CD34 Testing for Bone Marrow Transplantation Planning- What is New?

Detection of the CD34 antigen on the surface of leukocytes has proven to be a reliable surrogate marker for the identification of self-renewing, pluripotent Haematopoietic Progenitor Cells (HPCs) and has generally replaced the cumbersome colony forming unit assay for granulocytes and macrophages (CFU-GM). Assessment of apheresis products by measuring CD34+ cell counts by flow cytometry evaluates the most primitive HPCs along with maturing, lineage committed progenitors. Doses of >2 x 106 CD34+ HPCs/kg of patient body weight have been found to be predictive of both short-term and long-term hematopoietic recovery after high-dose chemotherapy.

Our laboratory at the Centre for Blood Cell Therapies (CBCT) at Peter MacCallum Cancer Centre performs CD34+ cell counts on 4 different sample types:

Peripheral Blood (PB) pre-apheresis to determine patient suitability for HPC-A collection;

HPC-A Product to determine the total CD34+ cell dose collected in the apheresis product;

Apheresis bulb samples at the end of apheresis to determine the total CD34+ dose collected prior to HPC-A processing; and

Reference vial samples to determine the viability and CD34+ dose recovered post cryopreservation and thawing.

The role of PB CD34+ cell counts in predicting the optimal timing of HPC-A collection is well established, as is its contribution to achieving an adequate CD34 dose. "Bulb" and "reference vial" specimens provide new applications for CD34+ cell counts that play an important role in optimising HPC-A transplantation.

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