Division of Hematology, University Hospital Basel, Switzerland.
Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland.
Transfusion. 2019 Mar;59(3):1052-1060. doi: 10.1111/trf.15107. Epub 2018 Dec 17.
CD34+ cell count correlates with engraftment potency after autologous stem cell transplantation. Assessment of CD34+ mainly occurs after apheresis and before cryopreservation with dimethyl sulfoxide (DMSO). The influence of postthaw CD34+ cell numbers over time to engraftment is not well studied, and determination of postthaw CD34+ cell counts is challenging for a variety of reasons. The aim of this retrospective study was to systematically assess the value of postthaw CD34+ cell counts in autologous grafts with and without DMSO removal.
Between January 2008 and December 2015, 236 adult patients underwent a total of 292 autologous stem cell transplantations. Median age at transplantation was 56 years, and the main indication was multiple myeloma (60%). DMSO removal was done in 96 grafts (33%), either by centrifugation or by Sepax method.
Patients receiving grafts containing DMSO showed a significantly faster platelet (p = 0.02) and RBC (p = 0.001) engraftment. DMSO removal was not associated with fewer infusion-related adverse events. We observed a good correlation between CD34+ cell count after apheresis and CD34+ cell count after thawing/washing (r = 0.931). Ninety grafts (31%) showed a significant loss of viable CD34+ cells, which translated into a delayed engraftment.
DMSO removal was associated with delayed platelet and RBC engraftment without preventing adverse events. CD34+ cell enumeration after thawing remains difficult to perform, but grafts showing higher cell loss during cryopreservation and thawing are associated with slower engraftment. Prospective studies on the role of DMSO removal and postthaw CD34+ enumeration using defined protocols are needed.
CD34+ 细胞计数与自体干细胞移植后的植入能力相关。CD34+ 的评估主要在单采后和用二甲基亚砜（DMSO）冷冻保存之前进行。冷冻保存后 CD34+ 细胞数量随时间推移对植入的影响尚未得到充分研究，并且由于各种原因，冷冻保存后 CD34+ 细胞计数的测定具有挑战性。本回顾性研究的目的是系统评估有和没有去除 DMSO 的自体移植物中冷冻保存后 CD34+ 细胞计数的价值。
2008 年 1 月至 2015 年 12 月期间，236 名成年患者共接受了 292 次自体干细胞移植。移植时的中位年龄为 56 岁，主要适应症为多发性骨髓瘤（60%）。在 96 个移植物（33%）中去除 DMSO，方法是离心或通过 Sepax 方法。
接受含有 DMSO 的移植物的患者血小板（p = 0.02）和红细胞（RBC）（p = 0.001）植入更快。去除 DMSO 与输注相关不良事件减少无关。我们观察到单采后 CD34+ 细胞计数与解冻/洗涤后 CD34+ 细胞计数之间存在良好的相关性（r = 0.931）。90 个移植物（31%）显示出有活力的 CD34+ 细胞的大量损失，这导致了植入延迟。
去除 DMSO 与血小板和 RBC 植入延迟有关，但不会预防不良事件。解冻后 CD34+ 细胞计数仍然难以进行，但冷冻保存和解冻过程中细胞丢失较多的移植物与植入延迟相关。需要使用定义的方案进行关于 DMSO 去除和解冻后 CD34+ 计数作用的前瞻性研究。
