title: Hematopoietic donor chimerism and graft-versus-myeloma effect in relapse of multiple myeloma after allogeneic bone marrow transplantation.
abstract: A large group of patients relapsing after allogeneic bone marrow transplantation (BMT) have obtained remission after infusion of leukocytes from their original donor, suggesting a graft-versus-myeloma effect. However, side effects such as graft-versus-host disease and myelosuppression are severe, and sometimes fatal, complications of this therapeutic approach. Previously we demonstrated that patients with leukemia who lack donor hematopoiesis in relapse after BMT experience severe and lasting aplasia after infusion of donor leukocytes. In two patients - one with extramedullary and one with marrow relapse after a sex-mismatched transplantation - we analyzed hematopoietic chimerism by cell sorting and bone marrow cultures. CD34-positive cells, CD4-CD8-positive cells, committed progenitors, and LTC-IC were of donor origin, as demonstrated by two-color fluorescence in situ hybridization (FISH). Additionally, in relapse complete donor T-cell chimerism was seen. In contrast, plasma cells were of recipient origin in the patient who had a relapse in the bone marrow. Both patients were treated with infusions of donor leukocytes from their original donor. Neither patient suffered myelosuppression, and one achieved a stable complete remission.
authors.affiliation: Department of Medicine 1, Bone Marrow Transplantation Unit, University of Vienna, Austria. felix.keil@akh-wien.ac.at
authors.forename: F
authors.initials: F
authors.lastname: Keil
authors.forename: P
authors.initials: P
authors.lastname: Kalhs
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.forename: O A
authors.initials: OA
authors.lastname: Haas
authors.forename: G
authors.initials: G
authors.lastname: Fritsch
authors.forename: A
authors.initials: A
authors.lastname: Chott
authors.forename: K
authors.initials: K
authors.lastname: Lechner
authors.forename: K
authors.initials: K
authors.lastname: Moser
authors.forename: J
authors.initials: J
authors.lastname: Ackermann
authors.forename: W
authors.initials: W
authors.lastname: Rabitsch
authors.forename: N
authors.initials: N
authors.lastname: Worel
authors.forename: C
authors.initials: C
authors.lastname: Mannhalter
authors.forename: H T
authors.initials: HT
authors.lastname: Greinix
mesh_terms: D000328:Adult; D018952:Antigens, CD34; D001706:Biopsy; D001782:Blood Donors; D001853:Bone Marrow / Q000002:abnormalities / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy; D020350:Graft vs Tumor Effect; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007937:Leukapheresis; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
chemical_list: D018952:Antigens, CD34