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The Assessment of the Hematopoietic Reservoir After Immunosuppressive
Therapy or Bone Marrow Transplantation in Severe Aplastic Anemia
Marina Podestà,
Giovanna Piaggio,
Francesco Frassoni,
Anna Pitto,
Panagiotis Zikos,
Mario Sessarego,
Monica Abate,
Maria Teresa
Van Lint,
Giovanni Berisso, and
Andrea Bacigalupo
From Divisione Ematologia 2, Ospedale S. Martino, Genova, Italy; and
Laboratorio Citogenetica, DIMI, Università degli Studi, Genova,
Italy.
We investigated the hematopoietic reservoir in 43 severe aplastic
anemia (SAA) patients following immunosuppression (IS) (n = 15) or
bone marrow transplantation (BMT) (n = 28), at a median interval of
5 years (range, 2-20) from treatment. All patients had normal blood
counts, good marrow cellularity, and normal numbers of colony forming
unit-granulocyte macrophages (CFU-GM). Burst forming unit-erythroid (BFU-E) and colony forming unit-granulocyte erythroid megakaryocyte macrophages (CFU-GEMM) numbers were reduced when compared with normal
controls. However, the most pronounced defect was observed at the level
of long-term culture-initiating cells (LTC-IC), which significantly
differed from controls (P < .00001) both for IS and BMT
patients. Their number did not improve with time and was not affected
by transplant or treatment-related variables. When IS patients were
compared with BMT we found comparable numbers of CFU-GEMM
(P = .8) and LTC-IC (P = .9), but lower numbers
of BFU-E and CFU-GM (P = .05 and P = .004,
respectively), suggestive of a persistent suppressive mechanism. These
data indicate that LTC-IC numbers are severely reduced in BMT and IS
patients, contradicting the common belief that the former are fully
reconstituted as compared with the latter. In addition, the number of
mature cells and committed progenitors does not seem to reflect the
real size of the hematopoietic reservoir and few stem cells may be
sufficient to guarantee normal hematopoiesis long term.
Blood, Vol. 91 No. 6 (March 15), 1998:
pp. 1959-1965
© 1998 by The American Society of Hematology.
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