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Blood, Vol. 95 No. 9 (May 1), 2000:
pp. 2993-2994
CORRESPONDENCE
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To the Editor: |
Normal T, B, and NK cell counts in healthy donors at 1 year after
blood stem cell harvesting
In an excellent review on the complications of peripheral
blood stem cell harvesting from healthy donors,1 Anderlini
et al pointed out the lack of data on late side effects.
Lymphocytopenia (primarily T-lymphocytopenia) is a recognized
short-term side effect of the harvest,2,3 possibly due to
the large number of lymphocytes coharvested with the stem
cells.2,4,5 The duration of the postharvest lymphocytopenia
is unknown. Total white blood cell counts late after harvest appear
normal.6,7 We have evaluated lymphocyte subset counts and
monocyte counts prior to and at about 1 year after harvest in order to
determine whether T-lymphocytopenia might last for more than 1 year
after harvest.
Nine healthy donors (6 males and 3 females) who agreed to have blood
drawn at 1 year after harvest were studied at 391-468 days (median,
408) following harvest of filgrastim-mobilized blood stem cells. Donor
age was 17-63 years (median, 49). Seven of the donors were also studied
at baseline (premobilization). Filgrastim (16 µg/kg/d) was given on 5 consecutive days. The donors underwent 1 or 2 12-liter aphereses, using
Cobe Spectra (Lakewood, CO). For the enumeration of mononuclear cell
(MNC) subsets, blood cells were separated on a Ficoll density gradient
and MNCs were stained with fluorochrome-conjugated monoclonal
antibodies and analyzed by 3-color flow cytometry as
described.8,9 B cells were defined as MNCs expressing CD19
or CD20 and not expressing CD3, CD13, CD14, CD16, CD56, CD10 or CD34.
Total CD4 T cells were defined as
CD3+CD4+CD8 MNCs. Total CD8
T cells were defined as
CD3+CD4CD8+ MNCs. Naive T
cells (CD45RAhigh CD4 T cells10,11 and
CD11alow CD8 T cells12,13) were specifically
studied, as reconstitution of these cells may be extremely slow in
adults.11 Naive CD4 T cells were defined as MNCs expressing
CD4, brightly expressing CD45RA, and not expressing CD8, CD13, CD14, or
CD16. Naive CD8 T cells were defined as MNCs brightly expressing CD8,
dimly expressing CD11a, and not expressing CD4, CD13, CD14, CD16, or
CD19. NK cells were defined as MNCs expressing CD16 or CD56 and not
expressing CD3 or CD14, and monocytes were defined as CD14+
MNCs. Absolute MNC subset counts were calculated as the absolute MNC
count multiplied by the percent of the subset divided by 100. Absolute
MNC count was the sum of absolute lymphocyte count and absolute
monocyte count determined by a clinical hematology laboratory. Normal
values of the MNC subset counts were established using blood from 103 adult healthy volunteers.
As shown in the Figure, at about 1 year after harvest, B cell,
CD4CD8 T cell, CD4 T cell (both
total and naive), CD8 T cell (both total and naive), and NK cell counts
were not lower than in the same donors at baseline and not lower than
in the 103 normal adult volunteers. However, monocyte counts were lower
at about 1 year, compared either to the same donors at baseline
(P = .02, paired Wilcoxon signed rank test) or to the normal
adult volunteers (P = .01, Mann-Whitney rank sum test). We
have not documented that the count of each MNC subset was low in our
donors early postharvest. However, consistent with the published
data,2,3 our donors' MNC subset counts were probably low
early after harvest because their median MNC count at 7-14 days after
harvest (1.5 × 109/L) was significantly lower than
the median MNC count of the same donors at baseline (2.2 × 109/L, P = .047, paired Wilcoxon signed rank
test) and significantly lower than the median MNC count of the normal
adult volunteers (2.2 × 109/L, P = .006,
Mann-Whitney rank sum test). It was also significantly lower than the
median MNC count of the donors at about 1 year after harvest (2.2 × 109/L, P = .03, paired Wilcoxon signed
rank test). We cannot exclude that our donors' lymphocyte subset
counts returned to normal before 1 year after harvest.
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Mononuclear cell subset counts in the blood of blood stem cell
donors before and at about 1 year after harvest, showing that B, T, and
NK cell counts are not low but that monocyte counts may be low at about
1 year after harvest.
Each patient is represented by a specific symbol. Two of the 9 donors
were studied only at about 1 year and not before harvest
(gray diamond and gray circle). The thick horizontal lines
denote the normal "range" (10th-90th percentile of 103 adult
healthy volunteers).
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Our data suggest that quantitative deficiency of B, T, and NK cells is
not present late after harvest while mild monocytopenia of unclear
clinical significance may occur.
Jan Storek
Monja A. Dawson
David G. Maloney
Fred Hutchinson Cancer Research Center and University of
Washington, Seattle, WA
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Footnotes |
Supported by National Institutes of Health (USA) grants
no. CA68496 and AI46108.
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References |
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