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Polyclonal CD5+/CD19+ B1a lymphocytes after allogeneic stem cell transplantation: a potential diagnostic pitfall.

Amir Qorbani1, Guofeng Gao2, Denis M Dwyre2

  • 1University of California, San Francisco (UCSF), UCSF Medical Center, Department of Pathology and Laboratory Medicine. San Francisco, CA, USA.

Autopsy & Case Reports
|December 21, 2020
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Summary

This case study highlights increased B1a cells, a type of innate-like B lymphocyte, following a hematopoietic stem cell transplant in a sickle cell disease patient. This finding is crucial for accurate diagnosis in post-transplant care.

Keywords:
Flow CytometryHematologyPathologyStem Cell Transplantation

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Area of Science:

  • Immunology
  • Hematology

Background:

  • B-lymphocytes are key to adaptive immunity, with B2 cells being the majority in circulation.
  • B1 cells, a distinct subset, possess innate immune characteristics and include B1a (CD5+) and B1b (CD5-) subtypes.
  • Limited data suggests a potential link between allogeneic bone marrow transplantation and elevated B1a cell counts.

Observation:

  • A 17-year-old female with homozygous sickle cell disease (HbSS) underwent hematopoietic stem cell transplant (HSCT).
  • Seven months post-HSCT, peripheral blood analysis revealed 16% immature mononuclear cells.
  • Flow cytometry identified these as polyclonal CD5+/CD20+ B-cells, constituting 66% of lymphocytes.

Findings:

  • The identified CD5+/CD20+ B-cells were characterized as B1a cells.
  • No evidence of lymphoproliferative disorders was found despite the high B1a cell count.
  • This represents a rare, non-neoplastic observation of increased circulating B1a cells post-stem cell transplant.

Implications:

  • Accurate identification of B1a cells is vital to avoid misdiagnosis of atypical CD5+ lymphoproliferative disorders.
  • This case expands the understanding of B1a cell dynamics in non-hematological malignancy patients post-HSCT.
  • Further research is warranted to elucidate the mechanisms and clinical significance of increased B1a cells after stem cell transplantation.