Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Special Report
  • Published:

A European reference protocol for quality assessment and clinical validation of autologous haematopoietic blood progenitor and stem cell grafts

Abstract

Recently, the regulatory authorities have begun to show interest in haematopoietic stem cell products. On a professional rather than a regulatory basis, the International Society for Hematotherapy and Graft Engineering (ISHAGE) has established the Foundation for the Accreditation of Haematopoietic Cell Therapy (FACHT), which has drawn up guidelines for standards and accreditation of such activity. In Europe, the regulatory environment with regard to haematopoietic stem cell grafts, processing and storage are currently less stringent. However, in 1998 the European Joint Accreditation Committee Euro-ISHAGE/EBMT (JACIE) prepared a regulatory document ‘Standards for Blood and Marrow Progenitor Cell Collection, Processing and Transplantation’ which was approved by the EBMT General Assembly. The major objectives were to promote quality of medical and laboratory practice in haematopoietic progenitor cell transplantation. The standards extend and detail the pre-existing activity of EBMT centres including all phases of collection, processing and administration of these cells. This is the platform for the proposed reference protocol for CD34+ cell enumeration and clinical validation of quality assessment to ensure that appropriate standards of work and product quality are established and will be maintained. Bone Marrow Transplantation (2001) 27, 463–470.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. The Joint Accreditation Committee of ISHAGE-Europe and EBMT. Standards for blood and marrow progenitor cell processing, collection and transplantation 1998

  2. Serke S, Johnsen H, Huhn D et al. European survey of the flow cytometric determination of CD34-expression cells Cytotherapy 1999 1: 343–347

    Article  CAS  PubMed  Google Scholar 

  3. Krause DS, Fackler MJ, Civin CI et al. CD34: structure, biology, and clinical utility Blood 1996 87: 1–13

    CAS  PubMed  Google Scholar 

  4. Civin CI, Strauss LC, Brovall C et al. Antigenic analysis of hematopoiesis III. A hematopoietic progenitor cell surface antigen defined by a monoclonal antibody raised against KG-1a cells J Immunol 1984 133: 157–165

    CAS  PubMed  Google Scholar 

  5. Serke S, Sauberlich S, Huhn D . Multiparameter flow-cytometrical quantitation of circulating CD34(+)-cells: correlation to the quantitation of circulating haemopoietic progenitor cells by in vitro colony-assay Br J Haematol 1991 77: 453–459

    Article  CAS  PubMed  Google Scholar 

  6. Siena S, Bregni M, Brando B et al. Flow cytometry for clinical estimation of circulating hematopoietic progenitors for autologous transplantation in cancer patients Blood 1991 77: 400–409

    CAS  PubMed  Google Scholar 

  7. Fritsch G, Emminger W, Buchinger P et al. CD34 analysis in peripheral blood correlates with colony forming capacity – an update Prog Clin Biol Res 1992 377: 531–536

    CAS  PubMed  Google Scholar 

  8. Ravagnani F, Siena S, Bregni M et al. Methodologies to estimate circulating hematopoietic progenitors for autologous transplantation in cancer patients Haematologica 1991 76: (Suppl. 1) 46–49

    PubMed  Google Scholar 

  9. Hematopoietic Stem Cells. The Mulhouse Manual. In: Wunder E, Sovalat H, Henon P, Serke S (eds) Alpha Med Press: 1994 pp 1–317

  10. Wunder E, Sovalat H, Fritsch G et al. Report on the European Workshop on Peripheral Blood Stem Cell Determination and Standardization – Mulhouse, France, 6–8 and 14–15 February 1992 J Hematother 1992 1: 131–142

    Article  CAS  PubMed  Google Scholar 

  11. Inaba T, Shimazaki C, Ashihara E et al. Two-color flow cytometric analysis of CD34-positive peripheral blood stem cells mobilized by recombinant human granulocyte-colony stimulating factor for autotransplantation Prog Clin Biol Res 1992 377: 561–567

    CAS  PubMed  Google Scholar 

  12. Read EJ, O'Shaughnessy JA, Yu MY et al. Flow cytometric quantitation of circulating hematopoietic progenitor cells in breast cancer patients on chemotherapy Prog Clin Biol Res 1992 377: 523–530

    CAS  PubMed  Google Scholar 

  13. Bender JG, Williams SF, Myers S et al. Characterization of chemotherapy mobilized peripheral blood progenitor cells for use in autologous stem cell transplantation Bone Marrow Transplant 1992 10: 281–285

    CAS  PubMed  Google Scholar 

  14. Di Nicola M, Siena S, Bregni M et al. Quantization of CD34+ peripheral blood hematopoietic progenitors for autografting in cancer patients Int J Artif Organs 1993 16: (Suppl. 5) 80–82

    Article  PubMed  Google Scholar 

  15. Bender JG, Unverzagt KL, Walker DE et al. Characterization of CD34+ cells mobilized to the peripheral blood during the recovery from cyclophosphamide chemotherapy Prog Clin Biol Res 1992 377: 575–582

    CAS  PubMed  Google Scholar 

  16. Brecher ME, Sims L, Schmitz J et al. North American multicenter study on flow cytometric enumeration of CD34+ hematopoietic stem cells (see comments) J Hematother 1996 5: 227–236

    Article  CAS  PubMed  Google Scholar 

  17. Sutherland DR, Anderson L, Keeney M et al. The ISHAGE guidelines for CD34+ cell determination by flow cytometry. International Society of Hematotherapy and Graft Engineering J Hematother 1996 5: 213–226

    Article  CAS  PubMed  Google Scholar 

  18. Serke S, Arseniev L, Watts M et al. Imprecision of counting CFU-GM colonies and CD34-expressing cells Bone Marrow Transplant 1997 20: 57–61

    Article  CAS  PubMed  Google Scholar 

  19. Macey MG, McCarthy DA, van Agthoven A et al. How should CD34+ cells be analysed? A study of three classes of antibody and five leucocyte preparation procedures J Immunol Meth 1997 204: 175–188

    Article  CAS  Google Scholar 

  20. Lowdell MW, Bainbridge DR . External quality assurance for CD34 cell enumeration – results of a preliminary national trial. Royal Microscopical Society Clinical Flow Cytometry Group QA Schemes Bone Marrow Transplant 1996 17: 849–853

    CAS  PubMed  Google Scholar 

  21. Urashima M, Ohkawara J, Hoshi Y et al. Peripheral blood progenitor cell transplantation estimated by three-colour (CD34, HLA-DR, CD33) flow cytometry Acta Haematol 1994 92: 23–28

    Article  CAS  PubMed  Google Scholar 

  22. Knape CC . Standardization of absolute CD34 cell enumeration (letter, comment) J Hematother 1996 5: 211–212

    Article  CAS  PubMed  Google Scholar 

  23. Lumley MA, McDonald DF, Czarnecka HM et al. Quality assurance of CD34+ cell estimation in leucapheresis products Bone Marrow Transplant 1996 18: 791–796

    CAS  PubMed  Google Scholar 

  24. Remacha AF, Martino R, Sureda A et al. Changes in reticulocyte fractions during peripheral stem cell harvesting: role in monitoring stem cell collection Bone Marrow Transplant 1996 17: 163–168

    CAS  PubMed  Google Scholar 

  25. Johnsen HE, Knudsen LM . Nordic flow cytometry standards for CD34+ cell enumeration in blood and leukapheresis products: report from the second Nordic Workshop. Nordic Stem Cell Laboratory Group (NSCL-G) J Hematother 1996 5: 237–245

    Article  CAS  PubMed  Google Scholar 

  26. Johnsen HE, Baech J, Nicolaisen K et al. Validation of the Nordic flow cytometry standard for CD34+ Cell enumeration in blood and autografts: report from the Third Workshop J Hematother 1999 8: 15–28

    Article  CAS  PubMed  Google Scholar 

  27. Knudsen LM, Gaarsdal E, Jensen L et al. Evaluation of mobilized CD34+ cell counts to guide timing and yield of large-scale collection by leukapheresis J Hematother 1998 7: 45–52

    Article  CAS  PubMed  Google Scholar 

  28. Weaver CH, Hazelton B, Birch R et al. An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy Blood 1995 86: 3961–3969

    CAS  PubMed  Google Scholar 

  29. Knudsen LM, Gaarsdal E, Jensen L et al. Improved priming for mobilization of and optimal timing for harvest of peripheral blood stem cells J Hematother 1996 5: 399–406

    Article  CAS  PubMed  Google Scholar 

  30. Bolwell BJ, Goormastic M, Andresen S et al. Platelet transfusion requirements during autologous peripheral blood progenitor cell transplantation correlate with the pretransplant platelet count Bone Marrow Transplant 1997 20: 459–463

    Article  CAS  PubMed  Google Scholar 

  31. Lowenthal RM, Faberes C, Marit G et al. Factors influencing haemopoietic recovery following chemotherapy-mobilised autologous peripheral blood progenitor cell transplantation for haematological malignancies: a retrospective analysis of a 10-year single institution experience Bone Marrow Transplant 1998 22: 763–770

    Article  CAS  PubMed  Google Scholar 

  32. Stewart DA, Guo D, Luider J et al. Factors predicting engraftment of autologous blood stem cells: CD34+ subsets inferior to the total CD34+ cell dose Bone Marrow Transplant 1999 23: 1237–1243

    Article  CAS  PubMed  Google Scholar 

  33. Reiffers J, Faberes C, Boiron JM et al. Peripheral blood progenitor cell transplantation in 118 patients with hematological malignancies: analysis of factors affecting the rate of engraftment J Hematother 1994 3: 185–191

    Article  CAS  PubMed  Google Scholar 

  34. Nademanee A, Sniecinski I, Schmidt GM et al. High-dose therapy followed by autologous peripheral-blood stem-cell transplantation for patients with Hodgkin's disease and non-Hodgkin's lymphoma using unprimed and granulocyte colony-stimulating factor-mobilized peripheral-blood stem cells J Clin Oncol 1994 12: 2176–2186

    Article  CAS  PubMed  Google Scholar 

  35. Pettengell R, Morgenstern GR, Woll PJ et al. Peripheral blood progenitor cell transplantation in lymphoma and leukemia using a single apheresis Blood 1993 82: 3770–3777

    CAS  PubMed  Google Scholar 

  36. Schwartzberg L, Birch R, Blanco R et al. Rapid and sustained hematopoietic reconstitution by peripheral blood stem cell infusion alone following high-dose chemotherapy Bone Marrow Transplant 1993 11: 369–374

    CAS  PubMed  Google Scholar 

  37. Morton J, Morton A, Bird R et al. Predictors for optimal mobilization and subsequent engraftment of peripheral blood progenitor cells following intermediate dose cyclophosphamide and G-CSF Leuk Res 1997 21: 21–27

    Article  CAS  PubMed  Google Scholar 

  38. Haas R, Witt B, Mohle R et al. Sustained long-term hematopoiesis after myeloablative therapy with peripheral blood progenitor cell support Blood 1995 85: 3754–3761

    CAS  PubMed  Google Scholar 

  39. Steen R, Tjonnfjord GE, Gaudernack G et al. Differences in the distribution of CD34 epitopes on normal haemopoietic progenitor cells and leukaemic blast cells Br J Haematol 1996 94: 597–605

    Article  CAS  PubMed  Google Scholar 

  40. Sutherland DR, Keating A . The CD34 antigen: structure, biology, and potential clinical applications J Hematother 1992 1: 115–129

    Article  CAS  PubMed  Google Scholar 

  41. Civin CI, Almeida-Porada G, Lee MJ et al. Sustained, retransplantable, multilineage engraftment of highly purified adult human bone marrow stem cells in vivo Blood 1996 88: 4102–4109

    CAS  PubMed  Google Scholar 

  42. Dercksen MW, Weimar IS, Richel DJ et al. The value of flow cytometric analysis of platelet glycoprotein expression of CD34+ cells measured under conditions that prevent P-selectin-mediated binding of platelets Blood 1995 86: 3771–3782

    CAS  PubMed  Google Scholar 

  43. Dercksen MW, Rodenhuis S, Dirkson MK et al. Subsets of CD34+ cells and rapid hematopoietic recovery after peripheral-blood stem-cell transplantation J Clin Oncol 1995 13: 1922–1932

    Article  CAS  PubMed  Google Scholar 

  44. Bender JG, Unverzagt K, Walker DE et al. Phenotypic analysis and characterization of CD34+ cells from normal human bone marrow, cord blood, peripheral blood, and mobilized peripheral blood from patients undergoing autologous stem cell transplantation Clin Immunol Immunopathol 1994 70: 10–18

    Article  CAS  PubMed  Google Scholar 

  45. Tjonnfjord GE, Steen R, Evensen SA et al. Characterization of CD34+ peripheral blood cells from healthy adults mobilized by recombinant human granulocyte colony-stimulating factor Blood 1994 84: 2795–2801

    CAS  PubMed  Google Scholar 

  46. Baech J, Johnsen HE . Technical aspects and clinical impact of hematopoietic progenitor subset quantification Stem Cells 2000 18: 76–86

    Article  CAS  PubMed  Google Scholar 

  47. To LB, Haylock DN, Simmons PJ et al. The biology and clinical uses of blood stem cells Blood 1997 89: 2233–2258

    CAS  PubMed  Google Scholar 

  48. van der WE, Richel DJ, Holtkamp MJ et al. Bone marrow reconstitution after high-dose chemotherapy and autologous peripheral blood progenitor cell transplantation: effect of graft size (see comments) Ann Oncol 1994 5: 795–802

    Article  Google Scholar 

  49. Olivieri A, Offidani M, Montanari M et al. Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: a single center experience Haematologica 1998 83: 329–337

    CAS  PubMed  Google Scholar 

  50. McQuaker I, Haynes A, Stainer C et al. Mobilisation of peripheral blood stem cells with IVE and G-CSF improves CD34+ cell yields and engraftment in patients with non-Hodgkin's lymphomas and Hodgkin's disease Bone Marrow Transplant 1999 24: 715–722

    Article  CAS  PubMed  Google Scholar 

  51. Ketterer N, Salles G, Raba M et al. High CD34(+) cell counts decrease hematologic toxicity of autologous peripheral blood progenitor cell transplantation Blood 1998 91: 3148–3155

    CAS  PubMed  Google Scholar 

  52. 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: 2547–2555

    Article  CAS  PubMed  Google Scholar 

  53. Scheid C, Draube A, Reiser M et al. Using at least 5 × 106/kg CD34+ cells for autologous stem cell transplantation significantly reduces febrile complications and use of antibiotics after transplantation Bone Marrow Transplant 1999 23: 1177–1181

    Article  CAS  PubMed  Google Scholar 

  54. Tricot G, Jagannath S, Vesole D et al. Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients Blood 1995 85: 588–596

    CAS  PubMed  Google Scholar 

  55. Watts MJ, Sullivan AM, Leverett D et al. Back-up bone marrow is frequently ineffective in patients with poor peripheral-blood stem-cell mobilization J Clin Oncol 1998 16: 1554–1560

    Article  CAS  PubMed  Google Scholar 

  56. Millar BC, Millar JL, Bell JB et al. Role of CD34+ cells in engraftment after high-dose melphalan in multiple myeloma patients given peripheral blood stem cell rescue Bone Marrow Transplant 1996 18: 871–878

    CAS  PubMed  Google Scholar 

  57. Papadopoulos KP, Ayello J, Reiss RF et al. CD34+ cell dose requirements for rapid engraftment in a sequential high-dose chemotherapy regimen of paclitaxel, melphalan, and cyclophosphamide, thiotepa, and carboplatin (CTCb) with PBPC support in metastatic breast cancer J Hematother Stem Cell Res 1999 8: 357–363

    Article  CAS  PubMed  Google Scholar 

  58. Haas R, Mohle R, Fruhauf S et al. Patient characteristics associated with successful mobilizing and autografting of peripheral blood progenitor cells in malignant lymphoma Blood 1994 83: 3787–3794

    CAS  PubMed  Google Scholar 

  59. Haynes A, Hunter A, McQuaker G et al. Engraftment characteristics of peripheral blood stem cells mobilised with cyclophosphamide and the delayed addition of G-CSF Bone Marrow Transplant 1995 16: 359–363

    CAS  PubMed  Google Scholar 

  60. Schwella N, Beyer J, Schwaner I et al. Impact of preleukapheresis cell counts on collection results and correlation of progenitor-cell dose with engraftment after high-dose chemotherapy in patients with germ cell cancer J Clin Oncol 1996 14: 1114–1121

    Article  CAS  PubMed  Google Scholar 

  61. Faucher C, Le Corroller AG, Chabannon C et al. Autologous transplantation of blood stem cells mobilized with filgrastim alone in 93 patients with malignancies: the number of CD34+ cells reinfused is the only factor predicting both granulocyte and platelet recovery J Hematother 1996 5: 663–670

    Article  CAS  PubMed  Google Scholar 

  62. Menendez P, Redondo O, Rodriguez A et al. Comparison between a lyse-and-then-wash method and a lyse-non-wash technique for the enumeration of CD34+ hematopoietic progenitor cells Cytometry 1998 34: 264–271

    Article  CAS  PubMed  Google Scholar 

  63. Gratama JW, Orfao A, Barnett D et al. Flow cytometric enumeration of CD34+ hematopoietic stem and progenitor cells. European Working Group on Clinical Cell Analysis Cytometry 1998 34: 128–142

    Article  CAS  PubMed  Google Scholar 

  64. Sovalat H, Wunder E, Tienhaara A et al. Commentary: prospects for standardization of stem cell determination within Europe J Hematother 1993 2: 293–296

    Article  CAS  PubMed  Google Scholar 

  65. Verwer BJH, Ward DM . An automated classification algorithm for ProCOUNT flow cytometric acquisition and analysis J Hematother 1997 6: 169–173

    Article  Google Scholar 

  66. Read EJ, Kunitake ST, Carter CS et al. Enumeration of CD34+ hematopoietic progenitor cells in peripheral blood and leukapheresis products by microvolume fluorimetry: a comparison with flow cytometry J Hematother 1997 6: 291–301

    Article  CAS  PubMed  Google Scholar 

  67. Cabezudo E, Querol S, Cancelas JA et al. Comparison of volumetric capillary cytometry with standard flow cytometry for routine enumeration of CD34+ cells Transfusion 1999 39: 864–872

    Article  CAS  PubMed  Google Scholar 

  68. Johnsen HE, Hoffmann M, Gisseloe C et al. Recommendation for assessing agreement between two methods of CD34 enumeration Bone Marrow Transplant 2001 (submitted).

  69. Schiødt I, Knudsen LM, Jensen L et al. Flow cytometry comparison of CD34 subsets in bone marrow and peripheral blood after priming with glycosylated or non-glycosylated rhG-CSF (letter) Bone Marrow Transplant 1998 21: 1167–1169

    Article  PubMed  Google Scholar 

  70. Larsson K, Bjorkstrand B, Ljungman P . Faster engraftment but no reduction in infectious complications after peripheral blood stem cell transplantation compared to autologous bone marrow transplantation Support Care Cancer 1998 6: 378–383

    Article  CAS  PubMed  Google Scholar 

  71. Estern Cooperative Oncology Group, ECOG Common Toxicity Criteria. 2000

  72. Barnett D, Granger V, Storie I et al. Quality assessment of CD34+ stem cell enumeration: experience of the United Kingdom National External Quality Assessment Scheme (UK NEQAS) using a unique stable whole blood preparation Br J Haematol 1998 102: 553–565

    Article  CAS  PubMed  Google Scholar 

  73. Barnett D, Janossy G, Lubenko A et al. Guidelines for the Flow Cytometric Enumeration of CD34+ Haematopoietic Stem Cells. Prepared by the CD34+ Haematopoietic Stem Cell Working Party. General Haematology Task Force of the British Committee for Standards in Haematology Clin Lab Haematol 1999 21: 301–308

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Serke, S., Johnsen, H. A European reference protocol for quality assessment and clinical validation of autologous haematopoietic blood progenitor and stem cell grafts. Bone Marrow Transplant 27, 463–470 (2001). https://doi.org/10.1038/sj.bmt.1702813

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702813

Keywords

This article is cited by

Search

Quick links