients received bone marrow (BM) and 18 received peripheral blood stem cells (PBSC) from their HLA-identical siblings. Eight of the patients received minor and three received major ABO-incompatible grafts. Table 1 shows the patient and donor characteristics. Transplantation procedureThe patients were conditioned by ablative cyclophosphamidebased regimens (81%) or fludarabine-based reduced intensity regimens. 6 All the patients received short-course methotrexate and cyclosporine for GVHD prophylaxis. All the donorrecipient pairs were CMV-seropositive. Recombinant human G-CSF was used until neutrophil engraftment after day þ 1 in BM group, but not in the PBSC. All the blood products were leucofiltered and irradiated. The pretransplant evaluation of the mismatched patient-donor pairs, the decision for erythrocyte and plasma depletion of the harvest and posttransplant transfusion policy were designed by our transplant center's transfusion medicine consultant (Dr Arslan), according to recently pu...

The significance of mixed chimaerism and cell lineage chimaerism monitoring in paediatric patients post haematopoietic stem cell transplant

“…Bader et al (2005) described it as a simple and accurate method for chimaerism testing 22 . Recipient‐ and donor‐derived red cells in peripheral blood can also be assessed by red cell agglutination in blood group antigen mismatched HSCTs 29 . However, this method has a low sensitivity with reactions being graded from weak to strong, not producing any actual quantifiable results.…”

“…22 Recipientand donor-derived red cells in peripheral blood can also be assessed by red cell agglutination in blood group antigen mismatched HSCTs. 29 However, this method has a low sensitivity with reactions being graded from weak to strong, not producing any actual quantifiable results. Both RCP and agglutination testing are limited to erythrocyte chimaerism only, making it suitable for red cell disorders.…”