ISSN 2531-1379 VOLUME 45, ISSUE 4, OCTOBER-DECEMBER, 2023 HEMATOLOGY TRANSFUSION AND CELL THERAPY
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TaggedH1Hematology, Transfusion and Cell Therapy TaggedP ISSN 2531-1379 print version ISSN 2531-1387 online versionTaggedEnd EDITOR INCHIEF Eduardo Magalh~aes Rego, Ribeir~ao Preto, Brazil DEPUTYEDITOR Erich Vinicius de Paula, Campinas, Brazil ASSOCIATE EDITORS Alfredo Mendrone Junior S~ao Paulo, Brazil Belinda Pinto Sim~oes Ribeir~ao Preto, Brazil Behnaz Bayat Giessen, Germany Carla Luana Dinardo S~ao Paulo, Brazil CarlosS ergio Chiattone S~ao Paulo, Brazil C armino Antonio de Souza Campinas, Brazil DanteM ario Langhi Junior S~ao Paulo, Brazil Dimas Tadeu Covas Ribeir~ao Preto, Brazil Elvira Deolinda Rodrigues Pereira Velloso S~ao Paulo, Brazil Fabiola Traina Ribeir~ao Preto, Brazil Helio Moraes de Souza Uberaba, Brazil Irene Lorand-Metze Campinas, Brazil Jos e Orlando Bordin S~ao Paulo, Brazil Luis Fernando S. Bouzas Rio de Janeiro, Brazil Marcelo Pasquini Wisconsin, USA M arcio Nucci Rio de Janeiro, Brazil Marcos Borato Viana Belo Horizonte, Brazil Marcos de Lima Cleveland, USA Margareth Castro Ozelo Campinas, Brazil Maria Helena Pitombeira Fortaleza, Brazil Maria Stella Figueiredo S~ao Paulo, Brazil Marilda de Souza Gon¸calves Salvador, Brazil Nelson Hamerschlak S~ao Paulo, Brazil Nelson Spector Rio de Janeiro, Brazil Nicola Conran Campinas, Brazil PauloS ergio da Silva Santos S~ao Paulo, Brazil Roberto Passetto Falc~ao Ribeir~ao Preto, Brazil Rodrigo Tocantins Calado Ribeir~ao Preto, Brazil Sara Teresinha Olalla Saad Campinas, Brazil Silvia Maria Meira Magalh~aes Fortaleza, Brazil Valder Arruda Philadelphia, USA Vanderson Rocha S~ao Paulo, Brazil Vania Tietsche de Moraes Hungria S~ao Paulo, Brazil Editorial Board Alois Gratw€ohl Basel, Switzerland Alvaro Urbano-Ispizua Barcelona, Spain Andrea Bacigalupo Genoa, Italy ^Angelo Maiolino Rio de Janeiro, Brazil Antonio Fabron J unior Marilia, Brazil Christian Gisselbrecht Paris, France Corrado Tarella Turin, Italy Daniel Tabak Rio de Janeiro, Brazil DavidG omez Almaguer Mexico City, Mexico Elbio A. DAmico S~ao Paulo, Brazil Enric Carreras Barcelona, Spain Eugenia Maria Amorim Ubiali - Ribeir~ao Preto, Brazil Fernando Ferreira Costa, Campinas, Brazil Frederico Luiz Dulley S~ao Paulo, Brazil Gino Santini Genoa, Italy Guillermo Dighiero Montevideo, Uruguay Guillermo Ruiz-Arguelles Puebla, Mexico Jesus Fernando San Miguel Salamanca, Spain Jo~ao Carlos Pina Saraiva Bel em, Brazil La ercio de Melo Belo Horizonte, Brazil L ılian Maria Castilho Campinas, Brazil Linamara Rizzo Batistella S~ao Paulo, Brazil Lucia Mariano da Rocha Silla Porto Alegre, Brazil Marcos Antonio Zago Ribeir~ao Preto, Brazil Maria de Lourdes L. F. Chauffaile S~ao Paulo, Brazil Maria do Socorro P. de Oliveira Rio de Janeiro, Brazil Mario Cazolla Pavia, Italy Mary Evelyn Flowers Seattle, USA Nelson Abrahin Fraiji Manaus, Brazil Nelson J. Chao Durham, USA Paul M. Ness Baltimore, USA PauloC esar Naoum S~ao Jos e do Rio Preto, Brazil Raul C. Ribeiro Memphis, USA Raul Gabus Montevideo, Uruguay Ricardo Pasquini Curitiba, Brazil Richard K. Burt Chicago, USA Sergio Giralt New York, USA V^ania Tietsche Hungria S~ao Paulo, Brazil Vicente Odone Filho S~ao Paulo, Brazil PAST EDITORS Antonio P. Capanema 1973-1981; Milton A. Ruiz 1981-1990; Carlos S. Chiattone 1991-1994; Milton A. Ruiz 1995-2014; Fernando Ferreira Costa 2015-2022. The Hematology, Blood Transfusion and Cell Therapy succeeded the Revista Brasileira de Hematologia e Hemoterapia (Brazilian Journal of Hematology and Hemotherapy) , ISSN 1516-8484, which succeeded the Boletim da Sociedade Brasileira de Hematologia e Hemoterapia (Bulletin of the Brazilian Society of Hematology and Hemotherapy) ISSN 0102-7662, which was published from 1973 to 1998 with 179 issues in 20 volumes. ABHH Rua Diogo de Faria, 775/conjunto 133 04037-002 Vila Clementino - S~ao Paulo/SP - Brazil (11) 2369-7767 / (11) 2338-6764 (WhatsApp) E-mail: abhh@abhh.org.br www.abhh.org.br HTCT Internal Editorial Committee Executive Secretary: Luciana de Souza secretaria@rbhh.org | www.htct.com.br The Hematology, Transfusion and Cell Therapy is the offi cial publication of the Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), the Associazione Italo-Brasiliana di Ematologia (AIBE), Eurasian Hematology Oncology Group (EHOG), and the Sociedade Brasileira de Oncologia Pedi atrica (SOBOPE), published by Elsevier Editora Ltda. The journal is indexed to the Literatura Latino-Americana e do Caribe em Ci^encias da Sa ude (Lilacs), SciELO Brazil, PubMed/PMC, Web of Science (ESCI), Extramed and Scopus. It is distributed for free to regional libraries and Medical, Pharmacy and Biochemistry Schools in Brazil and sister societies in South, Central and North America and Europe. 2023 Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved. All rights reserved and protected by law 9.610 - 19/02/98. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from ABHH and the Publisher. 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Board Of Directors 2022-2023 President Jos e Francisco Comenalli Marques J unior Vice-President Angelo Maiolino Administrative Director DanteM ario Langhi J unior Vice Administrative Director Silvia Maria Meira Magalh~aes Scientific Director Dimas Tadeu Covas Vice-Scientific Director Rodrigo do Tocantins Calado Financial Diretor Alfredo Mendrone J unior Vice Financial Director Leny Nascimento da Motta Passos Director of Communications Renato Sampaio Tavares Vice-Director of Communications Jorge Vaz Pinto Neto Director of Institutional RelationsEduardo Magalh~aesRego Vice-Director of Institutional RelationsCarlosS ergio Chiattone Director of Professional PracticeGlaciano Nogueira Ribeiro Vice-Director of Professional PracticeCelso Rodrigues Arrais Commitee Coordinator Carmino Antonio de Souza Emeritus Scientific Director Roberto Passetto Fal¸c~ao General Manager AlineAch^e Deliberative Committee Elected 2020-2023 Leny Nascimento da Motta Passos Edvan de Queiroz Cruso e Jorge Vaz Pinto Neto Glaciano Nogueira Ribeiro Gustavo Henrique Silveira Fabiana Akil V^ania Tietsche de Moraes Hungria Violete Petitto Laforga Jos e Eduardo Bernardes Rodrigo do Tocantins Calado de Saloma Rodrigues Celso Arrais Rodrigues da Silva Alfredo Mendrone Junior Jos e Francisco Comenalli Marques J unior Ana Clara Kneese Virgilio do Nascimento Katia Borgia Barbosa Pagnano Elected 2022-2025 Aderson da Silva Araujo Angelo Maiolino Carla Luana Dinardo Eduardo Magalh~aesRego Jo~ao Paulo de Oliveira GuimarÐes Karina Correia Barcelos Monika Conchon Renato Luiz Guerino Cunha Renato Sampaio Tavares Rodolfo Delfi ni Can¸cado Silvia Maria Meira MagalhÐes Talita Maira Bueno da Silveira Thiago Xavier Carneiro Vanderson Rocha Vaneuza Araujo Moreira Funke Lifelong Deliberative Committee Carlos Sergio Chiattone Carmino Antonio de Souza DanteM ario Langhi J unior Dimas Tadeu Covas Eur ıpedes Ferreira Fernando Ferreira Costa H elio Moraes de Souza H elioRamos Jo~ao Carlos Pina Saraiva Jos e Orlando Bordin Jos eKerbauy Marco Antonio Zago Milton Artur Ruiz Nelson Ibrahim Fraiji Nelson Hamerschlak Nelson Spector Orion de Bastos Ricardo Pasquini Roberto Passetto Falc~ao Romeu Ibrahim de Carvalho Sara Teresinha Olalla Saad Therezinha Verrastro de Almeida Ubiratan Ouvinha Peres Past Presidents of Sociedade Brasileira de Hematologia e Hemoterapia 1950 Walter Oswaldo Cruz 1951 Michel Abujamra 1954 Darcy Lima 1955 Jos e Candido C. Villela 1957 Joaquim M. Barreto 1959 Oswaldo Kessler Ludwing 1961 Walter Hupsel 1963 Rui Faria 1965 Orion Bastos 1967 Ubiratan Ouvinha Peres 1970 Oswaldo Mellone 1973 Pedro Cl ovis Junqueira 1975 Pedro Cl ovis Junqueira 1977 Maria Nazareth Petrucelli 1979 Celso Carlos de C. Guerra 1981 Jacob Rosenblit 1983 Luiz Gast~ao M. Rosenfeld 1985 Augusto Luiz Gonzaga 1987 Helio Ramos 1988 Milton Artur Ruiz 1990 Nelson Hamerschlak 1992Eur ıpedes Ferreira 1994 Jo~ao Carlos Pina Saraiva 1996 Jo~ao Pedro E. M. Pereira 1998 Celso Carlos de C. Guerra 2000 Dante M ario Langhi Junior 2002 Dante M ario Langhi Junior 2004 Carlos S ergio Chiattone 2006 Carlos S ergio Chiattone 2008 Carlos S ergio Chiattone Past Presidents of Col egio Brasileiro de Hematologia 1965 Hildebrando M. Marinho 1967 Michel Abujamra 1969 Romeu Ibrahim de Carvalho 1971 Paulo Barbosa da Costa 1973 Romildo Lins 1975 Renato Rego Failance 1977 Dilson Jos e Fernandes 1981 Jos eKerbauy 1985 Eurico Coelho 1989 Romeu Ibrahim de Carvalho 1993 Jos eKerbauy 1997 Roberto Passetto Falc~ao 2005 Jos e Orlando Bordin Past Presidents of Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular 2009 Carlos S ergio Chiattone Jos e Orlando Bordin 2010-2013: Carmino Antonio deSouza 2014-2017: Dimas Tadeu Covas 2018-2021: Dante Langhi J unior Associa¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular
Associazione Italo-Brasiliana di Ematologia Board of Directors - 2021-2022 President Carlos S. Chiattone (Brazil) Vice-President Stefano Luminari Scientific Director −Brazil Carmino Antonio de Souza Treasurer −Brazil Natalia Zing Honorary PresidentsGino Santini and Angelo Maiolino and Ricardo Pasquini Scientific Director −ItalyMaurizio Martelli Treasurer −ItalyLuca Arcaini Board of Advisors - Brazil Eduardo Magalh~aes Rego, Eliana C. M. Miranda, Guilherme Duffl es, Irene de Almeida Biasoli, Marcia Torresan Delamain, Milton Artur Ruiz, Sergio A.B. Brasil, Thais Fischer Board of Advisors - Italy Angelo Michelle Carella, Gian Luca Gaidano, Ignazio Majolino, Maurizio Martelli, Robin Fo a, Teodoro Chisesi Associazione Italo-Brasiliana di Ematologia Viale Benedetto XV 16100 - Genoa GE Italy Eurasian Hematology Oncology Group Board of Directors President Giuseppe Saglio Vice-President Birol Guvenc General Secretaryehmus Ertop Member Ahmad Ibrahim, Lebanonn Member Burhan Ferhanoglu, Turkiye Member Carmino de Souza, Brazil Member Claudio Cerchione, Italy Member Jean FranO´ ois Rossi, France Member Moshe Mittelman, Israel Member Tariq Mughal, USA Member Vera Donnenberg, USA Eurasian Hematology Oncology Group www.ehog.net - sekreterlik@hematoloji.org.tr Yurt Mahallesi Kurttepe Cad. 71517 Sokak No.2 Sabahattin Akg€un Apt. Kat.1 Daire.1 ¸Cukurova - Adana Phone: 00 90 555 881 01 99 Sociedade Brasileira de Oncologia Pedi atrica Board of Directors - 2021-2022 President Nevi¸colino Pereira de Carvalho Filho 1st Vice-President Flavia Delgado Martins 1st SecretaryCarla Renata Pacheco Donato Macedo 1st Treasurer Tatiana El Jaick Bonif acioCosta 2nd Vice-President Mario Jos e Aguiar de Paula 2nd SecretaryMaristella Bergamo Francisco dos Reis 2nd Treasurer Carolina Madalena Souza Pinto Alvares Members of Advisory Board Andrea Maria Capellano, Elione Soares de Albuquerque, Elvis Terci Valera, Simone dos Santos Aguiar, Val eria Pereira Paiva Sociedade Brasileira de Oncologia Pedi atrica www.sobope.org.br - sobope@uol.com.br / sobope@sobope.org.br 94/53 04077-020 S~ao Paulo-SP Phone: 55 11 5052-7537
TaggedH1CONTENTSTaggedEnd Editorial Equity program: strategies on clinical studies as an aggregating potential Edvan de Queiroz Crusoe, Abrah~ao Elias Hallack Neto, Deise Ferreira Nantes, Eduardo Flavio Oliveira Ribeiro, Fernando Monteiro Correia Pinto, Jaisson Andre Pagnoncelli Bortolini, James Farley Rafael Maciel, Jose Francisco Comenalli Marques Junior, Lorena Costa Corr^ea, Marcelo Eduardo Zanella Capra, Maria do Perp etuo Socorro Sampaio Carvalho, Nelcivone Soares de Melo, Rafaela Vasques de Oliveira Quintas, Thiago Xavier Carneiro, Violete Petitto Laforga and Renato Luiz Guerino Cunha ....................... 417 Original Articles Natural killer cells 56bright16 have higher counts in the umbilical cord blood than in the adult peripheral blood Vinicius Campos de Molla, Míriam Cristina Rodrigues Barbosa, Alfredo Mendrone Junior, Matheus Vescovi Gon¸calves, Eliza Kimuraa Fabio Guirao, Mihoko Yamamoto and Celso Arrais-Rodrigues ................................................................................................ ................................ 419 Correlation of serological and molecular markers in the screening for hepatitis B virus in blood bank in northern Brazil Lucas Jos e do Nascimento Cruz, Katarine Antonia dos santos Barile and Carlos Eduardo de Melo Amaral ................................................................................................ .................. 428 Lactate dehydrogenase as a hematopoietic stem cell mobilization biomarker in autologous transplantation Perla R. Colunga-Pedraza, Mariela Irabien-Zu~niga, Carlos Sa ul Rodriguez-Roque, Carlos de la Cruz-de la Cruz, Andr esG omez-DeLe on, Paola Santana-Hern andez, Jos e Carlos Jaime-P erez, Consuelo Mancías-Guerra and David G omez-Almaguer .................................... 435 A survey on insight of blood donors during COVID pandemic in Southern India Deepika Chenna, Dhivya Kandasamy, Ganesh Mohan, Kalyana Chakravarthy Pentapati and Shamee Shastry ................................................................................................ ........................................... 442 Genotyping of the rare Para-Bombay blood group in southern Thailand Yanisa Rattanapan, Nurdina Charong, Sodsai Narkpetch and Takol Chareonsirisuthigul ....................... 449 To study the effect of ‘Covishield’ vaccination on pre-donation platelet counts of plateletpheresis donors Akshaya Tomar, Amit Kumar Biswas, Amit Pawar, Ujjwal Dimri, Deepak Kumar and Ajay Kumar Baranwal ................................................................................................ ................................. 456 Platelet transfusion in patients with liver cirrhosis cross-talk with neutrophil: Prospective study Mona Mahmoud Hassouna, Mohammed Sayed Mostafa, Hazem Metwally Omar, Esraa Azab Mohammed and Heba Mohamed Abdallah ............................................................................. 461 Lipidsprofile in children and adolescents withb-thalassemia major Hayder Kadhim Jabbar, Meaad Kadhum Hassan and Lamia Mustafa Al-Naama .................................... 467 TaggedFigure TaggedEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedFigure TaggedEnd Volume45•Number 4•October/December 2023
Review Articles Antibiotic prophylaxis in acute childhood leukemia: What is known so far? Mauro Cesar Dufrayer, Yasmine Massaro Carneiro Monteiro, Fabianne Altruda de Moraes Costa Carlesse, Fabrizio Motta, Liane Esteves Daudt and Mariana Bohns Michalowski ..................................... 473 Correlation between ABO blood type, susceptibility to SARS-CoV-2 infection and COVID-19 disease severity: A systematic review Danyela Martins Bezerra Soares, David Augusto Batista S aAra ujo, Jorge Luiz de Brito de Souza, Rebeca Bessa Maurício, Emanuela Martins Bezerra Soares, Franklin de Castro Alves Neto, Maria Suelly Nogueira Pinheiro, Vitor Carneiro de Vasconcelos Gama, Pedro Braga-Neto, Paulo Ribeiro N obrega and Gislei Frota Arag~ao .......................................................................................... 483 Case Reports Anaplastic multiple myeloma with amplification of the IGH-CCND1 gene fusion Rafael Nobrega Alencar, Gracia Aparecida Martinez, Maria Gabriella Cordeiro and Elvira D R P Velloso ................................................................................................ ...................................... 495 Thrombotic thrombocytopenic purpura as initial presentation of HIV in pregnancy Ebellins Tabares Calvache, J ulia Plentz Portich, Tayse Yone Barbeta and Cristiane Seganfredo Weber ................................................................................................ ........................ 499 The tale of two organs: allogeneic hematopoietic stem cell transplantation following liver transplantation in a myelofibrosis patient Donald J. Bastin, Gillian Mount, Cyrus C. Hsia, Mohammad Jarrar, Kit McCann, Anargyros Xenocostas, Anouar Teriaky and Uday Deotare .............................................................................................................. 502 Primary intraocular lymphoma: case report and proposed diagnostic algorithm Pedro Giovanini Lopes, Fl avio Calice Ferreira, T ulio Christofoletti and Evaldo Pasquini Landi .................. 505 Daratumumab for donor-specific anti-HLA antibody desensitization in a case of HLA-mismatched allogeneic stem cell transplantation Uroosa Ibrahim and Alla Keyzner ............................................................................................................... 510 Letters to the Editor Characterization of convalescent plasma: Findings reported between aliquots of donors and units processed in a Blood Bank in Lima-Peru Alfredo Goytendia, Veralucia De la Vega and Ina Perez .............................................................................. 513 Fluorescence in situ hybridization (FISH) in imprint of biopsies suspected of lymphoproliferative neoplasms: report on 17 cases Roberta Maria da Silva Oliveira Safranauskas, Denise da Cunha Pasqualin, Renata Kiyomi Kishimoto, Maria Marta Silva, Cristina Kaori Oki, Renee Zon Filippi, Alanna Mara Pinheiro Sobreira Bezerra and Elvira Deolinda Rodrigues Pereira Velloso ................................................................................................... 516 Images in Clinical Hematology Acute monocytic leukaemia with histiocytic differentiation and erythrophagocytosis Ver onicaRold an Galiacho, Xabier Martin Martitegui, Maite Moreno Gamiz, Javier Arzuaga-Mendez, Elena Amutio and Juan Carlos García-Ruiz ................................................................................................. 519 Anaplastic morphology in IgD multiple myeloma Ver onicaRold an Galiacho, Maite Moreno Gamiz, Idoya Ancin Arteaga, Marta Alonso Varela, Elena Amutio Díez and Juan Carlos García-Ruiz ......................................................................................... 521
Editorial Equity program: strategies on clinical studies as an aggregating potential Edvan de Queiroz Crusoe a,*,Abrah~ao Elias Hallack Neto b, Deise Ferreira Nantesc, Eduardo Flavio Oliveira Ribeiro d, Fernando Monteiro Correia Pinto e, Jaisson Andre Pagnoncelli Bortolini f, James Farley Rafael Maciel g, Jose Francisco Comenalli Marques Junior h, Lorena Costa Corr^ea i, Marcelo Eduardo Zanella Capra j, Maria do Perp etuo Socorro Sampaio Carvalhok, Nelcivone Soares de Melol, Rafaela Vasques de Oliveira Quintas m, Thiago Xavier Carneiro n, Violete Petitto Laforgao, Renato Luiz Guerino Cunha p aHospital Universit ario Professor Edgard Santos da Universidade Federal da Bahia (HUPES UFBA), Rede D’or Oncologia, Salvador, BA, Brasil bUniversidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica M edica. Hospital Albert Sabin de Juiz de Fora, Juiz de Fora, MG, Brasil c Hospital Santa Casa de Miseric ordia de Campo Grande e Grupo GSH, Campo Grande, MS, Brasil dServi¸co de Hematologia e Oncologia do Hospital Santa L ucia, DF, Brasil e Oncologia Am ericas, Rio de Janeiro, RJ, Brasil f Clinica oncol ogica SOMA, Florian opolis, SC, Brasil g Hospital Rio Grande, Natal, RN, Brasil hHospital Vera Cruz, Benefic^encia Portuguesa, Campinas, SP, Brasil i Centro Universit ario Integrado Amaury de Medeiros - Universidade de Pernambuco (UPE), Hospital das Clínicas da Universidade Federal de Pernambuco, Grupo Oncoclínicas, Recife, PE, Brasil j Grupo Hospitalar Concei¸c~ao, Hospital Nossa Senhora da Concei¸c~ao, Porto Alegre, RS, Brasil kFunda¸c~ao de Hematologia e Hemoterapia do Estado do Amazonas (HEMOAM), Brasil l HEMOLABOR Laborat orio e Pesquisas, Goi^ania, GO, Brasil mHospital de Clínicas Doutor Alberto Lima, Hospital S~ao Camilo e S~ao Luis, Macap a, AP, Brasil nHospital Ophir Loyola, Bel em, PA, Brasil oUnimed de Ponta Grossa, Ponta Grossa, PR, Brasil pGrupo Oncoclínicas, S~ao Paulo-SP, Instituto Oncoclínicas, Rio de Janeiro, RJ, Brasil ARTICLE INFO Article history: Available online 13 July 2023 * Corresponding author at: Hospital Universit ario Professor Edgard Santos da Universidade Federal da Bahia (HUPES UFBA), R. Dr. Augusto Viana, s/n - Canela, Salvador, BA CEP 40110-060, Brasil. E-mail address: edvancrusoe@gmail.com (E.d.Q. Crusoe). https://doi.org/10.1016/j.htct.2023.07.001 2531-1379/ 2023 Published by Elsevier España, S.L.U. on behalf of Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). hematol transfus cell ther. 2023;45(4):417−418 Hematology, Transfusion and Cell Therapy www.htct.com.br
The principle of health equity aims at equal access by all population diversities, mainly the most vulnerable ones. When it comes to the Brazilian public Unified Health System (SUS) and granting somehow access to different individuals, we still have many challenges. One challenge is the availability of new technologies, a major advance, but it tends to create imbalance between the public and supplementary health sectors, especially because of the cost involved in the process and delay of these technologies in getting to the public sector. Pondering over the aspect of equity and technological development, a tool that can substantially help is clinical research. The Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH), through its Equity Program, recognizes that there is a possible convergence with this aspect and understands the importance of clinical trials for the principle of equity, once the most modern technology is linked to trials, not only in terms of therapy, but diagnosis as well, among other possibilities. Social disparities cause discomfort to the minds and hearts of true humans, and we from ABHH live with this concern. We live and work in the attempt to reduce imbalances and inequalities. We have effectively achieved some victories in making life more egalitarian. However, extra efforts should be devoted so we can successfully accomplish this aim. Essentiality points out the minimum and what, in fact, every individual needs, and the role of SUS is fundamental. It is internationally acknowledged by many as a model and carries out several population health actions. Concerning the hematologic specialty, challenges are plenty. We have few specialists and unfortunately, despite all the hard efforts made to reach the most distant corners, allowing the system capillarization, not every individual can have access to what they need. Hematology and Transfusion Medicine is a complex specialty for the management of cases and is also pioneer in the development of technologies. As a result, the specialty uses this to evolve in dealing with patients and their specificities. A critical point for general health equity, but mainly for the specialties demanding constant implementations, such as hematology, reflects in the added cost of such novelties. Unfortunately, the price of new technologies strongly contributes to limit and/or delay their arrival in SUS, making the public system inharmonious compared to the supplementary system. Health research is indispensable for moving towards our evolution and, undoubtedly, it aims at a more fulfilling and decent life. It is in constant evolution with even more enhanced rules after the Second World War. An important evolution in the clinical research model were the steps of technological development by study phases until culminating in the best model, namely the randomized trials. In these trials, individuals are randomly allocated to different groups with the purpose of obtaining a balanced sample, in other words, in balance; and then proving that there is an advantage in terms of evolution when comparing the new technology with the previous one. However, recently, still in this process of improving clinical trials, both American and European regulatory agencies have identified an imbalance concerning the type of participants on studies based on skin color and ethnicity, and they have started to demand greater participation of Black and non-white people in new trials.1 Therefore, clinical trials, randomized or not, contemplate the principle of equity at all times and keep improving. Other data advantageous to clinical research is the fact that these studies are sponsored by the pharmaceutical industry. Some will criticize, alleging that patients are offered like guinea pigs so companies can profit even more with their new treatments or tools. On the other hand, these research studies were responsible for extensively changing the course of modern medicine, unquestionably aggregating new technologies and improvements. Keep in mind that in our country it is required that patients have all research expenses covered by the sponsor, thus, decreasing the costs to the health system instead of increasing them. This whole combination for a country as Brazil, so diverse and with limitations of access to new technologies, mainly in SUS, favors patients towards equity in research participation. ABHH, along with its equity committee, has been playing a leading and key role to identify, understand, and correct potential limiting factors within hematology, transfusion medicine and cellular therapy in order to support and enhance the whole principle of equity. Within our specialty, there is a frenetic technological development and sensitizing our colleagues who develop clinical research to a joint growth with the population, in the most different places of Brazil, will be of paramount importance to allow us to follow the right track for equity expansion. We hope to change the premise that what is new and best comes first just for a few people. Let us foster the principle of equity with the implementation and encouragement for the development of clinical research, which undoubtedly adds value to everyone independently, but mainly to SUS. Conflicts of interest The authors declare no conflicts of interest. reference 1. Birhiray MN, Birhiray RE. Practical strategies for creating diversity, equity, inclusion, and access in cancer clinical research: DRIVE. Blood Adv. 2023;7(8):1507–12. 418 hematol transfus cell ther. 2023;45(4):417−418
Original article TaggedH1Natural killer cells 56 bright16 have higher counts in the umbilical cord blood than in the adult peripheral bloodTaggedEnd TaggedPVinicius Campos de Molla a,b, Míriam Cristina Rodrigues Barbosaa, Alfredo Mendrone Juniorb, Matheus Vescovi Gon¸calvesa,*, Eliza Kimuraa Fabio Guiraoa, Mihoko Yamamotoa, Celso Arrais-Rodriguesa,b TaggedEnd TaggedP aUniversidade Federal de S~ao Paulo (Unifesp), S~ao Paulo, SP, Brazil bHospital 9 de Julho, S~ao Paulo, Brazil TaggedEnd TAGGEDPARTICLE INFO Article history: Received 31 January 2022 Accepted 3 July 2022 Available online 19 August 2022TaggedEnd TAGGEDPA B S T R A C T Introduction and hypothesis: Umbilical cord blood (UCB) is an alternative source of hematopoietic stem cells for allogeneic hematopoietic stem cell transplantation in the absence of a compatible donor. The UCB transplantation has a lower incidence of chronic graft versus host disease (GvHD), but is associated with slower engraftment and slower immune reconstitution, compared to other sources. Dendritic cells (DCs) and Natural Killer cells (NKs) play a central role in the development of GvHD and the graftversusleukemia (GvL) effect, as well as in the control of infectious complications. Method: We quantified by multiparametric flow cytometry monocytes, lymphocytes, NK cells, and DCs, including their subsets, in UCB samples from 54 healthy newborns and peripheral blood (PB) from 25 healthy adult volunteers. Results: In the UCB samples, there were higher counts of NK cells 56bright16 (median 0.024£109/L), compared to the PB samples (0.012£109/L, p<0.0001), NK 56dim16bright (median 0.446£109/Lvs. 0.259£109/L for PB samples, p= 0.001) and plasmacytoid dendritic cells (pDCs, median 0.008£109/ L for UCB samplesvs.0.006£109/L for PB samples, p= 0.03). Moreover, non-classic monocyte counts were lower in UCB than in PB (median 0.024£109/Lvs.0.051£109/L, respectively, p<0.0001). Conclusion: In conclusion, there were higher counts of NK cells and pDCs and lower counts of non-classic monocytes in UCB than in PB from healthy individuals. Thesefindings might explain the lower incidence and severity of chronic GvHD, although maintaining the GvL effect, in UCB transplant recipients, compared to other stem cell sources. 2022 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).TaggedEnd TaggedEndTaggedPKeywords: Plasmacytoid dendritic cell Natural killer cells Umbilical cord blood Peripheral bloodTaggedEnd TaggedH1IntroductionTaggedEnd TaggedPIn the last few years, allogeneic hematopoietic stem cell transplantation (HSCT) has improved clinical outcomes, with less transplant-related mortality (TRM) and better overall survival (OS).1 Despite the advance in the knowledge of immune TaggedEnd * Corresponding author at: Universidade Federal de S~ao Paulo (Unifesp), Rua Diogo de Faria, 824, CEP: 04037-002, S~ao Paulo, Brazil. E-mail address: https://doi.org/10.1016/j.htct.2022.07.001 2531-1379/ 2022 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). TaggedEndhematol transfus cell ther. 2023;45(4):419−427 TaggedFigure TaggedEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedFigure TaggedEnd
TaggedEndTaggedPreconstitution in HSCT, there are still gaps in this field, such as the mechanisms of immunotolerance, graft-versus-hostdisease (GvHD) or graft-versus-leukemia (GvL) effect.2 TaggedEnd TaggedPThe umbilical cord blood (UCB) transplant was performed for the first time in 1988.3 The UCB transplant is associated with delayed engraftment, increased risk of infections, greater engraftment failure and worse TRM, compared to bone marrow (BM) and peripheral blood (PB) sources.4 However, the UCB transplant usually causes less acute GvHD (aGvHD) and chronic GvHD (cGvHD) with similar rates of leukemia-free survival.5 This could be explained by distinctive patterns of immune reconstitution according to the graft source,6 regardless of the conditioning regimen.7 TaggedEnd TaggedPDendritic cells (DCs) are antigen-presenting cells, making the connection between innate and adaptive immunity,8 as well as coordinating the immune system through activation and stimulation of T and B cells, the tolerance by removal of self-reactive T cells 9 and the linkage with regulatory T cells.10 So, the DCs play a key role in the immune system control. In the PB, the DCs are present in two subsets: myeloid (or conventional) DCs (mDCs) and plasmacytoid DCs (pDCs). The pDCs (CD123+CD11c) produce interferon (IFN) I and are implicated in the viral immune response, immune tolerance and memory. At the same time, mDCs (CD123-CD11c+) are responsible for a proinflammatory effect. Each DC subset is flexible in vivo and its responses vary according to factors, such as its activation state, the nature of the stimulus received and the inflammatory microenvironment.11 In the immune recovery after the HSCT, the DCs play a relevant role in the aGvHD, cGvHD, GvL and host response to infections,12 while a poor DC reconstitution is associated with an increased risk of relapse and poor survival.13,14 TaggedEnd TaggedPThe NKT cells (NKTs) are T cells that express NK receptors, including NK 1.1 (CD161c) and semi-invariant CD1drestricted ab T-cell receptors (TCRs). There are two types of NKTs: the type I NKT (or iNKT), that expresses the Va24-Ja18, and the type II NKT that expresses TCRs other than the Va24-Ja18. 15 TaggedEnd TaggedPNatural killer cells (NKs) are components of the innate immune system, eliminating tumor and infected cells, promoting cellular lysis in the absence of the HLA class I receptor. The NK cells are categorized as the NK 56dim16bright (90% of NKs in PB), with a predominant cytotoxic effect through the release of granzyme B and perforin, and the NK 56bright16 , related to the interferon gamma (INFg) andtumor necrosis factor a (TNF-a) secretion. 16 The NKs are the first cells to recover after the HSCT and strongly contribute to the GvL effect, possibly due to the killer-cell immunoglobulin-like receptor (KIR) mismatch.17 It has been shown that low counts of the NK 56bright16 after the HSCT are associated with a lower survival rate 18 and that KIR mismatches improve survival.19 TaggedEnd TaggedPTo better understand the mechanisms involved in different outcomes in the HSCT using UCB or PB, we compared the composition of immune-related cells in these two HSC sources (monocytes, B lymphocytes, T cells, NK cells and DCs and their subsets) in samples of UCB and PB.TaggedEnd TaggedH1MethodsTaggedEnd TaggedH2Population and designTaggedEnd TaggedPThis was a descriptive study. Samples of 54 UCB and 25 PB were collected between September 2015 and July 2017. UCB samples from healthy newborns, with a minimum gestational age of 35 weeks, were collected at the Cellular Therapy Center of the Hospital Sírio Liban^es (before freezing). The UCB from neonates with any antenatal risk factors were excluded. The PB samples were collected from healthy adult blood donors at the Hospital S~ao Paulo / UNIFESP Blood Center. The blood donors and pregnant women who agreed to donate the UCB (both ≥ 18 years old), without any documented chronic illness or infectious disease, entered the study. The blood donor volunteers who had received blood transfusion in the last 3 months were excluded.TaggedEnd TaggedPThe study was approved by the local ethics committee of the participating centers and all volunteers (blood donors and mothers) gave their informed consent before entering the study, in accordance with the Declaration of Helsinki.TaggedEnd TaggedH2Cell identification and count byflow cytometryTaggedEnd TaggedPFresh EDTA-anticoagulated PB or UCB samples were processed in up to 24 hours after collection. The total number of nucleated cells from the UCB was quantified by the Coulter AcTDiff 2 (Beckman Coulter, Brea, USA) and the PB cells, by the Cell Dyn Ruby (Abbott, Illinois, USA), and the erythroblasts were quantified by microscopy to correct the leukocyte count. Leukocytes and subsets were analyzed byflowcytometry.TaggedEnd TaggedPCells were stained using an 8-color monoclonal antibodies panel (Table 1): CD16 FITC / CD56+CD4 PE / CD11c PerCP Cy5.5 / CD8+CD19 PC7 / CD123 APC / CD3+CD14 APC-H7/ HLA-DR Pac Blue/ CD45 OC-515, by the stain-lyse-wash method. The reagents were purchased from: Cytognos, Salamanca (CD16, CD56, CD4, CD45), BDB, San Jose, CA (CD11c, CD3, CD14), TaggedEnd Table1 – Monoclonal antibodies used. Monoclonal antibody Company Clone FITC CD16 Cytognos 3G8 PE CD56 Cytognos C5.9 CD4 Cytognos Edu-2 PerCP Cy5.5 CD11c BD Biosciences B-ly6 PC7 CD8 Immunotech SFCI21Thy2D3 CD19 Immunotech J3-119 APC CD123 Biolegend 6H6 APC-H7 CD3 BD Biosciences SK7 CD14 BD Biosciences MɸP9 PB HLA-DR Biolegend L243 OC-515 CD45 Cytognos GA90 TaggedEnd420 hematol transfus cell ther. 2023;45(4):419−427
TaggedEndTaggedPImmunotech Brea (CD8), Immunotech Marseille (CD19) and Biolegend, San Diego (HLA-DR, CD123). Data acquisiton: 500,000 events for each sample tube were performed using the FACSCANTOII flow cytometer (BDB- San Jose, CA) and the FACsDIVA software (BDB- San Jose, CA) and the Infinicity software (Cytognos, SL) was used for data analysis. The NK cells (CD3-, CD19-, CD14- and CD56+), were classified as NK 56bright16 orNK56dim16bright. Monocytes (CD45+, CD11c+ and HLA-DR+) were classified as: classic (CD14++CD16-), TaggedEndTaggedPintermediate (CD14++CD16+) and non-classic (CD14 dimCD16+ +). Dendritic cells (HLA-DR++, CD3-, CD19-, CD14- and CD56-) were classified as pDC (CD123+/ CD11c-) and mDC (CD123-/ CD11c++) (Figure 1−3).TaggedEnd TaggedH2Statistical methodsTaggedEnd TaggedPThe descriptive statistical analysis was reported by using percentages (categorical variables) and ranges and medians TaggedEnd TaggedFigure Figure 1–Dot plot graphs of flow cytometry analyses showing gating strategy to natural killer cell identification. NK cells have small size and complexity, strong CD45, are negative for CD3 and HLA-DR and have positive CD56 (A−E). They are further divided into two subpopulations: NK CD56++/CD16- and NK CD56+/CD16+.TaggedEnd hematol transfus cell ther. 2023;45(4):419−427 421
TaggedEndTaggedP (continuous variables). Comparisons between UCB and PB were performed using the Mann-Whitney test. Ap-value of < .05 was considered significant. The SPSS version 21.0 (SPSS Inc., Chicago, IL) was used for all statistical analyses.TaggedEnd TaggedH1ResultsTaggedEnd TaggedH2Clinical characteristicsTaggedEnd TaggedPSeventy-nine samples (54 UCB and 25 PB) were obtained. The UCB samples were collected from newborns with a median gestational age of 40 weeks (range: 36 to 43 weeks) and birth weight of 3.263kg (range: 2.530 to 4.005kg). Twenty-nine (54%) newborns were male. Vaginal delivery was more commonly used (74%) than the cesarean section (26%). The PB sample donor median age was 33 years old (range 18 to 66 years old) and 15 (60%) were male.TaggedEnd TaggedH2Absolute counts of WBCs and subpopulationsTaggedEnd TaggedPThe total white blood cell (WBC) count was higher in the UCB than in the PB (10.782 £109 vs. 6.980 £109, p < 0.0001). The total number of cells from most lineages (neutrophils, eosinophils, monocytes and B cells) were higher in the UCB, while TaggedEndTaggedPtotal T cells, NK cells and total DCs were similar in both groups (Table 2). Among subpopulations, many differences were noted: non-classic monocytes, double positive CD4+CD8 + T cells and double negative CD4-CD8- T cells were in higher counts in the PB than in the UCB (0.051 £109 vs. 0.024 £109, p <0.0001; 0.005 £109 vs. 0.001 £109, p <0.0001; 0.054 £109 vs. 0.039 £ 109, p = 0.005, respectively). However, the pDCs were in lower counts in the PB than in the UCB (0.006£109 vs. 0.008 £109, p = 0.03, Table 3). No significant statistical difference was observed in mDC counts between the groups.TaggedEnd TaggedH2Relative frequencies of WBCs and subpopulationsTaggedEnd TaggedPThe proportion of B cells and NK cells were higher in the UCB samples when compared to the PB samples (16% vs. 11%, p<0.0001; 20%vs. 11%, p<0.006, respectively).TaggedEnd TaggedPIn terms of relative frequencies of subpopulations, classic monocytes were the predominant subset, being present in a higher count in the UCB vs. the PB (89% vs. 77%, p < 0.006 £ 109), respectively. The classic monocytes:nonclassic monocytes ratio was 28.3 in the UCB and 7.0 in the PB (p<0.0001).TaggedEnd TaggedPThe T cells CD4+ were more prevalent than the T cells CD8 + in both the PB and the UCB (CD4: CD8 ratio 1.8 and 2.3, TaggedEnd TaggedFigure Figure 2–Dot plot graphs of flow cytometry analyses showing gating strategy to natural killer cell identification. NK cells have small size and complexity, strong CD45, are negative for CD3 and HLA-DR and have positive CD56 (A−E). They are further divided into two subpopulations: NK CD56++/CD16- and NK CD56+/CD16+.TaggedEnd TaggedEnd422 hematol transfus cell ther. 2023;45(4):419−427
TaggedEndTaggedPrespectively), while the T cells CD8+ were more frequent in the PB (31%) than in the UCB (27%, p=0.03).TaggedEnd TaggedPThe NK cells 56dim16bright counts were the predominant subset in both samples (96% and 93%, PB and UCB, respectively). The ratio between the subtypes (NK cell NK 56dim16bright:NK56bright16 ) was lower in the UCB (13.7) vs. the PB (24, p = 0.03). NK 56dim16bright proportions of the pDC in the UCB, compared to the PB from normal adultsTaggedEnd TaggedPThe mDCs were the predominant subtype in both the PB and UCB, being 3 times the number of pDCs in the PB and 1.8 times the number of pDCs in the UCB. However, there was no difference in mDC absolute counts between the two groups. The pDC proportion was 25% in the PB and 36% in the UCB (p<0.0001). The mDC:pDC ratio was 3.0 in the PBvs.1.8 in theUCB (p<0.0001).TaggedEnd TaggedPThe CD4:CD8 ratio was higher in the UCB (2.3) than in the PB (1.8, p = 0.01), and the NK cell NK 56dim16bright:NK 56bright16 ratio was lower in the UCB (13.7) vs. the PB (24, p= 0.03). The intermediate monocytes:non-classic monocytes ratio was 28.3 in the UCB and 7.0 in the PB (p < 0.0001) (Figure 4).TaggedEnd TaggedH1DiscussionTaggedEnd TaggedPIn the present study, we compared concentrations (cells per liter) and frequencies (%) of WBCs and subsets in the TaggedEndTaggedPUCB and PB from healthy individuals and observed higher counts and frequencies of the NK 56bright16 NK cells and pDCs and lower counts and frequencies of non-classic monocytes in the UCB.TaggedEnd TaggedPTo the best of our knowledge, this is the first study that compared subsets of the NK (NK 56dim16bright and NK 56bright16 ) between the UCB and PB. The NK 56bright16 is a more immature NK cell, presenting a more humoral immune response profile, secreting the INF-g, TNF-a, IL-10, IL-13 and granulocyte-macrophage colony-stimulating factor, rather than the direct cytotoxic effect of the NK 56dim16bright. They usually do not present KIR receptors and present higher expressions of the heterodimer CD94/ NKG2A (major inhibitor receptor), which confers a lower alloreactivity than their more mature NK 56dim16bright counterpart.20 Therefore, there are higher counts and higher frequencies of NK 56bright16 NK cells and plasmacytoid dendritic cells in the UCB than in the PB.TaggedEnd TaggedPOf interest, the monocyte maturation was clearly more evident in the PB than in the UCB samples. The PB showed high proportions of the late phases of monocyte differentiation, such as intermediate and non-classic monocytes, which was also observed by some previous studies.21 These populations represent a shift towards higher antigen-presenting activity and they are considered as monocyte-derived DCs 22 and are also being related to autoimmune diseases, such as rheumatoid arthritis and Crohn’sdisease.23 TaggedEnd TaggedEnd TaggedFigure Figure 3–Dot plot graphs of flow cytometry analyses showing gating strategy to monocyte identification. Monocytes have higher size and complexity than lymphocytes, CD45+, CD14+, strong HLA-DR and CD11c (A−E). They were further divided into classic (CD14+CD16-), intermediate (CD14+CD16+) and non-classic (CD14low/CD16+) (F).TaggedEnd hematol transfus cell ther. 2023;45(4):419−427 423
TaggedPWe found higher counts of pDCs in the UCB than in the PB, corroborating the findings of Prabhu SB et al. 21; the pDC produces the IFN type I, which is related to antiviral response, immune tolerance and anti-tumor immunity through secretion of the type-I IFN and TNF-a. 24 Moreover, our group previously demonstrated that grafts with a high pDC content lead to a lower aGVHD and lower mortality risk after the HSCT.18 TaggedEnd TaggedPThe GvHD is a reaction caused in part by donor alloreactive T CD8+ and T cell depletion (in vivo or ex vivo), which is a common strategy to mitigate this complication.25,26 Here we demonstrated TaggedEndTaggedPa higher concentration of the T CD8+ in the PB, compared to the UCB, as has been shown in previous studies.27−29 TaggedEnd TaggedPAll these findings in the PB: more mature monocytes, a higher concentration of T CD8+ and lower counts of pDC and NK56bright16 , compared to the UCB, might explain the higher incidence of the cGvHD when the PB is used as a stem cell source for the HSCT.30 Conversely, the more tolerogenic profile observed in the UCB, compared to the PB, could explain the lower risk of the cGvHD with similar relapse rates as evidence of the sustained GvL effect.5,31,32 TaggedEnd TaggedEnd TaggedFigure Figure4–Concentrations of lymphocytes, CD4 T cells, NK cells, dendritic cells and monocytes and respective subsets in PB and UCB samples.TaggedEnd TaggedEnd424 hematol transfus cell ther. 2023;45(4):419−427
TaggedPOur study has limitations, such as small sample size and the use of PB samples without the stimulation of granulocyte colony-stimulating factors, as commonly used for the HSCT, which could change the cells counts and frequencies.TaggedEnd TaggedH1ConclusionTaggedEnd TaggedPIn conclusion, we observed higher counts of NK 56 bright16 cellsand pDCs and lower counts of non-classic monocytes in the UCB, compared to the PB from healthy individuals. Even though the PB analyzed in this study was not obtained through apheresis, our findings could suggest that the UCB cell profile is more tolerogenic than the PB and thisfinding might explain the lower incidence and severity of the cGVHD in UCB recipients, compared to other stem cell sources, although maintaining the GVL effect. Future research is needed for a better understanding of immune reconstitution in the HSCT and to explain the differences regarding immune TaggedEndTaggedPreconstitution and the GvHD risk, the GvL effect and other clinical outcomes in the HSCT among different stem cell sources.TaggedEnd TaggedH1Authorship statementTaggedEnd TaggedPM.C.R.B., V.C.M, M.V.G. and C.A.R. designed the research, performed research, analyzed data and wrote the paper; V.C.M, M.V.G. and C.A.R. performed statistical analysis; A. M. J. and C. A. A provided cord blood samples, M.C.R.B., M.Y. and M.V. G. performed flow cytometry analysis, critical review and revised the manuscript. All authors drafted and approved the manuscript and agreed with its submission.TaggedEnd TaggedH1Financial Disclosure StatementTaggedEnd TaggedPThe authors have nothing to disclose.TaggedEnd TaggedEnd Table 2 – Relative distribution and absolute counts of total leukocytes, neutrophils, eosinophils, monocytes, lymphocytes (T-cells, B cells and NK cells) and dendritic cells in peripheral blood and umbilical cord blood samples. Cellular population PBN% UCBN% P PBNx109/L UCBNx109/L P WBC 6.98 (4.44−13.9) 10.78 (3.74−17.38) <.0001 Neutrophils 60%(35−70) 60%(25−78) NS 4.38 (1.64−9.53) 6.46 (1.51−12.1) <.0001 Immature Neutrophils .2%(0−.9) 5%(0−20) <.0001 .007 (.00−0.43) .30 (.00−1.52) <.0001 Eosinophils 2%(.2−5.6) 3%(.7−9) NS 1.53 (.01−.43) 3.38 (.085−.73) <.0001 Monocytes (total) 5.5%(3−8.4) 9%(2.6−23) <.0001 .44 (.23−.67) 1.03 (.18−2.58) <.0001 Lymphocytes (total) 30%(21−55) 26%(12−57) .052 1.91 (1.49−3.88) 2.75 (.89−4.97) <.0001 T-cells 75%(55−85) 61%(37−82) .0001 1.57 (.83−3.09) 1.64 (.55−3.16) NS B-cells 11%(7−21) 16%(4−31) <.0001 .23 (.11−.51) .43 (.06−1.53) <.0001 NKcells 11%(2−37) 20%(5−46) <.006 .27 (.06−.71) .48 (.14−1.38) <.0001 Dendritic cells .33 (.24−79) .22 (.07−.76) <.0001 .024 (.01−.06) .024 (.016−.08) NS PBPeripheral blood, UCBUmbilical cord blood, WBC white blood count, pDCs plasmacytoid dendritic cells, mDCs myeloid dendritic cells. TaggedEnd Table3 – Relative distribution, absolute counts and ratios of monocytes, T-cells, NK cells and dendritic cells subpopulation. Cellular population PBN%* UCBN%* P PBNx109/L UCBNx109/L P Monocytes Classic (A) 77%(61−86) 89%(75−97) <.0001 .32 (.17−.57) .89 (.14−2.38) <.0001 Intermediate 9%(6−24) 8%(2−22) .017 .041 (.02−.14) .074 (.02−.22) <.0001 Non-classic (B) 11%(6−22) 3%(1−13) <.0001 .051 (.02−.11) .024 (.01−.15) <.0001 (A:B ratio) 7 28.3 <.0001 Tcells CD4+ 60%(33−85) 68%(47−84) .001 0.94 (.05−1.88) 1.11 (0.32−2.46) NS CD8+ 31%(12−60) 27%(13−47) .03 .45 (.22−1.04) 0.45 (.14−.78 NS (CD4:CD8 ratio) 1.8 2.3 .01 CD4+CD8+ .3%(0−.9) .1%(0−1.4) <.0001 .010 (.00−.01) .001 (.00−.03) .001 CD4-CD8- 4%(1.4−10) 2.5%(1−5) <.0001 .054 (.02−.14) .039 (.01−.10) .005 NKTcells .32 (.10−2.34) .27 (.05−.66) .07 .032 (.01−.23) .027 (.01−.06) .07 NKcells CD56dim/CD16+(C) 96%(76−99) 93%(72−99) .03 .26 (.05−.70) .45 (.01−1.35) .001 CD56bright/CD16-(D) 4%(1.5−24) 7%(1−29) .03 .01 (.01−.03) .02 (.01−.19) <.0001 (C:D ratio) 24 13.7 .03 Dendritic cells pDC 25%(14−41) 36%(14−62) <.0001 .006 (.003−.02) .008 (.001−.03) .03 mDC 75%(59−87) 64%(38−89) <.0001 .018 (.01−.05) .015 (.003−.06) NS (mDC:pDC ratio) 3 1.8 <.0001 PB Peripheral blood, UCB Umbilical cord blood, pDCs plasmacytoid dendritic cells, mDCs myeloid dendritic cells. hematol transfus cell ther. 2023;45(4):419−427 425
TaggedH1Conflicts of interestTaggedEnd TaggedPThere are no conflicts of interest to report.TaggedEnd TaggedH1AcknowledgmentsTaggedEnd TaggedPM.C.R.B. was supported by the Coordena¸c~ao de Aperfei¸coamento de Pessoal de Nível Superior (CAPES, No. 001). V.C.M. was supported by the Conselho Nacional de Desenvolvimento CientíficoeTecnol ogico (CNPq Process No. 141575/2018-2).TaggedEnd taggedh1referencestaggedend TaggedP 1. Improved survival after allogeneic hematopoietic stem cell transplantation in recent years. A single-center study. Biol Blood Marrow Transplant [Internet]. 2011;17(11):1688–97. Available from: http://linkinghub.elsevier.com/retrieve/pii/ S1083879111002072.TaggedEnd TaggedP 2. van den Brink MRM, Velardi E, Perales M-A. Immune reconstitution following stem cell transplantation. Hematology [Internet]. 2015;2015(1):215–9. Available from:. http://www. asheducationbook.org/cgi/doi/10.1182/asheducation2015.1.215.TaggedEnd TaggedP 3. 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