Original Article

Engraftment Kinetics of Neutrophils and Platelets in Peripheral Blood Stem Cells Transplant Patients in a Quaternary Care Centre

Abstract

Background: This study aimed to evaluate the rate of neutrophil and platelet engraftment in pediatric hematopoietic stem cell transplant (HSCT) patients. Additionally, it sought to assess whether engraftment kinetics were influenced by CD34+ cell dose, CD3+ cell dose in T cell-replete transplants with post-transplant cyclophosphamide (PTCy), and the type of stem cell transplantation.

Materials and Methods: The study included 60 pediatric patients undergoing hematopoietic stem cell transplantation between August 2023 and January 2024. Flow cytometry was used to quantify CD34+ cells. A peripheral smear and the haematology analyzer were used to measure the platelet count and neutrophils from day 1+ to day 28+.

Results: Among 60 patients, 3 were autologous (5%), 15 were MRD (25%), 6 were MUD (10%), 30 were T-cell-repleted transplants with PTCy (50%), and 6 were TCRα/β-depleted transplants (10%). The neutrophil and platelet engraftment were correlated with demographic characteristics (e.g., age and gender) and clinical factors (e.g., transplant, diagnosis, and CD34+ cell dosage levels). In addition, CD3+ T cell dosages of ≥2×108 cells/kg or < 2×108 cells/kg were also correlated with engraftment kinetics. Both the type of peripheral blood stem cell transplant (PBSCT) and the CD3+ T cell dose showed a statistically significant association with neutrophil engraftment.

Conclusion: This study showed a poor correlation between CD34+ cell dosage and engraftment. However, maximum engraftment occurred between day 10+ and day 14+ in fully matched transplants. T cell-repleted transplants with PTCy exhibited maximum engraftment between 15–18 days, and all TCR α/β depleted transplants engrafted between day 10+ and day 14+.

1. Ljungman P, Bregni M, Brune M, et al. Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009. Bone Marrow Transplant. 2010;45(2):219-34.
2. Kamel AM, El-Sharkawy N, Mahmoud HK, et al. Impact of CD34 subsets on engraftment kinetics in allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant. 2005;35(2):129-36.
3. Eapen M, Horowitz MM, Klein JP, et al. Higher mortality after allogeneic peripheral-blood transplantation compared with bone marrow in children and adolescents: the Histocompatibility and Alternate Stem Cell Source Working Committee of the International Bone Marrow Transplant Registry. J Clin Oncol. 2004 Dec 15;22(24):4872-80.
4. Tsirigotis P, Shapira MY, Or R, et al. The number of infused CD34+ cells does not influence the incidence of GVHD or the outcome of allogeneic PBSC transplantation, using reduced-intensity conditioning and antithymocyte globulin. Bone Marrow Transplant. 2010;45(7):1189-96.
5. Pulsipher MA, Chitphakdithai P, Logan BR, et al. Donor, recipient, and transplant characteristics as risk factors after unrelated donor PBSC transplantation: beneficial effects of higher CD34+ cell dose. Blood. 2009;114(13):2606-16.
6. Abraham L, Pramod J. Effect of CD34+ cell dose on neutrophil and platelet engraftment kinetics in haematopoietic stem cell transplantation–A single-centre experience. Indian J Physiol Pharmacol. 2021;65(3):188-92.
7. Chang YJ, Xu LP, Liu DH, et al. Platelet engraftment in patients with hematologic malignancies following unmanipulatedhaploidentical blood and marrow transplantation: effects of CD34+ cell dose and disease status. Biol Blood Marrow Transplant. 2009;15(5):632-8.
8. Siena S, Schiavo R, Pedrazzoli P, et al. Therapeutic relevance of CD34 cell dose in blood cell transplantation for cancer therapy. J Clin Oncol. 2000;18(6):1360-77.
9. Cesaro S, Tintori V, Nesi F, et al. A prospective study on the efficacy of mobilization of autologous peripheral stem cells in pediatric oncohematology patients. Transfusion. 2013;53(7):1501-9.
10. Bensinger W, Appelbaum F, Rowley S, et al. Factors that influence collection and engraftment of autologous peripheral-blood stem cells. J Clin Oncol. 1995;13(10):2547-55.
11. Brown RA, Adkins D, Goodnough LT, et al. Factors that influence the collection and engraftment of allogeneic peripheral-blood stem cells in patients with hematologic malignancies. J Clin Oncol. 1997;15(9):3067-74.
12. Diamond DJ, Chang KL, Jenkins KA, et al. Immunohistochemical analysis of T cell phenotypes in patients with graft-versus-host disease following allogeneic bone marrow transplantation. Transplantation. 1995;59(10):1436-44.
13. Kawanishi Y, Passweg J, Drobyski WR, et al. Effect of T cell subset dose on outcome of T cell-depleted bone marrow transplantation. Bone Marrow Transplant. 1997;19(11):1069-77.
14. Takahashi T, Prockop SE. T-cell depleted haploidentical hematopoietic cell transplantation for pediatric malignancy. Front Pediatr. 2022;10:987220.
15. Kesavan MR, Ramya U, Shivani P, et al. Optimizing CD3 cell dose in children undergoing unmanipulated haploidentical stem cell transplantation with post-
Files
IssueVol 19 No 3 (2025) QRcode
SectionOriginal Article(s)
Keywords
CD34 cells; Peripheral blood stem cell transplant; CD3 T cell dosage; engraftment

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Manoharan E, Ramalingam T, Raj R, Vaidhyanathan L. Engraftment Kinetics of Neutrophils and Platelets in Peripheral Blood Stem Cells Transplant Patients in a Quaternary Care Centre. Int J Hematol Oncol Stem Cell Res. 2025;19(3):215-222.