Hematopoietic stem cell (HSC) biology studies have shown that several adhesion molecules, such as CXCR4, VLA4, VLA5, CD44, Cd11a and L-selectin, are involved in self-renewal, trafficking, survival and adhesion of HSC to their niches.1 Similarly to adult HSC, umbilical cord blood (UCB) HSC have been shown to highly express CXCR4 and other adhesion molecules involved in engraftment and trafficking.2, 3
The applicability of UCB transplantation had been historically limited by the small cell number available from a single unit.4 Over the past decade, the utilization of double UCB (dUCB) unit grafts was shown to, at least in part, overcome the cell dose limitation and has been adopted by several institutions.5, 6 Our group7 and others5, 8 have shown that despite the infusion of two UCB units, in the vast majority of cases only a single unit will predominate and provide long-term lympho-hematopoietic recovery. Available data shows that UCB unit predominance is influenced by the T-cell content an interaction between T cells from both donor units.5, 7 Identifying additional factors that determine the long-term predominant unit after dUCB transplantation will allow us to further refine UCB graft selection, and potentially improve outcomes. Thus, we studied whether the expression of CXCR4 on UCB CD34+ cells and different CD34+ cells subsets were also involved in unit predominance after dUCB transplantation.
We studied patients with hematological malignancies undergoing dUCB transplantation after myeloablative (MA) or nonmyeloablative (NMA) conditioning regimens at the University of Minnesota between 2005 and 2009. To be included in this analysis, patients were required to have achieved neutrophil engraftment with chimerism and had post-thaw flow cytometry data for the two UCB donor units. Patient demographics, laboratory and engraftment data were prospectively collected and available from the University of Minnesota Blood and Marrow Transplant Database. Graft selection, conditioning, immunosuppressive regimens and supportive care have been previously reported.4, 9 A total of 68 patients were included in this analysis. In all, 41 patients (60%) were male. The majority of the patients (62%, n=42) were older than 35 years old. The median recipient weight was 82 kg (range: 22–145 kg). Most patients received a unit with at least 1 HLA mismatch (54%, n=37), and in 37% of the cases (n=25), both units were 4/6 HLA matched with the recipient. Acute leukemias were the indication for transplantation in 52% of the cases (n=35), and lymphoid malignancies in 23% (n=33), and other diagnoses in 25% (n=10). Forty-two patients (62%) received a NMA conditioning regimen. In 54 patients (80%) there was gender mismatch between the two units, and in 55 patients (81%) there was ABO incompatibility between the two units. The median follow-up time was 2 years (range 1.0–3.2 years).
Cord predominance, investigated descriptively by looking the median dose between the predominant and non-predominant units among the study population, was defined as ⩾70% of chimerism by day +100 post transplantation by PCR of informative polymorphic variable number tandem repeat and more commonly, short tandem repeat regions in the recipient and donor as previously described.7 Donor chimerism was determined in bone marrow at days 21, 100, 180, 360 and 720 after transplantation, with additional time points as needed. Engraftment studies showed that by day +100 and subsequent time points after transplantation, a median chimerism from the predominant unit >70% was observed in 97% and 94% of MA and NMA, respectively (P=0.35).
CXCR4 was highly expressed in 98% of the CD34+ cells in UCB grafts, with no significant differences between the predominant and non-predominant units regarding MFI (Figures 1a–d). It has been reported that UCB CD34+CXCR4+ cell subset ranges from 8 to 80%.2, 10 Discrepancies may, at least in part, be due to technical differences on UCB processing, staining and source. In our study, we only included clinically utilized UCB units obtained from six cord blood banks in contrast to Timeus et al.10 and Ohno et al.2 that used ‘research’ cord blood units. In part, cryopreservation may have been produced a slight decrease on CXCR4 expression levels as reported.10 In our study, thawing and staining process were uniform for all units, and CXCR4 expression should not have been significantly influenced by this factors.
It has been shown that CXCR4 is involved in homing and engraftment.11 In addition, priming of hematopoietic progenitors with reagents, such as complement fragment 3a12 and prostaglandins,13 leads to CXCR4 activation with increased migration towards a SDF1 gradient and improved engraftment. The proportion of CD34+CXCR4+ cells in the predominant UCB unit was 1.7% (range 0.5–6.5%) vs 2.0% (0.6–5.2%) in the non-predominant. The intensity of expression of CXCR4 on CD34+ cells, as measured by MFI, was similar for the predominant (36.5; range 3.7–214) and non-predominant unit (44.1; range 3.7–219) (P=0.34). Thus, both the proportion of CD34+CXCR4+ cells and the intensity of CXCR4 expression on CD34+ cells were found to be similar between the predominant and non-predominant units (Table 1). We also found no difference in the time to neutrophil recovery whether the CXCR4 expression on the predominant unit was above (18 days, range 6–40) or below (22 days; range 0–39) the median MFI (P=0.26).
Although homing of HSCs depends the CXCR4/SDF1 axis, the expression of CXCR4 in UCB CD34+ cells was not associated with unit predominance (Figure 1e). Subsequent to homing and engraftment, as shown by our group7 and others,8 the unit that will provide long-term lympho-hematopoietic recovery is largely determined by T-cell content and interactions between the T cells of the two donor UCB units.5 Although CD34+ viability has also been shown to predict predominance after dUCB transplantation, it is only predictive when one of the two units’ viability is below 75%6 and was not a factor in our study.
In summary, our data shows that in dUCB transplantation CXCR4 expression is not a predictor of long-term predominant UCB unit. Although CXCR4 expression on UCB CD34+ cells did not influence unit predominance in our study, it is possible that function/activation rather than expression alone may influence homing, engraftment and possibility of long-term predominance. Thus, as most CD34+ cell express CXCR4, functional responsiveness to a SDF1 gradient in a transwell system may be a better parameter to be considered in future studies. An ongoing phase I/II study, based on pre-clinical data,12, 13 is testing this hypothesis by priming one of two UCB units composing the graft with C3a and Prostaglandin E2.14, 15
Lapidot T, Dar A, Kollet O . How do stem cells find their way home? Blood 2005; 106: 1901–1910.
Ohno N, Kajiume T, Sera Y, Sato T, Kobayashi M . Short-term culture of umbilical cord blood-derived CD34 cells enhances engraftment into NOD/SCID mice through increased CXCR4 expression. Stem Cells Dev 2009; 18: 1221–1226.
Timeus F, Crescenzio N, Basso G, Ramenghi U, Saracco P, Gabutti V . Cell adhesion molecule expression in cord blood CD34+ cells. Stem Cells 1998; 16: 120–126.
Brunstein CG, Barker JN, Weisdorf DJ, DeFor TE, Miller JS, Blazar BR et al. Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic disease. Blood 2007; 110: 3064–3070.
Gutman JA, Turtle CJ, Manley TJ, Heimfeld S, Bernstein ID, Riddell SR et al. Single-unit dominance after double-unit umbilical cord blood transplantation coincides with a specific CD8+ T-cell response against the nonengrafted unit. Blood 2010; 115: 757–765.
Scaradavou A, Smith KM, Hawke R, Schaible A, Abboud M, Kernan NA et al. Cord blood units with low CD34+ cell viability have a low probability of engraftment after double unit transplantation. Biol Blood Marrow Transplant 2010; 16: 500–508.
Ramirez P, Wagner JE, Defor TE, Blazar BR, Verneris MR, Miller JS et al. Factors predicting single-unit predominance after double umbilical cord blood transplantation. Bone Marrow Transplant 2012; 47: 799–803.
Kanda J, Rizzieri DA, Gasparetto C, Long GD, Chute JP, Sullivan KM et al. Adult dual umbilical cord blood transplantation using myeloablative total body irradiation (1350 cGy) and fludarabine conditioning. Biol Blood Marrow Transplant 2011; 17: 867–874.
Barker JN, Weisdorf DJ, DeFor TE, Blazar BR, McGlave PB, Miller JS et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood 2005; 105: 1343–1347.
Timeus F, Crescenzio N, Saracco P, Doria A, Fazio L, Albiani R et al. Recovery of cord blood hematopoietic progenitors after successive freezing and thawing procedures. Haematologica 2003; 88: 74–79.
Broxmeyer HE . Chemokines in hematopoiesis. Curr Opin Hematol 2008; 15: 49–58.
Ratajczak J, Reca R, Kucia M, Majka M, Allendorf DJ, Baran JT et al. Mobilization studies in mice deficient in either C3 or C3a receptor (C3aR) reveal a novel role for complement in retention of hematopoietic stem/progenitor cells in bone marrow. Blood 2004; 103: 2071–2078.
Hoggatt J, Singh P, Sampath J, Pelus LM . Prostaglandin E2 enhances hematopoietic stem cell homing, survival, and proliferation. Blood 2009; 113: 5444–5455.
Cutler CS, Shoemaker D, Ballen KK, Robbins D, Desponts C, Kao GS et al. FT1050 (16,16-dimethyl Prostaglandin E2)-enhanced umbilical cord blood accelerates hematopoietic engraftment after reduced intensity conditioning and double umbilical cord blood transplantation. ASH Annu Meet Abstr 2011; 118: 653.
Brunstein CG, McKenna DH, DeFor TE, Sumstad D, Ratajczak M, Laughlin MJ et al. Priming of hematopoietic progenitor cells (HPC) with complement fragment 3A (C3A) to promote homing of umbilical cord blood (UCB): safety profile. Biol Blood Marrow Transplant 2012; 18: S210.
This work was supported in part by grants from the National Cancer Institute CA65493 (JEW, JSM, CGB), the Children’s Cancer Research Fund (JEW, TED), the American Cancer Society Audrey Meyer Mars International Fellowship in Clinical Oncology (PR) and Pontificia Universidad Católica de Chile (PR), American Society of Blood and Marrow Transplantation Robert A Good New Investigator Award (CGB), and Leukemia and Lymphoma Society Scholar in Clinical Research Award (CGB).
The authors declare no conflict of interest.
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Ramirez, P., Wagner, J., DeFor, T. et al. CXCR4 expression in CD34+ cells and unit predominance after double umbilical cord blood transplantation. Leukemia 27, 1181–1183 (2013) doi:10.1038/leu.2012.261
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