Elsevier

Transplantation Proceedings

Volume 43, Issue 1, January–February 2011, Pages 241-243
Transplantation Proceedings

Bone marrow transplantation
Predictive Value of Immature Reticulocyte and Platelet Fractions in Hematopoietic Recovery of Allograft Patients

https://doi.org/10.1016/j.transproceed.2010.12.030Get rights and content

Abstract

Hematopoietic progenitor cell transplantation is the treatment of choice for patients with malignant hematologic diseases. Neutrophil (NEUT) and platelet (PLT) counts are used to evaluate hematologic engraftment of transplanted patients. Recent-generation hematology analyzers offer an alternative way to evaluate immature peripheral blood (PB) cell fractions, which may also give an indication of hematopoietic recovery. The immature reticulocyte fraction (IRF) and immature platelet fraction (IPF) in PB samples may provide early indicators of transplant success. We evaluated the predictive value of IRF and IPF for the hematologic recovery of 46 adult patients undergoing allogeneic PB progenitor cell transplantation. We observed that IRF recovery anticipated by 4 days compared with NEUT recovery (11 vs 15 d) and IPF by 2 days compared with PLT (10 vs 12 d). The recovery was different for patients undergoing a nonmyeloablative regimen (NMA); we observed an early IRF recovery by 5 days compared with NEUT (10 vs 15 d) and a IPF compared with PLT recovery by 2 days (9 vs 11 d). We also observed significant correlations between NEUT and PLT recovery with recoveries of the new parameters IRF and IPF. We concluded that IRF and IPF predicted hematopoietic recovery. For allografted patients after NMA regimens, prediction was even more clinically relevant. These immature fractions open new perspectives for monitoring patient transfusion support through the posttransplantation recovery.

Section snippets

Patients

Between January 2008 and July 2009, we studied 46 adult patients with hematologic malignancies who underwent allogeneic PBPC transplant: 37 related and 9 unrelated grafts. The diagnoses were: acute leukemia (n = 18), chronic myeloid leukemia (n = 4), non-Hodgkin lymphoma (n = 6), multiple myeloma (n = 4), myelodysplasia (n = 6) and other malignancies (n = 8). The conditioning regimen was myeloablative in most cases (n = 29) versus nonmyeloablative (n = 17). All patients signed informed consent

Results

Preconditioning hematologic parameters were used for comparisons with values at days 0 and serially after transplantation (Fig 1). According to established protocols, on day 0 patients received 5.1 × 106 CD34+ cells/kg recipient (range, 1.9–7.3). On this day the median values of classic hematologic parameters were 2.7 × 109/L for leukocytes, 2.3 × 109/L for neutrophils, and 70 × 109/L for platelets. The kinetics of patient recovery was recorded during the hospitalization period (Fig 1).

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Discussion

Cellular immaturity fractions predicted the hematopoietic recovery of patients after PBPC transplantation. For allotransplanted patients after NMA regimens the prediction was even more noteworthy and clinically relevant.

Evaluation of these fractions could help with monitoring of patients' transfusional support throughout posttransplant recovery. Better management of blood components avoids alloimmunization and reduces costs. These immaturity fractions open new perspectives in patient follow-up

References (8)

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A.P. Gonçalo and I.L. Barbosa contributed equally to this work.

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