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ctt-journal > Dyshlevaya et al. (Abstract)

Dyshlevaya et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract28

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Lineage-specific chimerism in patients after allogeneic hematopoietic stem cell transplantation

Zarema M. Dyshlevaya, Elena V. Skorobogatova, Alexei A. Maschan, Adrey A. Bologov

The Russian Children's Research Hospital, Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia

Correspondence: Zarema M. Dyshlevaya, The Russian Children's Research Hospital, 117, Leninskii pr, 117997, Moscow, Russia, E-mail: dishleva@spam is badmail.ru

Abstract

Despite impressive progress in the treatment of aplastic anemia (AA) and acute myeloid leukemia (AML) by allogeneic hematopoietic stem cell transplantation (HSCT) the problem of rejection and relapse remains very important. We investigated chimerism in CD34+, CD3+, CD56+ and CD15+ cells to define their predictive role in rejection/relapses.

Patients and methods: We reviewed the records of 42 AA patients (pts) and 27 AML pts (complete remission I (CRI) = 11 pts, CR>I = 8 pts, non-CR = 8 pts). All cell populations were isolated by magnetic antibodies with an estimation of the portion of recipient’s own cells in peripheral blood or bone marrow. The median age was 7 years (range 1–17). The conditioning regimes were immunoablative in AA pts and myeloablative in AML pts.

Results: The achievement of engraftment was 100% in all pts. In pts with AA on day +30 the full donor chimerism (DC) in all cell populations was achieved in 25 pts (group A). Seventeen pts had mixed chimerism (MC) in CD3+, and CD56+ cells (group B). Disease free survival (DFS) was 100% in group A and 22% in group B, p=0.01. On day +100 9 pts from group B and 1 pt from group A had MC. After donor lymphocyte infusion (DLI) +/- fludarabine five pts achieved DC without GvHD.

In the AML pts DC in all cell populations was achieved on day +30 in 24 (89%) pts (group A). Three pts had MC in CD34+ and CD56+ cells (group B). Chimerism on day +30 did not influence the DFS. On day +60 2 pts from group A and 5 pts from group B had MC with DFS of 87% and 14% respectively (p=0,02). DLI+/-IL-2 was effective in 2 pts only. The median time between decreased CD34+ cell chimerism and relapse was 87 days (range 25–302)

Conclusions: Our results show: 1. AA pts with MC in CD3+ cells on day +30 need preemptive therapy. 2. AML pts with MC on day +60 in CD34+ cell line have a very high risk of relapse and need more intensive therapy (DLI +/- chemotherapy). Chimerism in other cell populations does not influence the risk of relapse/rejection.

Keywords: allogeneic hematopoietic stem cell transplantation, lineage-specific chimerism, AML, AA