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Original Article

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Blood Res 2019; 54(4):

Published online December 31, 2019

https://doi.org/10.5045/br.2019.54.4.274

© The Korean Society of Hematology

Clinical significance of T cell receptor excision circle (TREC) quantitation after allogenic HSCT

Neveen Lewis Mikhael1, Manal Elsorady2

Author Info. +

1Clinical Pathology Department, Alexandria Faculty of Medicine, 2Clinical Hematology Department, Head of BMT Unit, Alexandria Faculty of Medicine, Alexandria, Egypt

Correspondence to : Neveen Lewis Mikhael, M.D.
Clinical Pathology Department, Alexandria Faculty of Medicine, Elkhartoum Square, Alexandria, Egypt
E-mail: Neveen.Lewis@alexmed.edu.eg

Received: August 28, 2019; Revised: October 15, 2019; Accepted: November 5, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background

Hematopoietic stem cell transplantation (HSCT) is a well-established treatment modality for a variety of diseases. Immune reconstitution is an important event that determines outcomes. The immune recovery of T cells relies on peripheral expansion of mature graft cells, followed by differentiation of donor-derived hematopoietic stem cells. The formation of new T cells occurs in the thymus and as a byproduct, T cell receptor excision circles (TRECs) are released. Detection of TRECs by PCR is a reliable method for estimating the amount of newly formed T cells in the circulation and, indirectly, for estimating thymic function. The aim of this study was to determine the role of TREC quantitation in predicting outcomes of human leucocyte antigen (HLA) identical allogenic HSCT.

Methods

The study was conducted on 100 patients receiving allogenic HSCT from an HLA identical sibling. TREC quantification was done by real time PCR using a standard curve.

Results

TREC levels were inversely related to age (P=0.005) and were significantly lower in patients with malignant diseases than in those with benign diseases (P=0.038). TREC levels could predict relapse as an outcome but not graft versus host disease (GvHD) and infections.

Conclusion

Age and nature of disease determine the TREC levels, which are related to relapse.

Keywords TRECs, Immune, Allogenic, HSCT, Outcomes

Article

Original Article

Blood Res 2019; 54(4): 274-281

Published online December 31, 2019 https://doi.org/10.5045/br.2019.54.4.274

Copyright © The Korean Society of Hematology.

Clinical significance of T cell receptor excision circle (TREC) quantitation after allogenic HSCT

Neveen Lewis Mikhael1, Manal Elsorady2

1Clinical Pathology Department, Alexandria Faculty of Medicine, 2Clinical Hematology Department, Head of BMT Unit, Alexandria Faculty of Medicine, Alexandria, Egypt

Correspondence to:Neveen Lewis Mikhael, M.D.
Clinical Pathology Department, Alexandria Faculty of Medicine, Elkhartoum Square, Alexandria, Egypt
E-mail: Neveen.Lewis@alexmed.edu.eg

Received: August 28, 2019; Revised: October 15, 2019; Accepted: November 5, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Hematopoietic stem cell transplantation (HSCT) is a well-established treatment modality for a variety of diseases. Immune reconstitution is an important event that determines outcomes. The immune recovery of T cells relies on peripheral expansion of mature graft cells, followed by differentiation of donor-derived hematopoietic stem cells. The formation of new T cells occurs in the thymus and as a byproduct, T cell receptor excision circles (TRECs) are released. Detection of TRECs by PCR is a reliable method for estimating the amount of newly formed T cells in the circulation and, indirectly, for estimating thymic function. The aim of this study was to determine the role of TREC quantitation in predicting outcomes of human leucocyte antigen (HLA) identical allogenic HSCT.

Methods

The study was conducted on 100 patients receiving allogenic HSCT from an HLA identical sibling. TREC quantification was done by real time PCR using a standard curve.

Results

TREC levels were inversely related to age (P=0.005) and were significantly lower in patients with malignant diseases than in those with benign diseases (P=0.038). TREC levels could predict relapse as an outcome but not graft versus host disease (GvHD) and infections.

Conclusion

Age and nature of disease determine the TREC levels, which are related to relapse.

Keywords: TRECs, Immune, Allogenic, HSCT, Outcomes

Fig 1.

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Figure 1.

TREC standard curve.

Blood Research 2019; 54: 274-281https://doi.org/10.5045/br.2019.54.4.274

Fig 2.

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Figure 2.

Correlation between TRECs and age in patients and controls.

Blood Research 2019; 54: 274-281https://doi.org/10.5045/br.2019.54.4.274

Fig 3.

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Figure 3.

Comparison between TREC levels at day 28 in patients with benign and malignant disease.

Blood Research 2019; 54: 274-281https://doi.org/10.5045/br.2019.54.4.274

Fig 4.

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Figure 4.

TREC levels at day 28 and outcomes of transplantation.

Blood Research 2019; 54: 274-281https://doi.org/10.5045/br.2019.54.4.274
Patient characteristics.
Relationship between outcomes and patient groups divided as having high or low TREC/mL.
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