Dear Dr. Janssen, I couldn't agree more. We, too, have occasionally encountered grafts with very small numbers of CFU-GM, which has not augured well for the patient's engraftment. Also, while the results aren't available speedily by any means, they still have some real-time value. The progenitor assay plates are usually scored at 14 days, of course. Assuming that the assay is plated on the day of infusion, then the results are available at just about the time one would begin looking for signs of myeloid engraftment. If the results are poor, one can tell the transplant physician that the progenitor assay results suggest that rapid engraftment is not likely, and that one should prepare for a more complex post-transplant course, including possibly collecting more donor cells for a boost. This is particularly relevant in patients receiving extensively-manipulated grafts, such as the T-cell-depleted marrow you mentioned. In that graft engineering processes are growing steadily more complex, the potential for impairing cell function seems likely to increase. Such deficits may be detectable only by a functional test, like the progenitor assay. Mind you, I'm not by any means unhappy with the CD34 measurement available these days -- the flow cytometry is remarkably accurate and precise, considering how rare the cells are. I'm just glad we assay function as well. Scott -------------------------------------------------- Scott R. Burger, M.D. Medical Director, Cell Therapy Clinical Laboratory Department of Laboratory Medicine and Pathology University of Minnesota burge009@gold.tc.umn.edu 612-626-4919 612-624-5411 (Fax)
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