Evidence of engraftment is usually seen within 3 weeks following stem cell transplantation and is identified as follows.
1. Fluorescence in situ hybridization (FISH) in sex-mismatched transplantation
2. Variable number of tandem repeats (VNTR) in same-sex-matched transplantation
3. HLA typing: mismatched transplantation
4. Donor-type red cell antigens
5. Immunoglobulin allotypes of donor
6. In severe combined immunodeficiency disease (SCID): the presence of adeno-sine deaminase (ADA) in white blood cells.
1. Aplastic anemia and leukemia:
a. Adequate bone marrow cellularity b. Increase in white blood cells with normal morphology and increase in platelet counts
2. SCID: improved immunologic parameters.
Causes of Failure to Engraft
• Increased genetic disparity
• T-cell depletion or GVHD prophylaxis
• Inadequate stem cell dose
• History of multiple transfusions in aplastic anemia
• Disordered microenvironment in storage disorders and osteopetrosis.
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