Methods of determining donor engraftment rely on the assessment of donor and recipient cell components in the recipient BM or PB, termed as chimerism analysis (see Chap. ( 1998) described for the first time that allogeneic non-myeloablative HSCT was better tolerated than any standard myeloablative conditioning, with a shorter period of neutropenia and a shorter period of platelet dependence. Furthermore, when comparing intensity of conditioning regimens, Slavin et al. The median time to neutrophil engraftment was 25 days (range 11–108) for children and 23 days (range 11–116) for adult recipients ( P = 0.6) (Ruggeri et al. A large study of 1268 patients (73% children) with acute leukemia (64% acute lymphoblastic leukemia (ALL), 36% acute myeloid leukemia) in remission analyzed engraftment kinetics and outcomes after a single-unit CB transplantation with myeloablative conditioning regimen. CB transplant is associated with delayed engraftment. Platelet recovery is also faster by approximately 6 days, i.e., platelet recovery of 20 × 10 9/L was reached at day +15 for PBSC patients and day +20 for patients receiving BM (Schmitz et al. In an EBMT study, the time interval for engraftment was 12 days for PBSC and 15 days for BM. Neutrophils exceed the threshold of 500 × 10 6/L between 2 and 6 days earlier with PBSC than after BM. Patients who received PBSC had significantly faster recovery of neutrophils and platelets compared to BM transplants. ( 2000) published a large retrospective multivariate analysis which compared results of 288 HLA-identical sibling PBSC transplantations with results of 536 HLA-identical sibling BM transplantations. Generally, there are three common sources of HSCT grafts: bone marrow (BM), harvested from the iliac crest peripheral blood stem cells (PBSC), following G-CSF mobilization of HSC to the peripheral circulation with later collection of these cells by leukapheresis and cord blood (CB). The two major factors affecting engraftment are the graft source and the hematopoietic stem cell transplant (HSCT) conditioning regimen. Platelet engraftment is usually defined as independence from platelet transfusion for at least 7 days with a platelet count of more than >20 × 10 9/L (Teltschik et al. Engraftment is most commonly defined as the first of three consecutive days of achieving a sustained peripheral blood neutrophil count of >500 × 10 6/L (Wolff 2002). Various definitions of engraftment exist in the literature.
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