Reticulocyte Parameters as Early Indicators of Hematopoietic Recovery after Bone marrow Transplantation

  • M. Tommasi
  • G. d’Onofrio
  • G. Zini
  • P. Salutari
  • S. Sica
  • G. Leone

Abstract

The evaluation of hematopoietic recovery after myeloablative chemotherapy in bone marrow transplant patients is based on sequential peripheral blood cell counting; particularly the absolute neutrophil count (ANC) >0,5xl09/l is the classical indicator of BM engraftment. The development of automated flow-cytometric analyzers has made available precise reticulocyte counts (RET) and the proportion of young, highly fluorescent reticulocytes (HFR) as accurate and early indices of haemopoietic recovery. We have studied 12 patients who received autologous PBSCT; peripheral blood mononuclear cells were collected after chemotherapy and rhG-CSF administration by repeated leukapheresis until a minimum of 4xl08 mononuclear cells. RET and percentage of HFR were obtained with the reticulocyte counter Sysmex-Toa R-1000. In our patients the three most useful indicators of BM recovery were HFR >5%, RET >20xl09/l and ANC >0,5xl09/l. Recovery of HFR >5% was obtained after a median time of 9 days, one day before recovery of RET and 4,5 days before recovery of ANC >0,5xl09/l; the rise of HFR fraction was the earliest sign of engraftment in 91,7% of our patients. In conclusion, these three parameters show an excellent predictive value close to 100% for monitoring of BMT engraftment in PBSCT.

Hematopoietic regeneration after myeloablative radiochemotherapy for bone marrow transplantation (BMT) is monitored by sequential peripheral blood cell counting. Until recently the earliest practical measure of the onset of recovery was absolute neutrophil count (ANC)1 Platelet count (PLT) is unreliable because of the many platelet transfusions given to most patients. Recent reports suggest that reticulocyte count (RET) performed by automated flow-cytometric methods is an early and accurate index of engraftment, especially if new indices which quantify the presence of young, highly fluorescent reticulocytes (HFR) are used.4,5,8,10,14 A great heterogeneity of threshold values exists in the literature as far as RET and reticulocyte subfractions are concerned, which makes the comparison of results obtained by different authors extremely difficult. Moreover, the transplant of stem cells collected by leukapheresis from peripheral blood (PBSCT) is characterized by very fast ANC and PLT recovery9,13,16, but RET and HFR have never been stdied in PBSCT patients.

The main objectives of our study were: 1) to define and compare the duration and characteristics of the hematopoietic suppression in PBSCT, in terms of peripheral blood cytopenia and supportive care requirements, in comparison with allo- and auto- BMT; 2) to determine the most suitable peripheral blood variables for the study of hematopoietic reconstitution; 3) to establish the clinical value of the selected variables in the monitoring of PBSCT patients.

Keywords

Depression Chrome Lymphoma Argon Sarcoma 

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References

  1. 1.
    Arnold R., Schmeiser T., Heith W. Frickhofen N., Pabst G. (1986) Hematopoietic reconstitution after bone marrow transplantation. Exp. Hematol. 14: 271–277PubMedGoogle Scholar
  2. 2.
    Beguin Y., Oris R., Fillet G. (1993) Dynamics of erythropoietic recovery following bone marrow transplantation: role of marrow proliferative capacity and erythropoietin production in autologous versus allogeneic transplants. Bone Marrow Transplant 11, 285 – 292PubMedGoogle Scholar
  3. 3.
    Bowen D., Bentley N., Hoy T., Cavili I. (1991) Comparison of a modified thiazole orange technique with a fully automated analyser for reticulocyte counting. J. Clin. Pathol. 44, 130 – 133PubMedCrossRefGoogle Scholar
  4. 4.
    Davies S.V., Cavili I., Bentley N., Fegan CD., Poynton C.H., Whittaker J.A. (1992) Evaluation of erythropoiesis after bone marrow transplantation: quantitative reticulocyte counting. Br. J. Haematol. 81, 12 – 17.PubMedCrossRefGoogle Scholar
  5. 5.
    Davis B.H., Bigelow N., Ball E.D., Mills L., Gibbons G.C. Ill (1989) Utility of flow cytometric reticulocyte quantification as a predictor of engraftment in autologous bone marrow transplantation. Am. J. Hematol. 32, 81 – 87.PubMedCrossRefGoogle Scholar
  6. 6.
    Davis B.H., DiCorato M., Bigelow N.C., Langweiler M.H. (1993) Proposal for standardization of flow cytometric reticulocyte maturity index (RMI) measurement. Cytometry 14, 318 – 36PubMedCrossRefGoogle Scholar
  7. 6.
    Davis B.H., DiCorato M., Bigelow N.C., Langweiler M.H. (1993) Proposal for standardization of flow cytometric reticulocyte maturity index (RMI) measurement. Cytometry 14, 318 – 36PubMedCrossRefGoogle Scholar
  8. 8.
    Greinix H.T., Linkesch W., Keil F. et al. (1994) Early detection of hematopoietic engraftment after bone marrow and peripheral blood stem cell transplantation by highly fluorescent reticulocyte counts. Bone Marrow Transplant 14, 307 – 313PubMedGoogle Scholar
  9. 9.
    Henon P.R., Liang H., Beck-Wirth G. et al. (1992). Comparison of hematopoietic and immune recovery after autologous bone marrow or blood stem cell transplants. Bone Marrow Transplant. 9, 285 – 291PubMedGoogle Scholar
  10. 10.
    Kanold J., Bezou M.J., Coulet M. et al. (1993) Evaluation of erythropoietic reconstitution after BMT by highly fluorescent reticulocyte counts compares favorably with traditional peripheral blood cell counting. Bone Marrow Transplant. 11, 313 – 318PubMedGoogle Scholar
  11. 11.
    Kuse R. (1993) The appearance of reticulocytes with medium or high RNA content is a sensitive indicator of beginning granulocyte recovery after aplasiogenic cytostatic drug therapy in patients with AML. Ann. Hematol. 66, 213 – 214PubMedCrossRefGoogle Scholar
  12. 12.
    Lazarus H.M., Chahine A., Lacerna K. et al. (1992) Kinetics of erythrogenesis after bone marrow transplantation. Am. J. Clin. Pathol. 97, 574 – 583PubMedGoogle Scholar
  13. 13.
    Pierelli L., Iacone A., Quaglietta A.M. et al. (1994) Haemopoietic reconstitution after autologous blood stem cell transplantation in patients with malignancies: a multicentre retrospective study. Br. J. Haematol. 86, 70 – 75PubMedCrossRefGoogle Scholar
  14. 14.
    Spanish Multicentric Study Group for Hematopoietic Recovery (1994). Fow cytometric reticulocyte quantification in the evaluation of hematologic recovery. Eur. J. Haematol. 53, 293 – 297Google Scholar
  15. 15.
    Tichelli A., Gratwohl A., Driessens A. et al. (1990) Evaluation of the Sysmex R-1000. An automated reticulocyte analyzer. Am. J. Clin. Pathol. 93, 70 – 78PubMedGoogle Scholar
  16. 16.
    To L.B., Roberts M.M., Haylock D.N. et al. (1992) Comparison of haematological recovery times and supportive care requirements for autologous recovery phase peripheral blood stem cell transplants, autologous bone marrow transplants and allogeneic bone marrow transplant. Bone Marrow Transplant. 9, 277–284PubMedGoogle Scholar

Copyright information

© Plenum Press, New york 1996

Authors and Affiliations

  • M. Tommasi
    • 1
  • G. d’Onofrio
    • 1
  • G. Zini
    • 1
  • P. Salutari
    • 1
  • S. Sica
    • 1
  • G. Leone
    • 1
  1. 1.Research Center for the Development and Clinical Evaluation of Automated Methods in Hematology Hematology ServiceUniversità Cattolica del Sacro Cuore-RomeItaly

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