Today we will be discussing allogeneic hematopoietic stem cell (or HSC) grafts, which are often used to treat patients with malignant and benign hematologic disorders. Grafts are often collected from unrelated HLA matched donors since related donors are rarely available. Transportation time and storage conditions are known to affect graft outcomes, but a recent article in Transfusion investigated how the quality of the graft affects clinical outcomes.
Here is Dr. Schwartz, who wrote an editorial on the subject:
“Watz et al studied the impact of graft quality, as defined by post-thaw total nucleated cells viability of a cryopreserved peripheral blood stem cell aliquot, on the clinical outcomes after allogeneic stem cell transplantation. Post-thaw total nucleated cell viability represent quote unquote “stress test” for the pre-freeze integrity and quality of the grafts.”
Dr. Watz, Dr. Uhlin and their colleagues evaluated clinical outcomes in 144 HSC transplant patients. Seventy-six patients with good cell viability above the median were compared to 68 patients who received inferior grafts with cell viability below the median.
Dr. Uhlin summarizes the results:
“Patients receiving PBSCs (peripheral blood stem cells) with inferior quality more frequently developed acute graft-versus-host disease than patients receiving grafts with better quality. No correlation could be observed when comparing the viability in newly arrived PBSC grafts to those that were frozen-thawed.”
The study team found that mortality was higher in the group with inferior grafts. Furthermore, higher concentrations of cells including white blood cells, platelets, CD34+ cells and CD3+ cells were found in grafts with poor quality which may point to a general exhaustive effect on nutrients and a decrease in pH during transport.
Dr. Uhlin adds:
“There is a need for better analysis for assessing graft quality in routine HSCT (hematopoietic stem cell transplantation). Analysis using necrosis markers on fresh PBSC grafts in not sufficient. Further studies are needed to optimize conditions for graft storage and handling and for better analyses to assess graft quality in routine transplantation care.”
We’ll be back with another edition of Transfusion News on October 30th. Thanks for joining us.
- Tanhehco YC, Schwartz J and Linenberger ML. Defining the quality of hematopoietic stem cell products: the devil is in the details. Transfusion 2015;55: 2300–2303.
- Watz E, Remberger M, Ringden O, Ljungman P, Sundin M, Mattsson J, Uhlin M. Quality of the hematopoietic stem cell graft affects the clinical outcome of allogeneic stem cell transplantation. Transfusion 2015;55:2339–2350.