Follow-up of leucocyte and reticulocyte counts for the prediction of early graft failure after non-HLA-identical BMT in children.
Allogeneic BMT using a non-genotypically HLA-identical donor may be curative for children suffering from lethal haematological diseases, who lack a genotypically HLA-identical donor. Unfortunately, graft failures are often seen, especially after T cell depletion of the graft. We studied whether untimely decreased counts of leucocytes and reticulocytes in peripheral blood might predict graft failure at an early stage. Fifty-five recipients of a non-genotypically HLA-identical BM graft were included in the study; data from these children were compared with those of 77 recipients of a genotypically HLA-identical BM graft. Time-related reference values of peripheral blood leucocyte and reticulocyte counts were established in graft recipients with proven donor-origin recovery after BMT. Graft failure after nonHLA-identical BMT was observed in 16 out of 55 children (29%) and after HLA-identical BMT in one out of 77 (1.3%). With respect to early graft failure, the predictive value of granulocyte numbers falling below the lower limit of the reference values and a rapid decline of reticulocyte numbers after their appearance in peripheral blood was 100% (95% confidence intervals of 83-100% and of 80-100%, respectively). Early immunosuppressive intervention was applied in six patients and was successful in three of them.
Gerritsen
E J
EJ
Department of Paediatrics, Leiden University Hospital, The Netherlands.
Stam
E D
ED
Van den Berg
H
H
Haraldsson
A
A
Van Tol
M J
MJ
Vossen
J M
JM
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000097:blood / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood* / Q000209:etiology*; D006680:HLA Antigens; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000097:blood / Q000628:therapy; D007958:Leukocyte Count; D017701:Reticulocyte Count; D013997:Time Factors; D014184:Transplantation, Homologous
D006680:HLA Antigens