Search

The information regarding the probability of finding a matched unrelated donor (MUD) within a relatively short time is crucial for the success of hematopoietic stem cell transplantation (HSCT), particularly in patients with malignancies. In this study, we retrospectively analyzed 315 Italian patients who started a search for a MUD, in order to assess the distribution of human leukocyte antigen (HLA) alleles and haplotypes in this population of patients and to evaluate the probability of finding a donor. Comparing two groups of patients based on whether or not a 10/10 HLA-matched donor was available, we found that patients who had a fully-matched MUD possessed at least one frequent haplotype more often than the others (45.6% vs 14.3%; P = 0.000003). In addition, analysis of data pertaining to the HLA class I alleles distribution showed that, in the first group of patients, less common alleles were under-represented (20.2% vs 40.0%; P = 0.006). Therefore, the presence of less frequent alleles represents a negative factor for the search for a potential compatible donor being successful, whereas the presence of one frequent haplotype represents a positive predictive factor. Antigenic differences between patient and donor observed at C and DQB1 loci, were mostly represented by particular B/C or DRB1/DQB1 allelic associations. Thus, having a particular B or DRB1 allele, linked to multiple C or DQB1 alleles, respectively, might be considered to be associated with a lower probability of a successful search. Taken together, these data may help determine in advance the probability of finding a suitable unrelated donor for an Italian patient.

Background. Persistent mixed chimerism represents a state wherein recipient and donor cells stably co-exist after haematopoietic stem cell transplantation. However, since in mostly of the studies reported in literature the engraftment state was observed in the nucleated cells, in this paper we determined the donor origin in the mature erythrocytes of patients with persistent mixed chimerism after transplantation for haemoglobinopathies. Results were compared with the engraftment state observed in singularly picked-up burst-forming unit-erythroid colonies and in the nucleated cells collected from the peripheral blood and from the marrow. Design and Methods. The donor origin of the erythrocytes was determined analyzing differences on the surface antigens of the erythrocytes suspension after incubation with anti-ABO and/or anti-C, -c, -D, -E and -e monoclonal antibodies by a flow cytometer. Short tandem repeats analysis was used to determine the donor origin of nucleated cells and burst-forming unit-erythroid colonies singularly picked up after 14 days incubation. Results. A proportion of donor-derived nucleated cells of 71%, 46%, 15% and 25% was observed at day 1364, 1385, 1314 and 932 respectively, in four transplanted patients affected by haemoglobinopathies. Similar results were also obtained in the erythroid precursors, analyzing the donor/recipient origin of the burst-forming unit-erythroid colonies, while on the contrary, at the same days of observation, a proportion of 100%, 100%, 73% and 90% donor-derived erythrocytes was observed in the four patients with persistent mixed chimerism. Conclusions. Our results showed that mostly of the erythrocytes present in four long-term transplanted patients affected by haemoglobinopathies and characterized by the presence of few donor engrafted nucleated cells were of donor origin. The indication that small proportions of donor engrafted cells might be sufficient to clinical control the disease in patients affected by haemoglobinopathies is relevant, although the biological mechanisms underlying these observations need to be further investigated.

Background Thalassemia major can be cured with allogeneic hematopoietic stem cell transplantation. Persistent mixed chimerism develops in around 10% of transplanted thalassemic patients, but the biological mechanisms underlying this phenomenon are poorly understood.Design and Methods The presence of interleukin-10-producing T cells in the peripheral blood of eight patients with persistent mixed chimerism and five with full donor chimerism was investigated. A detailed characterization was then performed, by T-cell cloning, of the effector and regulatory T-cell repertoire of one patient with persistent mixed chimerism, who developed stable split erythroid/lymphoid chimerism after a hematopoietic stem cell transplant from an HLA-matched unrelated donor.Results Higher levels of interleukin-10 were produced by peripheral blood mononuclear cells from patients with persistent mixed chimerism than by the same cells from patients with complete donor chimerism or normal donors. T-cell clones of both host and donor origin could be isolated from the peripheral blood of one, selected patient with persistent mixed chimerism. Together with effector T-cell clones reactive against host or donor alloantigens, regulatory T-cell clones with a cytokine secretion profile typical of type 1 regulatory cells were identified at high frequencies. Type 1 regulatory cell clones, of both donor and host origin, were able to inhibit the function of effector T cells of either donor or host origin in vitro.Conclusions Overall these results suggest that interleukin-10 and type 1 regulatory cells are associated with persistent mixed chimerism and may play an important role in sustaining long-term tolerance in vivo. These data provide new insights into the mechanisms of peripheral tolerance in chimeric patients and support the use of cellular therapy with regulatory T cells following hematopoietic stem cell transplantation.