A team of researchers at Princess Margaret Cancer Centre (PM) have identified a way to predict the likelihood of complications in patients undergoing stem cell transplants.
“By digging deeper into the status of certain cells within the immune system, our findings reveal a new strategy to identify individuals at high risk for complications—opening the door to better, more targeted therapies,” says the first author of the study Dr. Omnia Elebyary, who is a graduate student at the Princess Margaret Cancer Centre and the Faculty of Dentistry at the University of Toronto.
The type of transplant that the research team focused on is called an allogeneic hematopoietic stem-cell transplant. This type of transplant, which is carried out after chemotherapy or radiation treatment, involves infusing donor blood cells into the patient in hopes of creating a new immune system that can attack and kill any existing cancer cells. Blood infections are the most common complication for this procedure.
“The presence of an immune cell known as a polymorphonuclear neutrophil has previously been used to monitor the risk of bloodstream infections for patients receiving this type of transplant. However, little is known about whether the specific functions of these cells or their respective proportions in the bloodstream might provide deeper insights,” says Dr. Michael Glogauer, PM Clinician Investigator and senior author of the study.
The results, published in the Journal of Clinical Infectious Diseases, reveal that measuring the proportion of polymorphonuclear neutrophils (PMNs) in a ‘primed’ state after transplant could serve as a powerful tool to identify those at risk.
Immune cells become pre-activated or ‘primed’ when they come in contact with a foreign substance in the body—such as bacteria or viruses. Once they are in this state they are ready to fight off the invader.
Allogeneic stem cell transplants can cure various blood diseases, such as bone marrow failure, immunodeficiency and sickle cell anemia. However, white blood cell deficiencies, disrupted mucus membranes and a weakened immune system following the transplant increase the risk of infections.
The researchers analyzed blood and saliva samples from 76 patients receiving this transplant. They used the proportion of primed PMNs in the blood five days after the procedure to determine which patients fell into high and low PMN groups. Patients with more than 10% of their PMNs in the primed state were considered to have high levels. Patients in the low group were more susceptible to infections.
“These findings highlight the potential clinical value of this white blood cell subset in identifying patients at higher risk of bloodstream infections,” adds Dr. Glogauer. “This could be particularly important in patients undergoing chemotherapy and in those with bone marrow disorders.”
This work was supported by Friends for Life and The Princess Margaret Foundation.
Elebyary O, Fine N, Sun C, Saha ST, Robinson S, Mojdami ZD, Khoury N, Watson E, Coburn B, Lipton JH, Glogauer M. A Primed Neutrophil Subset Predicts the Risk of Bloodstream Infections in Allo-HSCT Patients: A Prospective Study. Clin Infect Dis. 2023 May 9:ciad277. doi: 10.1093/cid/ciad277. Epub ahead of print.