Reduced hemoglobin on day of peripheral blood progenitor cell collection is associated with low graft content of vascular progenitors and increased toxicity after autologous hematopoietic stem cell transplantation

Authors

  • Gurnaam Kasbia,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Farjah Al-Gahtani,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Jason Tay,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Laura Labonté,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Alan Tinmouth,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Timothy Ramsay,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Akira Gillingham,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Lin Yang,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Michael Halpenny,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Antonio Giulivi,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Sheryl McDiarmid,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • Lothar Huebsch,

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • David S. Allan

    1. From the Division of Hematology and Blood and Marrow Transplant Program, The Ottawa Hospital and University of Ottawa, Clinical Epidemiology Program and Regenerative Medicine Program, Ottawa Health Research Institute, and Canadian Blood Services, Ottawa, Ontario, Canada.
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  • AG was a recipient of a Summer Internship at Canadian Blood Services (CBS). AT is a recipient of a New Investigator Award from CBS/Canadian Institutes for Health Research. JT is University of Ottawa Centre for Transfusion Research Fellow supported by Canadian Blood Services. DSA is an Adjunct Scientist with CBS. Support for studentships was received through unrestricted contributions from Bayer Pharmaceuticals and from The Ottawa Hospital Foundation for Blood and Marrow Transplant Education and Research Fund.

David Allan, MD, MSc, FRCP (Canada), Blood and Marrow Transplant Program, Division of Hematology, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 704, Ottawa, ON, Canada K1H 8L6; e-mail: daallan@ohri.ca.

Abstract

BACKGROUND: Tissue damage after hematopoietic stem cell transplantation (HSCT) occurs as a result of high-dose chemotherapy and radiation. The aim was to determine the importance of pretransplant anemia on toxicity and red blood cell (RBC) transfusion requirements after autologous HSCT.

STUDY DESIGN AND METHODS: A total of 350 patients undergoing autologous HSCT were included in the analysis. Patient factors and pretransplant laboratory values of possible relevance were assessed in multivariate regression analysis.

RESULTS: Reduced hemoglobin (Hb) on the first day of peripheral blood progenitor cell (PBPC) collection was significantly associated with increased organ toxicity after HSCT, as measured by the Seattle criteria. Lower Hb levels at baseline before transplantation, but not at PBPC collection, were significantly associated with increased RBC transfusion requirements. In a second cohort of 28 patients, higher Hb levels on the day of PBPC collection were significantly associated with increased levels of endothelial-like vascular progenitor cells in PBPC grafts.

CONCLUSION: Our observations suggest that higher Hb levels on the day of PBPC collection may be a marker of reduced toxicity associated with HSCT and increased vascular progenitors in PBPC collections. Further, baseline anemia before transplant may reflect an unfavorable hematopoietic microenvironment that leads to increased RBC transfusion requirements.

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