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Whitby A, Whitby L, Fletcher M, Reilly JT, Sutherland DR, Keeney M, Barnett D. ISHAGE protocol: are we doing it correctly? CYTOMETRY PART B-CLINICAL CYTOMETRY 2011; 82:9-17. [PMID: 21915992 DOI: 10.1002/cyto.b.20612] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/06/2011] [Accepted: 07/08/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Flow cytometric CD34(+) stem cell enumeration is routinely performed to optimize timing of peripheral blood stem cell collections and assess engraftment capability of the apheresis product. While a number of different flow methodologies have been described, the highly standardized ISHAGE protocol is currently the most widely employed, with 204/255 (81%) international participants in the UK NEQAS CD34(+) stem cell enumeration program indicating their use of this method. Recently, two laboratories were identified as persistent poor performers, a fact attributed to incorrect ISHAGE protocol usage/setup. This prompted UK NEQAS to question whether other laboratories were making similar errors and, if so, how this might affect individual EQA performance. METHODS AND RESULTS In send out 0801, where two stabilized samples were issued, the EQA center surveyed 255 participants with flow analysis data and subsequent results collected. One hundred and ninety-six laboratories returned results with 103 returning dot plots. Eighty-three out of one hundred and three stated that they used the ISHAGE protocol gating strategy but 43% (36/83) were incorrectly set-up. Analysis of the data showed those incorrectly using single platform ISHAGE gating strategy were twice as likely to fail an EQA exercise compared to those using the protocol correctly. This failure rate increased two fold when incorrect ISHAGE protocol was used in a dual platform setting. CONCLUSION This study suggests a widespread fundamental lack of understanding of the ISHAGE protocol and the need to deploy it correctly, potentially having significant clinical implications and highlights the need to monitor participants rigorously in their deployment of the ISHAGE protocol. It is hoped that once these findings have been disseminated, performance can be improved.
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Affiliation(s)
- Alison Whitby
- UK NEQAS for Leucocyte Immunophenotyping, Department of Haematology, Royal Hallamshire Hospital, Sheffield S10 2QN
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2
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Fritsch G, Witt V, Dubovsky J, Matthes S, Peters C, Buchinger P, Printz D, Handgretinger R, Lion T, Gadner H. Flow cytometric monitoring of hematopoietic reconstitution in myeloablated patients following allogeneic transplantation. Cytotherapy 2010; 1:295-309. [PMID: 20426555 DOI: 10.1080/0032472031000141265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We report a routine flow cytometric (FACS) approach to quantify circulating leukocytes (NC) in myeloablated patients before and during regeneration after allogeneic transplantation of either whole bone marrow (BM) or of highly purified (> 99%) blood-derived CD34(+) cells (PBSC). METHODS Blood samples were analyzed daily between infusion of the transplant and hematopoietic reconstitution. Significant differences in the composition of NC types and CD34(+) cells were observed between the two CD34 sources. The detection threshold for NC was roughly 1 cell per w L blood. RESULTS The cell nadir of < 100 NC/ microL was reached on Day +4 (BM) and on day 0 (PBSC), when unusual CD34(+) cells of recipient genotype were detected in all patients. They were not clonogenic, showed high CD34 expression, but were negative for CD45, CD38, CD33, CD50, HLA-DR and Stro-1. Between Days +5 and +16, the onset of hematopoietic reconstitution was clearly detectable in multi-parameter evaluation of the FACS data. This was a median of 3.5 days before NC increased above 200/ w L blood and 4-10 days before granulocyte counts were > 500/ microL. It was marked by the appearance of monocytes, immature (CD38(+)) granulocytes, and clonogenic donor CD34(+) cells exhibited normal size and phenotype. DISCUSSION We conclude that dynamic FACS analyses can reliably detect hematopoietic reconstitution, but also graft rejection, before a visible increase NC numbers. This may have considerable impact on clinical management strategies.
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Affiliation(s)
- G Fritsch
- Children's Cancer Research Institute, St. Anna Kinderspital, Vienna, Austria
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Hulspas R, O'Gorman MR, Wood BL, Gratama JW, Sutherland DR. Considerations for the control of background fluorescence in clinical flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:355-64. [DOI: 10.1002/cyto.b.20485] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Martin-Henao GA, Torrico C, Azqueta C, Amill B, Querol S, Garcia J. Cryopreservation of hematopoietic progenitor cells from apheresis at high cell concentrations does not impair the hematopoietic recovery after transplantation. Transfusion 2005; 45:1917-24. [PMID: 16371044 DOI: 10.1111/j.1537-2995.2005.00643.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high number of nuclear cells (NCs) from hematopoietic progenitor cells-apheresis (HPC-A) requires cryopreservation in large volumes or at high NC concentrations. The effect of NC concentration during cryopreservation has yet to be examined. STUDY DESIGN AND METHODS In the experimental arm (n = 610, Protocol B), the first HPC-A sample from the patient was cryopreserved in two cryobags and subsequent collections in one cryobag, resulting in high NC concentrations (>100 x 10(6) NCs/mL) in most cases. The effect of NC concentrations at freezing in NC recovery after thawing and engraftment kinetics was analyzed and compared with a group of HPC-A cryopreserved at standard NC concentrations (n = 455, Protocol A). RESULTS The mean (SD) NC concentration at freezing was 78 (28) x 10(6) per mL (median, 82 x 10(6)/mL; range, 12 x 10(6)-156 x 10(6)/mL) and 183 (108) x 10(6) per mL (median, 156 x 10(6)/mL; range, 16 x 10(6)-678 x 10(6)/mL), for HPC-A cryopreserved according to Protocols A and B, respectively. The NC viabilities of the test vials and HPC-A components after thawing were 88 percent versus 85 percent and 85 percent versus 82 percent, and the cloning efficiency was 49 percent versus 33 percent for Protocols A and B, respectively (p < 0.001). Significant differences were not observed in the recovery of NCs. Days to neutrophil and platelet engraftment were not different between patients transplanted in the standard- (n = 143) or high-cell-concentration group (n = 238). CONCLUSION The cryopreservation of HPC-A at higher than standard NC concentrations has no adverse impact on hematopoietic reconstitution after transplantation.
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Fietz T, Arnold R, Massenkeil G, Rieger K, Reufi B, Thiel E, Knauf WU. Altered growth characteristics of cord blood cells after in vivo exposure to maternal acute myeloid leukemia and chemotherapy. Acta Haematol 2005; 114:121-4. [PMID: 16103638 DOI: 10.1159/000086588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 11/09/2004] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Antigens, CD34/biosynthesis
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Colony-Forming Units Assay
- Female
- Fetal Blood/cytology
- Granulocyte Precursor Cells/metabolism
- Granulocyte Precursor Cells/pathology
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/physiopathology
- Leukocyte Common Antigens/biosynthesis
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/metabolism
- Leukocytes, Mononuclear/pathology
- Maternal Exposure/adverse effects
- Pregnancy
- Pregnancy Complications, Hematologic/pathology
- Pregnancy Complications, Hematologic/physiopathology
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Affiliation(s)
- T Fietz
- Department of Hematology, Oncology and Transfusion Medicine, Campus Benjamin Franklin, Berlin, Germany.
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6
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Cassens U, Göhde W, Kuling G, Gröning A, Schlenke P, Lehman LG, Traoré Y, Servais J, Henin Y, Reichelt D, Greve B. Simplified Volumetric Flow Cytometry Allows Feasible and Accurate Determination of Cd4 T Lymphocytes in Immunodeficient Patients Worldwide. Antivir Ther 2004. [DOI: 10.1177/135965350400900309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The determination of CD4 cells is of crucial clinical importance for patients with AIDS. However, the high costs involved represent limitations for CD4 cell counting in developing countries. In order to provide an affordable technique, we introduced a simplified volumetric counting (SVC) technique without sample manipulations and investigated it in a multicentre study. Blood samples from 434 healthy donors and immunodeficient patients were tested in eight hospital laboratories in Europe, Africa and Asia. CD4 cell counts were compared using inhouse flow cytometric methods and the SVC technique. The SVC method was performed on a low-cost flow cytometer (CyFlow SL, Partec, Münster, Germany) after 15 min antibody incubation without pre-analytic manipulations, such as washing or erythrocyte lysing procedures. Linear regression analysis demonstrated a correlation of r=0.942 (Europe), r=0.952 (Africa) and r=0.989 (Asia) between the SVC technique and the in-house methods. Bland Altman plot analysis of all patient data showed a mean bias between the two methods of +26 CD4 cells in favour of the SVC technique (measured range: 6–1905 cells/μl; median CD4 cell count: 388/μl). Three centres used the FACS-count technique (Becton-Dickinson, San José, Calif., USA) as an in-house method dispensing with pre-analytic manipulations. The comparison of SVC and FACS-count method revealed a mean bias of +32 CD4 cells/μl (median CD4 cell count: 349/μl). The accuracy of the SVC was tested on standards with known CD4 cell counts ( n=6) and was shown to be 95.2%. The low-cost device and the simplified no-lyse, no-wash test procedure reduces the costs per determination and facilitates the use of flow cytometry in developing countries.
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Affiliation(s)
- Uwe Cassens
- Institute of Transfusion Medicine, University Hospital Münster, Germany
| | - Wolfgang Göhde
- Institute of Radiation Biology, University Hospital Münster, Germany
| | - Gudrun Kuling
- Department of Internal Medicine/Haematology, Helios-Kliniken Berlin, Robert-Rössle Klinik Berlin, Germany
| | - Arndt Gröning
- Institute of Laboratory and Transfusion Medicine, University Hospital Bad Oeynhausen, Germany
| | - Peter Schlenke
- Institute of Immunology and Transfusion Medicine, University Hospital Lübeck, Germany
| | | | - Yves Traoré
- University of Ougadougou, UFR/SVT, Burkina Faso
| | - Jean Servais
- Lux Development, Treatment and Research AIDS Center Kigali, Rwanda
| | - Yvette Henin
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Doris Reichelt
- Department of Internal Medicine, University Hospital Münster, Germany
| | - Burkhard Greve
- Institute of Radiation Biology, University Hospital Münster, Germany
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Fietz T, Rieger K, Dimeo F, Blau IW, Thiel E, Knauf WU. Stem cell mobilization in multiple myeloma patients: Do we need an age-adjusted regimen for the elderly? J Clin Apher 2004; 19:202-7. [PMID: 15597345 DOI: 10.1002/jca.20030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The upper age limit for autologous progenitor cell transplantation in multiple myeloma patients is increasing continuously. We examined whether this shift in the age of pretreated myeloma patients requires modification of mobilization regimen. We compared retrospectively 21 consecutive progenitor cell mobilizations in 15 pts < 60 years (median age 56, range 37-59) with 33 consecutive mobilizations in 23 pts > 60 years (median age 65, range 60-73) of age. The number of CD34 positive circulating cells before scheduled leukapheresis was a mean of 67,935 cells/mL (SEM +/- 17,614) in the younger population and a mean of 19,069 (SEM +/- 5,396) for older pts (P = 0.0027). In patients >60 years, 13/33 mobilizations (including 2 patients with 2 failing attempts) were not successful (39%), compared to 6/21 mobilizations (29%, including 1 patient with 3 failing attempts) in the younger population. The increased number of progenitor cells in the grafts of younger patients led to a more rapid regeneration of leukocytes and platelets after stem cell infusion. Our data show that stem cell mobilization in older multiple myeloma patients is inferior compared to a younger patient population. There is a trend towards more leukapheresis until the target stem cell dose has been collected, and the decreased number of progenitor cells in the actual graft delays engraftment of leukocytes and platelets. The overall number of unsuccessful mobilization attempts, however, did not differ significantly between both age groups. A special "age-adjusted" increase in the dose of growth factors seems unjustified. Improvements in timing of leukapheresis, growth factor application, and mobilizing chemotherapy regimen as well as the use of alternative cytokines should be investigated for both age groups.
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8
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Greve B, Beller C, Cassens U, Sibrowski W, Severin E, Göhde W. High-grade loss of leukocytes and hematopoietic progenitor cells caused by erythrocyte-lysing procedures for flow cytometric analyses. JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 2003; 12:321-30. [PMID: 12857373 DOI: 10.1089/152581603322023052] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
All current-flow cytometric techniques use erythrocyte-lysing procedures before leukocyte analysis. We investigated the impact of four lysing procedures with different flow cytometric techniques on the loss of leukocytes and hematopoietic progenitor cells in blood samples. A total of 280 determinations out of 10 samples were measured by two flow cytometers (FCMs), using a FACS-Calibur (Becton Dickinson) and a particle-analyzing system (PAS) with a "true volumetric unit" (Partec). All samples were prepared with four different commercially available erythrocyte-lysing reagents (n = 10, respectively). CD34(+) cells were determined in relation to counted leukocytes with both FCMs (dual platform determinations, 2-PF). In addition, further immunologic and nuclear staining determinations of cells with and without erythrocyte-lysing procedures were performed in the "true volumetric unit" (single platform mode 1-PF) using the PAS system (n = 10, respectively). In the 2-PF mode, both systems showed identical results for CD34(+) cells (r = 0.997). The comparison of 1-PF and 2-PF modes with immunologic stainings revealed a mean decrease of 34.5% for absolute amounts of CD45(+) cells [in detail: Becton-Dickinson (BD) lysis 40%; Ortho Diagnostics (OD) lysis 31%; Uti lyse (UL) 38%; Cylyse (CL) 29%] and of 41.3% for absolute concentration of CD34(+) cells [in detail: BD lysis 45%; OD lysis 40%; UL lysis 45%; CL lysis 34%] by the lysing procedures. In contrast, the nuclear stainings revealed a mean leukocyte loss of only 5% for the nonlysed samples and of 12% for lysed samples. All investigated lysing procedures induced a large loss of leukocytes and progenitor cells, obviously due to cell membrane destruction as demonstrated for identical samples in the 1-PF and 2-PF modes by immunologic and nuclear staining methods.
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Affiliation(s)
- Burkhard Greve
- Department of Radiobiology, University Hospital Münster, 48149 Münster, Germany.
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9
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Fietz T, Reufi B, Mücke C, Thiel E, Knauf WU. Flow cytometric CD34+ determination in stem cell transplantation: before or after cryopreservation of grafts? JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 2002; 11:429-35. [PMID: 11983115 DOI: 10.1089/152581602753658628] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Various attempts have been made to standardize and improve the reproducibility of flow cytometric determination of CD34+ hematopoietic progenitor cells. It is still not clear, however, whether the quantification of CD34+ cells in a stem cell graft should be done before or after cryopreservation. To address this issue, we investigated 78 unselected and 32 immunomagnetically selected autologous and allogeneic leukapheresis products (LA) before and after cryopreservation using pilot vials. Cell numbers were quantified within a Neubauer chamber, and CD34+ content was determined by flow cytometry; propidium iodide staining was used to exclude dead cells from analysis. Before freezing, the mean viable CD34 cell content in the unselected samples was 1.22% and increased after thawing to a mean of 2.16% of viable cells. Taking into account cell loss and cell death, the overall recovery of viable cells was 64.5%; all CD34+ cells could be recovered. Mean purity in the CD34-selected cell fraction was 85% (48-97) before and 91.3% (67-99) after thawing. The number of viable cells was 86.8% before and 86.1% after freezing with a 93.9% recovery of total cells. This leads to a mean 93.7% (SD +/- 23.1) recovery of viable cells and 100% (SD +/- 22.3) recovery of viable CD34+ cells. There was no significant difference in tolerance to freeze/thaw stress between cells from heavily pretreated autologous patients and healthy allogeneic donors. Our data show that freezing significantly increases the percentage of CD34(+) cells in unmanipulated LA, probably due to the death of granulocytes and mononuclear cells (MNCs). Nevertheless, the overall number of viable CD34+ cells in unselected as well as selected samples remains unchanged. Thus, CD34 data from different laboratories, for example, within multicenter trials, should be comparable independent of the different time points of acquisition.
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Affiliation(s)
- T Fietz
- Department of Medicine III (Hematology, Oncology and Transfusion Medicine), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, D-12200 Berlin, Germany
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10
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Serke S, van Lessen A, Hummel M, Szczepek A, Huhn D, Stein H. Circulating CD4+ T lymphocytes with intracellular but no surface CD3 antigen in five of seven patients consecutively diagnosed with angioimmunoblastic T-cell lymphoma. CYTOMETRY 2000; 42:180-7. [PMID: 10861691 DOI: 10.1002/1097-0320(20000615)42:3<180::aid-cyto4>3.0.co;2-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) accounts for less than 1% of all lymphatic malignancies. Oligoclonality or monoclonality for any of the T-cell receptor (TCR) chain genes can be demonstrated in the majority of the cases. During systematic screening for the presence of circulating lymphocytes with atypical coexpression of differentiation antigens in patients with T-cell lymphomas, we have discovered a minor population (accounting for 0.2% to 10.% of all lymphocytes) of atypical lymphocytes in the blood of five of seven patients consecutively diagnosed in 1997/1998 by lymph node histology to have AITL. The major distinguishing feature of these cells consists of the lack of the surface expression of the CD3 antigen, but not of the intracellular expression. These cells express the T-cell antigens CD2 and CD5 on their surface, but not CD7, and they express CD4 and CD45 at numbers of molecules per cell typical for T lymphocytes. Gene scan analyses for the TCR gamma chain revealed oligoclonality of these flow-sorted cells in one patient and monoclonality in two patients, the same patterns of TCR gamma chain gene as determined processing the respective diagnostic lymph nodes. Circulating CD4-expressing T lymphocytes with exclusively cytoplasmic expression of CD3 appear to represent the malignant population in patients with histologically diagnosed AITL.
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Affiliation(s)
- S Serke
- Department of Internal Medicine, Hematology-Oncology, Virchow Hospital, Charite, Humboldt-University, Berlin, Germany
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11
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Hildebrandt M, Serke S, Meyer O, Ebell W, Salama A. Immunomagnetic selection of CD34+ cells: factors influencing component purity and yield. Transfusion 2000; 40:507-12. [PMID: 10827251 DOI: 10.1046/j.1537-2995.2000.40050507.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In immunomagnetic selection of CD34+ cells from HPC transplants, not all factors that affect yield and purity of CD34+ cells are known. METHODS Forty-three consecutive procedures of immunomagnetic selection of CD34+ cells from peripheral blood HPCs and bone marrow harvests (autologous harvests, n = 27; allogeneic harvests; n=16) were performed by use of a cell selection system (Isolex 300i, Baxter Immunotherapy). The composition of the starting component and the subsets of CD34+ cells were analyzed for correlation with the yield and purity of the final component. RESULTS The mean purity of the final components was 84.3 percent (range, 27-99%), and the mean yield was 51.4 percent (range, 9.4-80. 4%). Partial regression analysis showed that, among the factors correlating with purity and/or yield, the RBC volume in the starting fraction had the highest predictive impact on the purity and yield of CD34+ cells, even after the exclusion of procedures using bone marrow harvests as an HPC source (beta coefficient, -0.704; p = 0. 001). CONCLUSION The use of the Isolex 300i system allows efficient recovery of CD34+ cells in routine selection procedures. The volume of RBCs in the starting component should be minimized to ensure a high yield and purity of the final component.
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Affiliation(s)
- M Hildebrandt
- Departments of Internal Medicine (Blood Bank) and Pediatrics, Charité, Campus Virchow Klinikum, Humboldt University, Berlin, Germany.
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Arseniev L, Pickerd N, Goudeva L, Hertenstein B, Ganser A. Comparative evaluation of commonly used clones and fluorochrome conjugates of monoclonal antibodies for CD34 antigen detection. JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 1999; 8:547-59. [PMID: 10791905 DOI: 10.1089/152581699319993] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CD34+ cell enumeration is currently the most appropriate technique for hematopoietic graft quality control. At the same time, numerous CD34 mAb have become commercially available. This study was designed to compare the commonly used clones 8G12 and QBEND-10 with the new clones 581 and BIRMA-K3. All available fluorochrome conjugates were tested: FITC, PE, and PE-Cy5 or PerCP for QBEND, BIRMA, 581, and 8G12 and FITC and PE for 581. Bone marrow from healthy donors (n = 5) and leukapheresis samples (n = 16) were stained, according to each manufacturer's protocol and analyzed using the FACScan. The following parameters were evaluated: % CD34+ cells detected and percentage of deviation from the median within each sample; mean channel fluorescence intensity of the CD34+ cells; resolution index (median channel fluorescence intensity of CD34+ cells/monocytes), % overlapping of CD34+ cell and monocyte fluorescence; proportion of CD34+ events after blocking with the same unlabeled clone; values of compensation requirements. Tables with results for each evaluated parameter separately were created, and rank points were applied. These scores represented the quality performance of the studied clones and fluorochrome conjugates and may be summarized as follows: 581 and 8G12 produced the best results, followed by BIRMA-K3 and QBEND10. The fluorochrome sequence was PE, PE-Cy5, PerCP, and FITC. However, all PE conjugates of the studied clones provided highly comparable results and conditions for CD34+ cell enumeration. When antigen coexpression must be studied and another dye than PE must be applied for CD34+ cell discrimination, the PE-Cy5 conjugates should be preferred.
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Affiliation(s)
- L Arseniev
- Department of Hematology/Oncology, Hannover Medical School, Germany
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13
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Johnsen HE, Baech J, Nikolajsen K. Validation of the Nordic flow cytometry standard for CD34+ cell enumeration in blood and autografts: report from the third workshop. Nordic Stem Cell Laboratory Group. JOURNAL OF HEMATOTHERAPY 1999; 8:15-28. [PMID: 10192298 DOI: 10.1089/106161299320532] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Following two workshops on standardization of enumeration of CD34+ cells in blood and leukapheresis products, the Nordic Stem Cell Laboratory Group (NSCL-G) evaluated the Milan/Mulhouse/Nordic standard in clinical practice during the third workshop (WS-III). This report documents an acceptable interlaboratory variation in the most clinically active laboratories, with a coefficient of variation (CV) below 0.19 in 7 of 8 analyses performed. The introduction of a pan-CD45 antibody in the analysis did not improve the CV. Comparison of two different CD34 class II antibodies on a total of 99 samples and procedures with and without washing on a total of 96 samples revealed a significant correlation (r2 >0.99) for all analyses. Finally, subset analysis of uncommitted and lineage-specific progenitors revealed major gating difficulties, indicating that further improvements are necessary. In an analysis of more than 600 patients undergoing mobilization and harvest of blood progenitors, with about 500 patients autografted, we found a significant correlation between blood levels of CD34+ cells and recovery of CD34+ cells from each harvest as well as between CD34+ cell number reinfused and time to neutrophil and platelet recovery. This report documents for the first time that the very simple Milan/Mulhouse method (termed The Nordic Standard) can be used by a group of laboratories to obtain important clinical information. Consequently, we consider this method as the conventional method in quality assessment of autografts, which should provide a benchmark for development of second-generation improvements.
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Affiliation(s)
- H E Johnsen
- The Department of Haematology, Herlev Hospital, University of Copenhagen, Denmark
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Serke S, Johnsen H, Huhn D, Kvalheim G. European survey of the flow cytometric determination of CD34-expressing cells. Cytotherapy 1999; 1:343-7. [DOI: 10.1080/0032472031000141275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Serke S, Beyer J, Rick O, Schwella N, Meyer O, Hildebrandt M, Huhn D. Analysis of CD34-expressing cells in clinical practice. Vox Sang 1998; 74 Suppl 2:469-75. [PMID: 9704484 DOI: 10.1111/j.1423-0410.1998.tb05459.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The flow cytometric determination of haemopoietic cells defined as CD34-expressing cells has greatly added to the improvement of the management of harvesting circulating haemopoietic cells for subsequent autologous reinfusion in the setting of high-dose chemo/(radio)-therapy. Additionally, this flow cytometric determination has replaced, in some institutions, the in-vitro culture test for CFU-GM as the measure to estimate the haemopoietic potential of the cells to be reinfused/transplanted.
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Affiliation(s)
- S Serke
- Department of Haematology-Oncology, Campus Virchow Hospital Charite, Humboldt University, Berlin, Germany
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Serke S, van Lessen A, Pardo I, Huhn D. Selective susceptibility of CD34-expressing cells to acquire flow cytometric features of apoptosis/necrosis on exposure to an ammonium chloride-based red blood cell lysing reagent. JOURNAL OF HEMATOTHERAPY 1998; 7:315-8. [PMID: 9735862 DOI: 10.1089/scd.1.1998.7.315] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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17
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Arseniev L, Hertenstein B, Link H, Ganser A, Serke S. Stem cell mobilization in normal donors. JOURNAL OF HEMATOTHERAPY 1998; 7:5-7. [PMID: 9507376 DOI: 10.1089/scd.1.1998.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Serke S, Huhn D. Circulating CD34-expressing cells: German Proficiency Testing Survey. JOURNAL OF HEMATOTHERAPY 1998; 7:37-43. [PMID: 9507379 DOI: 10.1089/scd.1.1998.7.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Determination of absolute numbers of CD34-expressing cells is critical in the setting of peripheral blood stem and progenitor cell transplantation/reinfusion. The diagnostic value of the parameter, CD34-expressing cells/microliter, has been validated. A survey of CD34-expressing cells has been integrated into a series of flow cytometry proficiency testing surveys (reticulocytes, lymphocytes, leukemia, and lymphoma) that we have established in Germany. Commercially available, modified, stabilized myeloblastic leukemia cells (KG1a cell line) spiked at different numbers into two normal blood samples were sent out, and report forms were returned from 50 of 58 participants. With a predicted percentage of CD34-expressing cells of 0.5% (sample A) and of 0.25% (sample B), the respective mean values analyzing data from 44 participants returning the completed forms were 0.49% (sample A) and 0.29% (sample B). The coefficients of variation were 57% and 83%, respectively. Engineered samples based on normal blood and on commercially available stabilized modified KG1a cells seem to be reliable material for external quality assessment surveys of CD34-expressing cells.
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Affiliation(s)
- S Serke
- Department of Internal Medicine, Virchow-Klinikum, Humboldt-University, Berlin, Germany
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Chabannon C, Moatti JP, Maraninchi D. Will CD34+ standardization solve all problems related to cell therapy? JOURNAL OF HEMATOTHERAPY 1997; 6:439-40. [PMID: 9368179 DOI: 10.1089/scd.1.1997.6.439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fritsch G, Printz D, Stimpfl M, Dworzak MN, Witt V, Pötschger U, Buchinger P. Quantification of CD34+ cells: comparison of methods. Transfusion 1997; 37:775-84. [PMID: 9280320 DOI: 10.1046/j.1537-2995.1997.37897424398.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Quantification of CD34+ stem and progenitor cells is predominantly performed by flow cytometric analysis of cells prepared by whole blood staining and red cell lysis. This method also includes cell washing, which is thought to cause the destruction and loss of some of the nucleated cells (NCs). To address this cell loss and its influence on the outcome of enumeration, three techniques for preparing cells for quantification of CD34+ cells were compared. STUDY DESIGN AND METHODS Blood (n = 179), bone marrow (n = 60), and leukapheresis components (n = 64) were examined by the use of density separation of mononuclear cells (MNCs) and two red cell-lysis procedures (wash and no-wash). Cell counts were determined in the original materials and after cell preparation. Absolute CD34+ cell counts were calculated using the flow cytometry-analyzed proportions of CD34+ cells and the various white cell counts. RESULTS Depending on the cell source and the cell preparation chosen, the loss of NCs ranged between 12 percent and 89 percent of the original white cell number. This loss of NCs was exclusively due to cell washing and predominantly affected granulocytic cells. Analysis of the flow cytometry data revealed that the relative CD34+ values in blood and bone marrow were roughly threefold higher in density separated MNCs than in those that underwent the lyse-and-wash procedure. Calculation of absolute CD34+ cell counts confirmed that the MNC procedure underestimated the CD34+ cell content by a median of 26 percent (blood), 21 percent (bone marrow), and 5 percent (leukapheresis component) when compared with the median yield from analysis and cell counting performed after the lyse-and-wash procedure. On the other hand, the conventional lysis procedure, which applies the original white cell counts for CD34+ quantification, was shown to overestimate the CD34+ cell content by a median of 1.2-fold, 1.33-fold, and 1.13-fold, respectively. CONCLUSION Neither density separation nor the whole-blood lysis procedure seems appropriate for optimal CD34+ quantification.
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Affiliation(s)
- G Fritsch
- Children's Cancer Research Institute, St. Anna Kinderspital, Vienna, Austria
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Höffkes HG, Lowe JA, Pedersen RO, Schmidkte G, McDonald DF. BIRMA-K3, a new monoclonal antibody for CD34 immunophenotyping and stem and progenitor cell assay. JOURNAL OF HEMATOTHERAPY 1996; 5:261-70. [PMID: 8817393 DOI: 10.1089/scd.1.1996.5.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A murine monoclonal antibody with specificity for the CD34 antigen has been produced and designated BIRMA-K3. The antibody characterized as IgG1(kappa) has been shown to react with KG-1a cells following treatment of the cells with glycoprotease enzyme, indicating reactivity with the class III epitope of CD34. It was possible to show that class I and class II anti-CD34 antibodies were not able to inhibit binding of BIRMA-K3. Investigation of FITC-labeled as well as PE-labeled BIRMA-K3 resulted in a clear cut-off staining of acute leukemias and CD34+ cell counts in patients submitted to high-dose chemotherapy and stem cell transplantation. The results obtained correlate strongly with those from HPCA-2, the Becton-Dickinson class III antibody.
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Affiliation(s)
- H G Höffkes
- Department of Medicine, Otto-von-Guericke University of Magdeburg, Germany
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Sutherland DR, Anderson L, Keeney M, Nayar R, Chin-Yee I. The ISHAGE guidelines for CD34+ cell determination by flow cytometry. International Society of Hematotherapy and Graft Engineering. JOURNAL OF HEMATOTHERAPY 1996; 5:213-26. [PMID: 8817388 DOI: 10.1089/scd.1.1996.5.213] [Citation(s) in RCA: 929] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The increased use of Peripheral Blood Stem Cells (PBSC) to reconstitute hematopoiesis in autotransplant and, more recently, allotransplant settings has not been associated with a consensus means to quality control the PBSC product. Since the small population of cells that bear the CD34 antigen are thought to be responsible for multilineage engraftment, graft assessment by flow cytometric quantitation of CD34+ cells should provide a rapid, reliable, and reproducible assay. Unfortunately, although a number of flow cytometric assays for CD34 enumeration have been described, the lack of a standardized method has led to the generation of widely divergent data. Furthermore, none of these assays has been validated as to interlaboratory reproducibility and suitability for widespread clinical application. In early 1995, the International Society of Hematotherapy and Graft Engineering (ISHAGE) established a Stem Cell Enumeration Committee, the mandate of which was to validate a simple, rapid, and sensitive flow cytometric method to quantitate CD34+ cells in peripheral blood and apheresis products. We also sought to establish its utility on a variety of flow cytometers in clinical laboratories and its reproducibility between transplant centers. Here, we describe the four-parameter flow methodology adopted by ISHAGE for validation in a multicenter study in North America.
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Cancelas JA, Querol S, Canals C, Bertran J, Limon A, Amill B, Petriz J, Garcia-Lopez J. CD34+ cell positive selection from mobilized peripheral blood by an indirect immunomagnetic method: effect of the type of mobilization and assessment of tumor depletion ability. JOURNAL OF HEMATOTHERAPY 1995; 4:531-8. [PMID: 8846013 DOI: 10.1089/scd.1.1995.4.531] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mobilized peripheral blood has been shown to be a suitable source of hematopoietic progenitor cells for autologous transplantation in oncologic patients. However, tumor cell contamination can potentially occur, although to a lesser extent than in the bone marrow. CD34+ cell positive selection has been developed as a system for the ex vivo purging of remaining tumor cells when used in mobilized peripheral blood. This method has shown a lower purification potential than that obtained with bone marrow or cord blood. The reason for this is not clear, but different groups have tried to improve the purity and yield of the positive selection on mobilized peripheral blood by predepletion of nonlymphoid cell populations, since they can induce nonspecific binding. The present study was designed to test an indirect immunomagnetic CD34+ cell selection method to make it reproducible, feasible, and effective for purging mobilized peripheral blood. Twenty-nine samples from mobilized peripheral blood were tested. The median starting CD34+ percentage was 0.8 (0.3%-4.2%), and the median final purity was 87% (32.7%-99.7%), with a median yield of 44.8% (15%-83.5%). The highest purity was reproducibly achieved when the starting percentage of CD34+ cells was higher than 0.65% (median purity 93.7, range 81%-99.7%, CV 6%) on samples obtained from patients primed with chemotherapy alone or chemotherapy plus recombinant human granulocyte-colony stimulating factor. No relation was found between the content of contaminating nucleated cells and the final CD34+ cell purity. This method showed a depletion capacity, assessed by PCR on samples contaminated with K562 leukemic cells, of about 3 logs. These results indicate that this indirect immunomagnetic method can produce high purity CD34+ cell fractions from mobilized peripheral blood with a high efficiency of tumor depletion.
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Affiliation(s)
- J A Cancelas
- Department of Cryobiology and Cell Therapy, Institut de Recerca Oncològica, Barcelona, Spain
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