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- Title
Serial chimerism analyses indicate that mixed haemopoietic chimerism influences the probability of graft rejection and disease recurrence following allogeneic stem cell transplantation (SCT) for severe aplastic anaemia (SAA): indication for routine assessment of chimerism post SCT for SAA
- Authors
Lawler, Mark; McCann, Shaun R.; Marsh, Judith C. W.; Ljungman, Per; Hows, Jill; Vandenberghe, Elisabeth; O’Riordan, Joan; Locasciulli, Anna; Soci, Gérard; Kelly, Alan; Schrezenmeier, Hubert; Marin, Pedro; Tichelli, Andr; Passweg, Jakob R.; Dickenson, Anne; Ryan, Jacqueline; Bacigalupo, Andrea
- Abstract
Ninety-one patients were studied serially for chimeric status following allogeneic stem cell transplantation (SCT) for severe aplastic anaemia (SAA) or Fanconi Anaemia (FA). Short tandem repeat polymerase chain reaction (STR-PCR) was used to stratify patients into five groups: (A) complete donor chimeras ( n = 39), (B) transient mixed chimeras ( n = 15) (C) stable mixed chimeras ( n = 18), (D) progressive mixed chimeras ( n = 14) (E) recipient chimeras with early graft rejection ( n = 5). As serial sampling was not possible in Group E, serial chimerism results for 86 patients were available for analysis. The following factors were analysed for association with chimeric status: age, sex match, donor type, aetiology of aplasia, source of stem cells, number of cells engrafted, conditioning regimen, graft-versus-host disease (GvHD) prophylaxis, occurrence of acute and chronic GvHD and survival. Progressive mixed chimeras (PMCs) were at high risk of late graft rejection ( n = 10, P < 0·0001). Seven of these patients lost their graft during withdrawal of immunosuppressive therapy. STR-PCR indicated an inverse correlation between detection of recipient cells post-SCT and occurrence of acute GvHD ( P = 0·008). PMC was a bad prognostic indicator of survival ( P = 0·003). Monitoring of chimeric status during cyclosporin withdrawal may facilitate therapeutic intervention to prevent late graft rejection in patients transplanted for SAA.
- Subjects
GRAFT rejection; TRANSPLANTATION immunology; DISEASE relapse; STEM cell transplantation; CELL transplantation; APLASTIC anemia
- Publication
British Journal of Haematology, 2009, Vol 144, Issue 6, p933
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/j.1365-2141.2008.07533.x