Protocol - White Cell Chimerism and Graft Failure

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This protocol uses existing medical records to record whether graft failure occurred and information about the cells tested. This protocol contains six of the 122 items from Center for International Blood and Marrow Transplant Research (CIBMTR) Form 2450, which consists of Yes/No and cell information choice responses and a single sample date collection response. Each question includes instructions from the CIBMTR Form 2450 Instruction Manual.

Specific Instructions

This protocol should be used at a series of time points after bone marrow or stem cell transplant, including 100 days, 6 months, 12 months, and then yearly. Also, as a preliminary question, it should be determined if chimerism studies were performed.




White Cell Chimerism and Graft Failure

1. Did late graft failure occur?

Late (or secondary) graft failure is defined when the recipient meets criteria for initial engraftment but subsequently develops loss of a previously functioning graft by development of at least two lines of cytopenia. Late graft failure is more often associated with allogeneic HCT than with autologous HCT. Some possible causes for late graft failure include graft rejection related to residual host immunity, persistent or progressive disease, low donor cell yield, medication side-effect, infection or GvHD. (Applebaum et al., 2009)

If the recipient meets the criteria of graft failure, check “yes.”

[ ] Yes

[ ] No

2. Date Sample Collected.

Enter the date the sample was collected for the chimerism test.

_ _ _ _ - _ _ - _ _

3. Cell Source. 

Report whether the specimen taken for chimerism testing was from a marrow or peripheral blood source.

[ ] Bone marrow

[ ] Peripheral blood

4. Cell type.

Indicate the cell type tested. If the specimen was not sorted for a specific cell line, indicate “unsorted / whole.” See the Chimerism Cell Types table for additional details on cell markers unique to certain cell lines.

[ ] Unsorted / whole

[ ] Red blood cells

[ ] Hematopoietic progenitor cells (CD34+ cells)

[ ] Total mononuclear cells (lymphs & monos)

[ ] T-cells (includes CD3+, CD4+, and/or CD8+)

[ ] B-cells (includes CD19+ or CD20+)

[ ] Granulocytes (includes CD33+ myeloid cells)

[ ] NK cells (CD56+)

[ ] Other

If other, specify: ___________________________

5. Were donor cells detected?

Molecular testing methods include RFLP and VNTR / STR. If a molecular method was used, indicate whether donor cells were detected. Report “yes,” if the testing identified any percentage of cells as being of donor origin.

[ ] Yes

[ ] No

6. Percent donor cells

Molecular testing methods include VNTR / STR, RFLP, and AFLP. Report the percentage of donor cells identified by molecular testing. If the test result did not detect any recipient cell population within the sensitivity of the assay, report 100% donor cells. If the test detected recipient cells, but indicated donor cells “> n%,” report “n + 1” percent donor cells. If the test detected donor cells but indicated donor cells “< n%,” report “n – 1” percent donor cells.


Copyright© 2020 National Marrow Donor Program and the Medical College of Wisconsin, Inc.

Personnel and Training Required

Personnel who are trained in performing medical record review

Equipment Needs


Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Medical record abstraction


Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy


Any age

Selection Rationale

The Sickle Cell Disease Curative Therapies Working Group selected questions from the Center for International Blood and Marrow Transplant Research (CIBMTR) as the best standardized methodology for collecting data on white cell chimerism. CIBMTR forms were developed with the international transplant community to establish a standard set of data elements to be collected for all transplant recipients. Additionally, there are comprehensive Forms Instruction Manuals to help investigators complete the questions.



Derived Variables


Process and Review

Not applicable.

Protocol Name from Source

Center for International Blood and Marrow Transplant Research (CIBMTR), Form 2450 (R5.0) Post-Transplant Essential Data, 2020


Center for International Blood and Marrow Transplant Research. (2020, January). Post-Transplant Essential Data (Post-TED) Form (CIBMTR Form 2450; Revision 5.0), Questions 16, 70, 73, 74, 78, 79. National Heart, Lung, and Blood Institute.

General References

Appelbaum, F. R., Forman, S. J., Negrin, R. S., & Blume, K. G. (2009). Thomas' hematopoietic cell transplantation: stem cell transplantation (4th ed.). Wiley-Blackwell.

Eapen, M., Brazauskas, R., Walters, M. C., Bernaudin, F., Bo-Subait, K., Fitzhugh, C. D., Hankins, J. S., Kanter, J., Meerpohl, J. J., Bolaños-Meade, J., Panepinto, J. A., Rondelli, D., Shenoy, S., Williamson, J., Woolford, T. L., Gluckman, E., Wagner, J. E., & Tisdale, J. F. (2019). Effect of donor type and conditioning regimen intensity on allogeneic transplantation outcomes in patients with sickle cell disease: A retrospective multicentre, cohort study. Lancet Haematology, 6(11), e585–e596.

Gluckman, E., Cappelli, B., Bernaudin, F., Labopin, M., Volt, F., Carreras, J., Pinto Simões, B., Ferster, A., Dupont, S., de la Fuente, J., Dalle, J. H., Zecca, M., Walters, M. C., Krishnamurti, L., Bhatia, M., Leung, K., Yanik, G., Kurtzberg, J., Dhedin, N., … Eurocord, the Pediatric Working Party of the European Society for Blood and Marrow Transplantation, and the Center for International Blood and Marrow Transplant Research. (2017). Sickle cell disease: An international survey of results of HLA-identical sibling hematopoietic stem cell transplantation. Blood, 129(11), 1548–1556.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX850701020000 Enter the date the sample was collected for more
the chimerism test show less
PX850701030000 Report whether the specimen taken for more
chimerism test was from a marrow or peripheral blood source show less
PX850701050000 Were donor cells collected? N/A
PX850701010000 Did late graft failure occur? N/A
PX850701060000 Percent donor cells N/A
PX850701040100 Indicate the cell type tested N/A
PX850701040200 Indicate the cell type tested: Other - If more
other, specify show less
Curative Therapies
Measure Name

White Cell Chimerism

Release Date

August 16, 2021


White cell chimerism (or donor leukocyte chimerism) is defined as the percentage of donor cells (0%-100%), usually by T cell (CD3) and myeloid (CD14/15 or CD33), after marrow or hematopoietic cell transplantation. Full donor chimerism is when 100% of marrow and peripheral blood cells are from the donor; anything less than 100% indicates a mixture of donor and recipient cells.


This measure is used to determine the outcome of grafting and hematopoietic stem cell transplantation. Donor leukocyte chimerism may decrease before complete graft failure or rejection, in which case sickle symptoms return and sickle treatment must be initiated. 


white cell chimerism, Center for International Blood and Marrow Transplant Research, CIBMTR, post-transplant, late graft failure, cell source, cell type, donor cells

Measure Protocols
Protocol ID Protocol Name
850701 White Cell Chimerism and Graft Failure

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