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

Lawler, M; McCann, SR; Marsh, JCW; Ljungman, P; Hows, J; Vandenberghe, E; O'Riordan, J; Locasciulli, A; Socie, G; Kelly, A; Schrezenmeier, H; Marin, P; Tichelli, A; Passweg, JR; Dickinson, A; Ryan, J; Bacigalupo, A

doi:10.1111/j.1365-2141.2008.07533.x

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

Lookup NU author(s): Professor Anne Dickinson

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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. © 2008 Blackwell Publishing Ltd.

Publication metadata

Author(s): Lawler M, McCann SR, Marsh JCW, Ljungman P, Hows J, Vandenberghe E, O'Riordan J, Locasciulli A, Socie G, Kelly A, Schrezenmeier H, Marin P, Tichelli A, Passweg JR, Dickinson A, Ryan J, Bacigalupo A

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2009

Volume: 144

Issue: 6

Pages: 933-945

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/j.1365-2141.2008.07533.x

DOI: 10.1111/j.1365-2141.2008.07533.x