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Prognostic utility of routine chimerism testing at 2 to 6 months after allogeneic hematopoietic cell transplantation.

Mossallam, Ghada I and Kamel, Azza M and Storer, Barry and Martin, Paul J (2009) Prognostic utility of routine chimerism testing at 2 to 6 months after allogeneic hematopoietic cell transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 15 (3). pp. 352-359. ISSN 1523-6536

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Article URL: http://dx.doi.org/10.1016/j.bbmt.2008.12.496

Abstract

The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice.

Item Type: Article
Additional Information: This article is available to subscribers only via the URL above.
DOI: 10.1016/j.bbmt.2008.12.496
PubMed ID: 19203726
NIHMSID: NIHMS96988
PMCID: PMC2662135
Grant Numbers: P01 HL 36444, P01 CA 18029, BI01-002-002 Contract No. 188
Keywords or MeSH Headings: Adolescent Adult Aged Bone Marrow Cells/immunology* Child Child, Preschool Cohort Studies Female Follow-Up Studies Graft vs Host Disease/immunology Hematopoietic Stem Cell Transplantation/methods* Humans Infant Infant, Newborn Male Middle Aged Survival Analysis T-Lymphocytes/immunology Transplantation Chimera/immunology* Transplantation Conditioning/methods Treatment Outcome Young Adult
Subjects: Therapeutics > Transplantation > Stem Cell transplantation
Depositing User: Library Staff
Date Deposited: 09 Mar 2009 19:02
Last Modified: 14 Feb 2012 14:42
URI: http://authors.fhcrc.org/id/eprint/257

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