ISSN 2531-1379 VOLUME 46, ISSUE 3, JULY-SEPTEMBER, 2024 HEMATOLOGY TRANSFUSION AND CELL THERAPY
Instituições Programa de Apoio em Residência Médica em Hematologia, Hemoterapia e Terapia Celular. Estudantes Residentes CATEGORIA DE Especialistas Médicos ou outros profissionais da saúde. Programa Sangue Jovem, estudandes de graduação, participantes de Ligas Acadêmicas. Organização na área da saúde que desenvolva atividades na área da hematologia, hemoterapia e terapia celular. www.abhh.org.br ASSOCIADOS
pilares Conheça os Social Educação Ciência Carreira Eventos; Hemoteca; HEMO.educa; Webinars; Podcast. Acesso a Medicamentos; Equidade; Um Só Sangue. Consensos e Diretrizes; Revista Científica HTCT; Registros; Plataforma Pesquisa Clínica. Sangue Jovem; Programa de Apoio em Residência Médica; Títulos e Certificações. Qualidade Serviço de Acreditação; CQI - Controle de Qualidade de Imunohematologia. www.abhh.org.br
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. Editorial production by Elsevier Espa~na, SLU Avinguda Josep Tarradellas, 20-30, 1er piso 08029, Barcelona DL: B-26732-2017 No responsibility is assumed by Elsevier for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.
Board Of Directors 2022-2023 President Angelo Maiolino Vice-President Eduardo Magalh~aesRego Administrative Director Glaciano Nogueira Ribeiro Vice Administrative Director Silvia Maria Meira Magalh~aes Scientific Director Carmino Antonio de Souza Vice-Scientific Director Dimas Tadeu Covas Financial Diretor Celso Arrais Rodrigues da Silva Vice Financial Director Leny Nascimento da Motta Passos Director of Communications Renato Sampaio Tavares Vice-Director of CommunicationsVania T. de Moraes Hungria Director of Institutional RelationsCarlosS ergio Chiattone Vice-Director of Institutional RelationsDante Langhi Junior Director of Professional PracticeEdvan de Queiroz Cruso e Vice-Director of Professional PracticeJos e Francisco Comenalli Marques Jr Director Social Action BoardJorge Vaz Pinto Neto Vice-Director Social Action BoardViolete Petitto Laforga Emeritus Scientific Director Roberto Passetto Falc~ao General Manager AlineAch^e Deliberative Committee Elected 2022-2025 Thiago Xavier Carneiro Aderson da Silva Araujo Silvia Maria Meira Magalh~aes Renato Sampaio Tavares Karina Correia Barcelos Jo~ao Paulo de Oliveira Guimar~aes Angelo Maiolino Carla Luana Dinardo Eduardo Magalh~aesRego Monika Conchon Renato Luiz Guerino Cunha Rodolfo Delfini Can¸cado Talita Maira Bueno da Silveira Vanderson Rocha Vaneuza Araujo Moreira Funke Elected 2024-2027 Leny Nascimento da Motta Passos Edvan de Queiroz Cruso e Jorge Vaz Pinto Neto Gustavo Henrique Silveira Marcos Daniel de Deus Santos Amanda Pifano Soares Ferreira Glaciano Nogueira Ribeiro Adriana Alves Scheliga Clarisse Lopes de Casto Lobo Roberto Jos e Pessoa de Magalh~aes Celso Arrais Rodrigues da Silva Jos e Eduardo Bernardes Jos e Francisco Comenalli Marques J unior V^ania Tietsche de Moraes Hungria Violete Petitto Laforga 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 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 - 2023-2024 President Nevi¸colino Pereira de Carvalho Filho 1st Vice-President Flavia Delgado Martins 1st SecretaryMaristela Francisco dos Reis 1st Treasurer Carolina Madalena Souza Pinto Alvares 2nd Vice-President Mario Jos e Aguiar de Paula 2nd SecretaryAnnemeri Livinalli 2nd Treasurer Patrick Rezende Godinho 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 The Brazilian association of hematology, hemotherapy, and cell therapy (ABHH) and its absolute commitment to ethics and absence of conflicts of interest Carmino Antonio de Souza, Eduardo Magalh~aes Rego, Glaciano Nogueira Ribeiro, Silvia Maria Meira Magalh~aes, Celso Arrais Rodrigues da Silva, Leny Nascimento da Motta Passos, Dimas Tadeu Covas, Renato Sampaio Tavares, Vania T.de Moraes Hungria, Edvan de Queiroz Cruso e, Jos e Francisco Comenalli Marques Jr, Carlos S ergio Chiattone, Dante Langhi Junior, Jorge Vaz Pinto Neto, Violete Petitto Laforga and Angelo Maiolino ................................................................................................ 219 Original Articles Nucleated red blood cell: a feasible quality parameter of cord blood units Andrea Tiemi Kondo, Kelen Cristina Arcuri Alvarez, Andrea Neri Folchini Cipolletta, Araci Massami Sakashita and Jose Mauro Kutner ...................................................................................... 221 Impact of dose and storage duration of platelet concentrates on platelet recovery between ABO identical and ABO non-identical random donor platelet transfusions in hemato-oncology patients Niladri Das, Satya Prakash, Ansuman Sahu, Ashutosh Panigrahi, Debasish Mishra and Somnath Mukherjee ................................................................................................ ..................................... 228 Analyses of the soluble levels of sCD40L, sCD62P and sCD40 in pediatric sickle cell anemia patients with abnormal transcranial Doppler Cinthya Pereira Leite Costa de Ara ujo, Maria do Carmo Menezes Bezerra Duarte and Leuridan Cavalcante Torres ................................................................................................ ......................... 237 Impact of waitlist time on post-HSCT survival: a cohort study at a hospital in southern Brazil Tatiana Schnorr Silva, Jaqueline Driemeyer Correia Horvath, Mariana Pinto Pereira, Caroline Nespolo de David, Dora Fraga Vargas, Lisandra Della Costa Rigoni, Ivaine Tais Sauthier Sartor, Luciane Beatriz Kern, Priscila de Oliveira da Silva, Alessandra Aparecida Paz, Liane Esteves Daudt and Claudia Caceres Astigarraga ................................. 242 Prognostic implications of theID1expression in acute myeloid leukemia patients treated in a resource-constrained setting Aleide S. Lima, Matheus F. Bezerra, Amanda Moreira-Aguiar, Isabel Weinh€auser, Bianca L. Santos, Raul M. Falc~ao, Maria L. Salustiano-Bandeira, Pedro L. Franca-Neto, Marinus M. Lima, Felipe Saldanha-Araujo, Juan L. Coelho-Silva, Diego A. Pereira-Martins, Marcos A. Bezerra and Antonio R. Lucena-Araujo ................................................................................................ ............................ 250 Outcomes of patients after mobilization failure of hematopoietic stem cells for autologous stem cell transplantation Diego Vinicius Santinelli-Pestana, Livia Netto Chaer, Livia Mariano, Leonardo Jun Otuyama, Alfredo Medrone Junior and Vanderson Rocha ............................................................................................ 256 TaggedEnd TaggedFigure TaggedEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedFigure TaggedEnd
RHCE and Kell genotyping and alloimmunization profile in patients with sickle cell disease in the Federal District of Brazil Larissa Espíndola Leite, F abioGon¸calves da Silva, Simone Kashima, Evandra Strazza Rodrigues and Rodrigo Haddad ................................................................................................ ........................................... 261 Peripheral lymphocyte subsets as predicting factors for molecular recurrence after imatinib discontinuation in a phase 2 imatinib discontinuation trial in patients with chronic myeloid leukemia Arthur Gomes Oliveira Braga, Katia Borgia Barbosa Pagnano, Marina Dal’B o Pelegrini Campioni, Ana Beatriz Pascoal Lopes, Gislaine Oliveira Duarte, Konradin Metze and Irene Lorand-Metze ............... 268 Comprehensive analysis of theHCKgene in myeloid neoplasms: Insights into biological functions, prognosis, and response to antineoplastic agents Maria Fernanda Lopes Carvalho, Bruna Oliveira de Almeida, Maura Lima Pereira Bueno, Hugo Passos Vicari, Keli Lima, Eduardo Magalh~aes Rego, Fernanda Marconi Roversi and Jo~ao Agostinho Machado-Neto ................................................................................................ .............................................. 273 Review Articles Barriers and motivations for blood donation: an integrative review Tiago Henrique Monteiro, Italo de Jesus da Rocha Ferreira, Antonio Carlos Fonseca Pontes Junior, Humberto Sanches Chocair and Jeniffer Dantas Ferreira ............................................................................ 283 Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: a Systematic Review Brittany Prescott and Denise E. Jackson ................................................................................................ ....... 289 Case Reports Successful allogeneic stem cell transplantation with a reduced-intensity conditioning in a case of leukocyte adhesion deficiency type III Dima Barhoom, Maryam Behfar, Rashin Mohseni and Amir Ali Hamidieh ............................................... 300 A rare pathogenic MCP mutation in patient with congenital TTP Fahrudin Masnic, Halima Resic, Selma Ajanovic, Amela Beciragic and Nejra Prohic ................................ 303 Mixedfield resolution in ABO phenotyping in a rare case of a blood donor with hematopoietic mosaicism Marcos Paulo Miola, Cristiane da Silva Rodrigues de Ara ujo,Oct avio Ricci Junior and Luiz Carlos de Mattos ................................................................................................ .................................. 306 gd T-cell acute lymphoid leukemia after BMT of AML: Case report Elissandra Machado Arlindo de Mattos, Mariela Granero Farias, Mariana Monteiro Burin and Ana Paula Alegretti ................................................................................................ ...................................... 311 Oligosymptomatic infection by SARS-Cov-2 in catastrophic antiphospholipid syndrome, a singular coincidence: a case report in an Ecuadorian hospital Jorge Luis V elez-P aez, Jhonny Manuel Carranza-Jara, Doryz Catalina Almeida-Posso, Steven S. Witkin and Cesar de Almeida-Neto ......................................................................................................................... 316 Images in Clinical Hematology Acute megakaryoblastic leukemia in a pediatric patient Bernhard Strasser and Alexander Haushofer .............................................................................................. 321 Osteoclasts in bone marrow metastases by carcinoma of unknown primary origin Ver onicaRold an Galiacho, Itziar Oiartzabal Ormategi, Javier Arzuaga Mendez and Juan Carlos García-Ruiz ................................................................................................ ............................... 323
Editorial The Brazilian association of hematology, hemotherapy, and cell therapy (ABHH) and its absolute commitment to ethics and absence of conflicts of interest Carmino Antonio de Souza a,b,*, Eduardo Magalh~aesRegoa,c, Glaciano Nogueira Ribeiroa,d, Silvia Maria Meira Magalh~aesa,e, Celso Arrais Rodrigues da Silvaa,f, Leny Nascimento da Motta Passosa,g, Dimas Tadeu Covasa,h, Renato Sampaio Tavaresa,i, Vania T.de Moraes Hungriaa,j, Edvan de Queiroz Cruso ea,k, Jos e Francisco Comenalli Marques Jra,b, CarlosS ergio Chiattonea,l, Dante Langhi Juniora,m, Jorge Vaz Pinto Netoa,n, Violete Petitto Laforgaa,o, Angelo Maiolinoa,p aAssocia¸c~ao Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), S~ao Paulo, SP, Brazil bUniversidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil c Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil dHospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil e Universidade Federal do Cear a (UFC), Fortaleza, CE, Brazil f Universidade Federal de S~ao Paulo (UNIFESP), Sao Paulo, SP, Brazil g Funda¸c~ao de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil hHemocentro de Ribeir~ao Preto, Universidade de S~ao Paulo (USP), Ribeir~ao Preto, SP, Brazil i Hospital das Clínicas da Universidade Federal de Goi as (HC UFG), Goiania, GO, Brazil j Faculdade de Ci^enciasM edicas da Santa Casa de S~ao Paulo (FCMSCSP), S~ao Paulo, SP, Brazil kHospital Universit ario Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil l Faculdade de Ci^enciasM edicas da Santa Casa de S~aoPaulo, S~ao Paulo, SP, Brazil mUniversidade Federal de S~ao Paulo (UNIFESP), S~ao Paulo, SP, Brazil nCentrodeC^ancer de Brasília (CETTRO), Brasília, DF, Brazil oCentro de Hematologia e Hemoterapia do Paran a (Hemepar), Curitiba, PR, Brazil pUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil ARTICLE INFO Article history: Available online 26 May 2024 * Corresponding author at: Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil. E-mail address: carmino@unicamp.br (C.A. de Souza). https://doi.org/10.1016/j.htct.2024.05.003 2531-1379/ 2024 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/). hematol transfus cell ther. 2024;46(3):219−220 Hematology, Transfusion and Cell Therapy www.htct.com.br
The Brazilian Association of Hematology, Hemotherapy, and Cell Therapy (ABHH) serves as the representative institution of the Brazilian Medical Association (AMB), entrusted with overseeing one of the most crucial medical specialties and bearing increasing responsibilities in advancing the wellbeing of both our patients and professionals in the field. The ongoing scientific advances within our extensive domain have needed ABHH to not only fulfill its institutional, managerial, legal, representative, and corporate duties but also to establish a method of operation for organizing and harmonizing all endeavors across scientific, educational, regulatory, ethical, and behavioral realms. Therefore, through the decision of its board and deliberative council, ABHH aims to publicly disclose its compliance policy.1 ABHH is committed to transparently reaffirming its statutory goals and the principles articulated in its ’Code of Ethics and Conduct,’ ensuring their application to directors, members, collaborators, and affiliated associated parties. Upholding the moral and ethical integrity of its leadership, ABHH respects both the Federal Constitution and all national legal frameworks, along with Codes of Ethics and Professional Conduct. Furthermore, it acknowledges and respects foreign legislation, particularly when it aligns with the foundational principles of the Brazilian legal system. In alignment with these principles, ABHH mandates that its leadership and all those institutionally involved adhere to consistent standards of conduct, mitigating risks that may lead to conflicts of interest and tangible or intangible harm. Acting with integrity, ABHH prioritizes honesty, loyalty, and trust in all endeavors, driving scientific research, the pursuit of new technologies, data sharing, professional empowerment, and societal advancement, especially for patients. Transparency and responsibility guide ABHH’s interactions with the private and public sectors, ensuring impartiality and fairness to all parties. Regardless of gender, race, color, or creed, ABHH fosters equity, extending equal care and attention to all. Demonstrating social responsibility, ABHH employs its resources to sustainably preserve its actions’ impact. ABHH unequivocally rejects any influence, advantage, or interest derived from illegal activities or situations that may compromise the integrity of its leaders, collaborators, or associated parties. Any potential conflict of interest, if identified, is subject to scrutiny and deliberation by ABHH’s leadership, Ethics and Legislation Committee, ensuring transparency and accountability. While secondary personal interests are not inherently inappropriate, ABHH recognizes the need to address conflicts that may impede its primary institutional goals. Mandatory declaration of conflicts, including in contractual agreements, serves to safeguard all stakeholders and reaffirm leadership integrity. ABHH remains committed to regular review and adaptation of its Compliance Policy, integrating relevant laws, and ensuring alignment with its guiding principles and values through transparent and inclusive processes. Conflicts of interest None. reference 1. Ruble JH. Tools for "decloaking" the elephant in the room: conflict of interest, shared decision-making, and patient-centered care. J Pain Palliat Care Pharmacother. 2015;29(2):173–7. https:// doi.org/10.3109/15360288.2015.1037519. PMID: 26095491. 220 hematol transfus cell ther. 2024;46(3):219−220
Original article TaggedH1Nucleated red blood cell: a feasible quality parameter of cord blood unitsTaggedEnd TaggedPAndrea Tiemi Kondo *, Kelen Cristina Arcuri Alvarez , Andrea Neri Folchini Cipolletta , Araci Massami Sakashita , Jose Mauro Kutner TaggedEnd TaggedPHospital Israelita Albert Einstein, S~ao Paulo, SP, Brazil TaggedEnd TAGGEDPARTICLE INFO Article history: Received 12 November 2022 Accepted 20 January 2023 Available online 2 March 2023TaggedEnd TAGGEDPA B S T R A C T Introduction: Umbilical cord blood is an alternative source of hematopoietic progenitor cells for bone marrow transplantation; however, it is associated with a higher graft failure rate. The presence of a high rate of nucleated red blood cells (NRBCs) seems to be related to a greater capacity for engraftment, although is also associated with fetal distress conditions. We analyzed the correlation of the NRBC with quality parameters and its association with the utilization score of a cord blood unit. Study design and method: Data of 3346 units collected in a public cord blood bank from May 2010 to December 2017 were analyzed, retrospectively, to identify factors associated with an increased number of nucleated red blood cells and its correlation with the engraftment capacity measured through total nucleated cells (TNCs) and CD34 positive cells. We also evaluated the utilization score of these units and identified an NRBC cutoff associated with a higher score. Results: The median volume collected was 104 mL (42−255), the pre-processing TNC count was 144.77 £ 107 (95.46−477.18), the post-processing TNC count was 119.44 £ 107 (42.7 −477.18), the CD34 count was 4.67£106 (0.31−48.01), the NRBC count was 5 (0−202) and the utilization score was 0.0228 (0.00143−0.9740). The NRBC showed a correlation with the collected volume, TNC and CD34 positive cells and a higher utilization score and the receiver operating characteristic (ROC) curve analysis identified thefive NRBC/100 leukocytes cutoff that correlates better with the probability of use. No association with pathological conditions and the NRBC rate was observed. Conclusions: The NRBC is a feasible parameter for the screening of the cord blood unit (CBU) and the minimum cutoff of five NRBC/100 leukocytes can be a strategy in conjunction with the TNC to identify better units for cord blood bank sustainability. 2023 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: Bone marrow transplantation Cord blood unit Cord blood bank Nucleated red blood cell Engraftment Quality parametersTaggedEnd TaggedEndAbbreviations: CBU, cord blood unit; HPCs, hematopoietic progenitor cells; TNCs, total nucleated cells; CFUs, colony-forming units; NRBCs, nucleated red blood cells TaggedEndTaggedEnd * Corresponding author at: Av Albert Einstein 627, Blood Bank−3rd Floor, 05652-900 S~ao Paulo, SP, Brazil. E-mail address: andrea.kondo@einstein.br (A.T. Kondo). https://doi.org/10.1016/j.htct.2023.01.009 2531-1379/ 2023 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. 2024;46(3):221−227 TaggedFigure TaggedEnd Hematology, Transfusion and Cell Therapy www.htct.com.br TaggedFigure TaggedEnd
TaggedH1IntroductionTaggedEnd TaggedPThe first cord blood transplant was performed in 1989. Since then, the cord blood unit (CBU) has become one of main sources of hematopoietic progenitor cells (HPCs) in poorly represented groups in voluntary bone marrow donors.1,2 However, the higher rate of graft failure has resulted in several studies being undertaken to identify factors that are associated with better engraftment.1,3 The total nucleated cells (TNCs), amount of CD34 positive progenitor cells, cell viability and number of colony-forming units (CFUs) in the clonogenic assay are variables associated with the grafting potential of the cord blood unit (CBU) and their determination before the unit selection improves the outcome in the cord blood transplant.4−7 TaggedEnd TaggedPMeanwhile, haploidentical transplantation has been increasingly used, based on the improvement in strategies to reduce the alloreactivity between donors and receptors. This type of transplant has the advantages of faster availability of the donor and greater access to collect additional cellular products in situations of graft failure or relapsed disease. As a result, haploidentical transplants have reduced cord blood selection for transplants and cord blood banks are looking for strategies to optimize their inventory, striving to maintain units with higher probability of use and greater sustainability.8 TaggedEnd TaggedPPublic banks established the criteria for units that should be cryopreserved based on the TNCs and CD34 positive cells and some studies have suggested applying scoring systems obtained by quality parameters of the CBU before storage.9,10 To implement these scores, it is necessary to perform tests by flow cytometry, which impact in costs; however, without new strategies, cord blood banks could evolve into bankruptcy.TaggedEnd TaggedPOn the other hand, new research is investigating cord blood cells as a source of stem cells for regenerative medicine, which seems to be a good alternative use of the CBU.11 Evaluations of better units for the bone marrow transplant (BMT) by a scoring system should be a method for the selection of inventory intended for research and for transplantation.TaggedEnd TaggedPThus, considering the economic impacts of the cord blood bank maintenance, the costs of performing all quality parameters and the necessity to identify the units to be used for research, this study retrospectively analyzed CBU data and considered the TNCs and CD34 correlation with other parameters, such as the collected volume and total nucleated red blood cells (NRBCs). This study evaluated if these parameters could be representative of the CBU proliferative potential and could be an easier way to better screen units for the bone marrow transplant. As the nucleated red blood cell can be associated with asphyxia or hemolytic disease, this study alsoverified its correlation with the ABO and RhD incompatibility and presence of variant hemoglobin, trying to exclude situations in which the NRBC is associated with a pathological condition with enhanced erythropoietin activity and does not represent the CBU proliferative condition.12−15 TaggedEnd TaggedH1MethodsTaggedEnd TaggedPA retrospective study was performed, through data of cord blood units of a public cord blood bank in Sao Paulo, Brazil. TaggedEndTaggedPThe entire process of collection, processing and cryopreservation followed recommendations published in the Brazilian Ministry of Health Standards and International Quality Standards Guidelines.TaggedEnd TaggedPAfter approval by the institutional ethics committee (CAAE: 41687914.2.0000.0071), the following data were collected: TaggedEndTaggedP1. Post-processing total nucleated cellsTaggedEnd TaggedPThis quantification was performed using the Pentra 120 DX Hematological Analyzer (Horiba Medical, Kyoto, Japan) and from 2012 using the XE2100 Analyzer (Sysmex Co. Kobe, Japan).TaggedEnd TaggedPTotal nucleated cells were determined by: Total leukocyte count cells=mL ð Þ final volume mL ð Þ ¼ total nucleated cells cells 107 TaggedEndTaggedP2. CD34 positive cellsTaggedEnd TaggedPThe amount of CD34 positive cells was measured on the Coulter Epics XL-MCL Flow Cytometer (Beckman Coulter, Bres, CA, USA), according to the International Society of Hemotherapy and Graft Engineering (ISHAGE) protocol, with a double platform.16 TaggedEnd TaggedPThe total of CD34 positive cells of the product was calculatedby: Post processing cellularity cells 107 percentage of CD34 positive cells ¼total CD34 positive cells cells 106 TaggedEnd TaggedPSince 2015, a single platform based on the ISHAGE guidelines was established and total CD34 positive cells were determinedby:17 CD34 positive cells cells=mL ð Þ final volume mL ð Þ ¼ total positive CD34 cells cells 106 TaggedEndTaggedP3. Nucleated red blood cellsTaggedEnd TaggedPNucleated red blood cells (NRBCs) were determined manually through the analysis of the peripheral blood smear submitted to the May−Grunwald−Giemsa stain, modified by the Rosenfeld Fonio Method, was used to measure the rate of NRBCs/100 leukocytes.18 Since 2012, the NRBC count started to be measured automatically by the XE2100 equipment (Sysmex Co., Kobe, Japan). Units with counts above 30 NRBCs/100 leukocytes were subjected to confirmation by manual count of the peripheral blood smear. TaggedEndTaggedP4. Utilization Score of the CBUTaggedEnd TaggedPThis score was calculated based on a previous study that determined the probability of the CBU selection for transplantation.10 TaggedEnd TaggedPIn this study, units from four cord banks (two in France, one in Germany and one in the United States) were TaggedEnd222 hematol transfus cell ther. 2024;46(3):221−227
TaggedEndTaggedPretrospectively analyzed based on total nucleated cells, CD34 cell count and HLA haplotype, divided into Caucasian and non-Caucasian groups, based on the National Marrow Donor Program (NMDP) database, to identify parameters associated with a higher probability of being transplanted.TaggedEnd TaggedPA logistic regression model was performed to assess the level of influence of these three parameters on the probability of use. Parameters with the lowest value of the Akaike Information Criterion were selected to derive a formula that reflects the probability of use, defined as the utilization score index of the CBU.10 TaggedEnd TaggedPThe utilization score was calculated by equation: Utilization score ¼ exp 6:736þ 0:192 TCN ð Þ þ 0:40 CD34 ð Þ ð Þ 1 þexp 6:736 þ 0:192 TCN ð Þ þ 0:040 CD34 ð Þ ð Þ TaggedEnd TaggedPTCNcells£10 8 and CD34 cells£106 TaggedEnd TaggedPIn this previous study, a receiver operating characteristic (ROC) analysis of this score determined maximal sensitivity andspecificity at the score of 0.0308.10 The CBUs were divided into two groups: Group A with the score up to 0.0308 and Group B with the score over 0.0308. TaggedEndTaggedP5. Newborn hemoglobin electrophoresisTaggedEnd TaggedPAll units were evaluated for the presence of variant hemoglobin using the electrophoresis technique in alkaline pH (cellulose acetate) and confirmed in an electrophoresis at an acid pH to identify hemoglobin S and C.19 TaggedEndTaggedP6. ABO and RhD incompatibilityTaggedEnd TaggedPABO incompatibility was defined in situations in which the mother had blood group O and the newborn had any blood type other than group O (A, B or AB). The RhD incompatibility wasdefined as those situations in which the mother was RhD negative, with the presence of the anti-D antibody and the newborn had positive RhD typing. Both conditions could lead to newborn hemolytic disease.20,21 TaggedEnd TaggedPThis study included all the CBUs collected from May 2010 to December 2017, which met the criteria for cryopreservation, consisting of a minimum initial count of 950 million cells pre-processing and units from mothers who signed informed consent for CBU donation. Related CBUs were excluded from this study.TaggedEnd TaggedH1StatisticsTaggedEnd TaggedPThe CBU data, such as TNCs, total CD34 positive cells, NRBC and utilization score, were expressed as median, minimum and maximum values. Normal distribution of variables was verified by the Kolmogorov−Smirnov test and by the graphical analysis. Qualitative variables were expressed in terms of absolute and relative frequencies (percentage). The Mann −Whitney test was used to compare these data between groups.TaggedEnd TaggedPThe intensity of the relationship between the variables was verified by Spearman’s correlation coefficient. The linear regression model was complemented to estimate the rate of erythroblasts according to the TNCs, CD 34 positive cells, TaggedEndTaggedPscore rate and presence of variant hemoglobin and ABO or RhD incompatibility. The ROC curve was performed to identify sensitivities and specificities for different values of the NRBC for the utilization score.TaggedEnd TaggedPThe data were tabulated using the SPSS software for Windows version 22.0 (IBM). The test results were evaluated when the descriptive level (p-value) was less than 0.05.TaggedEnd TaggedH1ResultsTaggedEnd TaggedPIn this period, 6707 CBUs were collected, of which 3346 units met the acceptable criteria and were analyzed in this study.TaggedEnd TaggedPThe median of volume collected was 104 mL (42−255), the pre-processing TNC count was 144.77 £ 107 (95.46−477.18), the postprocessing TNC, 9.44 £107 (95.46−477.18), the CD34, 4.67x106 (0.31−48.01), the NRBC, 5 (0−202), and the utilization score was 0.0228 (0.00143−0.9740). Variant hemoglobin was identified in 1.5% of the CBUs (49 units) and ABO and RhD incompatibility were described in 12.2% (409) and 3.8% (126), respectively, as described in Table 1.TaggedEnd TaggedPThe NRBC showed a correlation with the collected volume, TNCs and CD34 positive cells and had a higher utilization score, as described in Table 2. The CBUs were divided into two groups according to the utilization score: Group A, with 2083 units (62.3%) and the score below 0.0308, and group B, with 1246 units (37.2%) and the score equal to, or over 0.0308. Considering this optimal cutoff of the utilization score, the NRBC and volume of cord blood collected was different between groups: the mean volume was 96.84 mL (§22.42) in group A and 123.09 mL (§27.69) in group B and there were 6.4 NRBCs/100 leukocytes (§ 8.22) in group A and 10.96 NRBCs/100 leukocytes (§13.8) in the group B, as shown inTable3.TaggedEnd TaggedPThe CBUs were divided into two groups according to electrophoresis and presence of incompatibility. Group one showed normal hemoglobin and the absence of incompatibility, and group two, variant hemoglobin or the presence of any incompatibility. No difference was observed comparing TaggedEnd Table1 – Demographic characteristics of cord blood units. Variable Median Min−max Volume (mL) 104 42−255 Pre-processing TNC (cells£107) 144.77 95.46−477.18 Post-processing TNC (cells x 107) 119.44 42.7−402.65 Total CD34 positive cells (cells£106) 4.6 0.31−48.01 NRBC (cells/100 leukocytes) 5 0−202 Utilization score 0.0227 0.00143−0.9740 Variable n % Hemoglobin electrophoresis Normal 3292 98.9 Hemoglobin S 15 0.4 Hemoglobin C 5 0.2 Other 29 0.9 ABO incompatibility No 2650 79.2 Yes 409 12.2 RhD incompatibility No 2932 87.6 Yes 126 3.8 hematol transfus cell ther. 2024;46(3):221−227 223
TaggedEndTaggedPtheses parameters with the number of NRBCs or utilization score, as described in Tables 4 and 5.TaggedEnd TaggedPWe performed an ROC analysis of the NRBCs based on the utilization score, trying to identify a cutoff number of NRBCs TaggedEndTaggedPthat correlated better with the probability of use. Even though the correlation of the NRBC and the score was weak, we found 5 NRBCs/100 leukocytes, with a 67.3% sensitivity and 51.2% specificity, that should be considered as a screening parameter, shown in Figure 1. Considering this cutoff, we selected 1858 units that are correlated with better quality parameters, as described in Table 6.TaggedEnd TaggedH1DiscussionTaggedEnd TaggedPCord blood is an important source of progenitor cells, particularly for transplantation in pediatric patients or in a poorly represented population in voluntary donor groups. Several public cord blood banks, distributed in several countries, were created with the aim to collect alternative HPCs for BMT.TaggedEnd TaggedPAlthough the CBU seems to be good alternative source of HPC, a higher rate of graft failure can be observed, due to the lower dose of HPCs infused.22 Several studies have identified that total amount of nucleated cells, added to the total number of positive CD34 cells, post-thaw viability and in vitro expansion clonogenic assays have a better impact on unit grafting determination.3,5,23 Page et al. created and validated an Apgar Score for cord blood units based on total nucleated cells, CD34 positive cells, CFUs, mononuclear cell content and volume that correlates with neutrophil engraftment.9 Other studies evaluated some parameters that should be considered in the CBU graft and a guideline has been proposed for the CBU use for BMT based on the number of TNCs, HLA match, amount of CD34 cells and potency assays.24 TaggedEnd TaggedPIn general, banks depend on the use of their units to be financially viable. Over the past few decades, the decreasing use of units has made the maintenance of cord banks a new challenge for their managers. Based on these quality parameters of the CBU, some studies have tried to determine which graft factors should be considered for the cryopreservation and storage of units, looking for a cost-effective strategy to maintain the cord blood bank sustainability. Considering the optimal cell dose suggestion of 2.5 £ 107 TNC/kg for CBU transplantation, Querol et al. proposed a minimal pre-freezing level of 9 £108 TNC for the United Kingdom public banks and the need to discard 45% of the units collected.25 Magalon et al. analyzed the CBUs registered in the Bone Marrow Donor Worldwide (BMDW) and evaluated their utilization score in a derived model based on multivariate analysis. They concluded that each additional unit of TNC (1 £108) and CD34+ (1 £ 106) was associated with an odds ratio of 1.212 (confidence interval 1.186−1.238) and 1.041 (confidence interval 1.021−1.061), respectively, for increased utilization and they found that by using a pre-freezing level of 18 £108, thenumber of TNCs would be the best strategy with the lowest financial deficit for the bank.10 TaggedEnd TaggedPThis study calculated the utilization score, based on the Magalon et al.’s study, and identified 19.4% of our cord blood bank inventory with a higher utilization score, however only four units in this inventory were transplanted.TaggedEnd TaggedPWe found a correlation of NRBCs with the engraftment capacity, which could be a previous screening before processing and cryopreservation. Stevens et al. evaluated patients who underwent CBU transplantation and observed that the TaggedEnd Table 2 – Correlation of nucleated red blood cells with quality parameters of cord blood unit and utilization score. Parameter Correlation p-value Volume 0.076 <0.001 Preprocessing TNC 0.228 <0.001 CD34 positive cells 0.404 <0.001 Utilization score 0.270 <0.001 Spearman’s correlation. TaggedEnd Table 3 – Correlation of utilization score and presence of variant hemoglobin, with Apgar score showing asphyxia or presence of ABO or RhD incompatibility. Parameter Grupo A (n=2083) GrupoB (n=1246) p-value Median (min −max) Median (min −max) Volume 95; 42 200 122; 56−255 <0.001 NRBC 4; 0−152 7; 0−202 <0.001 TaggedEnd Table 4 – Correlation of nucleated red blood cells and presence of variant hemoglobin, presence of ABO or RhD incompatibility. Parameter Median (min−max) p-value Hemoglobin 0.096 Normal 5 (0−202) Variant 8 (0−72) ABO incompatibility 0.514 No 5 (0−202) Yes 6 (0−110) RhD incompatibility 0.471a No 5 (0−202) Yes 5 (0−73) Mann−Whitney test. a Kruskal−Wallis test. TaggedEnd Table 5 – Correlation of utilization score and presence of variant hemoglobin, presence of ABO or RhD incompatibility. Median (min−max) p-value Hemoglobin 0.470 Normal 0.0227 (0.0014−0.974) Variant 0.0235 (0.0085−0.8616) ABO incompatibility 0.205 No 0.023 (0.0014−0.9499) Yes 0.024 (0.0079−0.7556) RhD incompatibility 0.343 No 0.0230 (0.0014−0.9499) Yes 0.0252 (0.0093−0.3176) Mann−Whitney test. TaggedEnd224 hematol transfus cell ther. 2024;46(3):221−227
TaggedEndTaggedPunits with highest amount of NRBCs had a correlation with a greater amount of TCNs, CD34 positive cells and a greater number of CFUs (R2 = 0.21; p < 0.001, R2 = 0.27; p < 0.001 and R2 =0.22; p<0.001, respectively) and it was a prognostic factor of neutrophil engraftment.27 Based on this study, cord blood banks have adopted the practice of adding NRBCS to the total number of nucleated cells. In our study, there is a weak correlation of NRBCs in the CBU with the utilization score (R2 = 0.245), probably reflecting the NRBC correlation with CD34 positive cells (R2 =0.413). TaggedEnd TaggedPThere is still doubt about the mechanism by which the NRBC can influence the engraftment of the CBU. The TaggedEndTaggedPliterature evaluating the newborn with fetal distress demonstrates that a higher rate of NRBCs in the umbilical cord blood could be associated with situations, such as neonatal hypoxia, hemolytic diseases, pregnant women with preeclampsia, prolonged labor and gestational diabetes, reflecting a greater activity of erythropoietin.6,15,28,29 Lim et al. also identified the correlation between stress during delivery and higher numbers of nucleated cells, granulocytes, CD34 positive cells and hematopoietic progenitor cells in the umbilical cord blood, possibly by the mobilization by endogenous cytokines, improving the proliferative potential of the CBU.30 TaggedEnd TaggedPAlthough highly associated with pathological situations, cord blood has a normal NRBC number, probably reflecting greater hematopoietic activity in this period. Hanion−Lundberg et al. studied more than 1000 cord blood samples from single, uncomplicated pregnancies and showed a median NRBC of 8.55/100 leukocytes §10.27 (0−89), with no difference between samples from smoking mothers, anemia, use of illicit drugs or type of delivery.31 In our study, clinical screening was enough to select donors without hemolytic disease or the presence of variant hemoglobin.TaggedEnd TaggedPIn order to reduce CBU costs, public banks could use NRBC determination to screen better units that will be processed and cryopreserved. In our ROC analyses of the NRBC and TaggedFigure Figure1–ROC curve correlation values of NRBCs and utilization score.TaggedEnd TaggedEnd Table 6 – Correlation of cord blood unit quality parameters with nucleated red blood cells. NRBC group 1 (n=1476) NRBC group 2 (n=1858) p-value Median; min −max Median; Min −max Preprocessing TNC 136.64 (95.68 −335.78) 152.4 (95.46 −477.2) <0.001 CD34 positive cells 3.61 (0.31−32.4) 5.47 (0.59−48.01) <0.001 hematol transfus cell ther. 2024;46(3):221−227 225
TaggedEndTaggedPutilization score, the correlation is weak; however, we identified a cutoff of 5 NRBCs/100 leukocytes with a 67.3% sensibility and 51.2% specificity that should be considered as a screening parameter. If this screening strategy were used at our cord blood bank, it would reduce the number of cryopreserved units to 1858 (55.5%), with 45% of our inventory with a higher utilization score and units with a greater number of TNCs and CD34 positive cells. Galel et al. also evaluated the NRBC as a screening parameter for the CBU and showed a correlation between the NRBCs and the amount of CD34 positive cells.26 In our inventory, using NRBC screening would increase the median of CD34 positive cells from 5.61 £ 106 to 9.09 £ 106 (p < 0.001) and TNCs from 156.12 to 205.9£107 (p<0.001). The outcome with transplanted CBUs could not be evaluated in this study to correlate this screening parameter with the result in the clinical application of the inventory selected by this score.TaggedEnd TaggedH1ConclusionTaggedEnd TaggedPOur study shows that the number of NRBCs could be a feasible parameter for CBU screening, as it is associated with a greater number of TNCs and CD34 positive cells. Selection of the CBU with a high probability of use can contribute to thefinancial stability of the cord blood bank, reducing costs of processing, cryopreservation and maintenance of units. The quantification of NRBCs is already performed in all units and our minimum cutoff of 5 NRBCs/100 leukocytes can be a strategy, along with the TNCs, to better identify units for cord blood bank sustainable.TaggedEnd TaggedH1Conflicts of interestTaggedEnd TaggedPThe authors declare no conflicts of interest.TaggedEnd TaggedH1AcknowledgementsTaggedEnd TaggedPThis study did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.TaggedEnd taggedh1referencestaggedend TaggedP 1. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: thefirst 25 years and beyond. Blood. 2013;122 (4):491–8.TaggedEnd TaggedP 2. Rocha V, Gluckman E. Clinical use of umbilical cord blood hematopoietic stem cells. Biol Blood Marrow Transplant. 2006;12(1 suppl 1):34–41.TaggedEnd TaggedP 3. George TJ, Sugrue MW, George SN, Wingard JR. Factors associated with parameters of engraftment potential of umbilical cord blood. 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