title: Evaluation of immunomodulatory treatment based on conventional and lineage-specific chimerism analysis in patients with myeloid malignancies after myeloablative allogeneic hematopoietic cell transplantation.
abstract: Both conventional chimerism analysis (CCA) and lineage-specific chimerism analysis (LCA) have potential pitfalls as diagnostic means for the detection of minimal residual disease after allogeneic hematopoietic cell transplantation (aHCT). Therefore, the present study examines the results of both methods in order to determine how predictive consecutive evaluations were, with respect to the risk that the patient would relapse during post-transplant follow-up and with respect to responsiveness to immunomodulatory treatment. A total of 168 individuals with acute myeloid leukemia (AML) (n = 137) and myelo dysplastic syndrome (n = 31) were investigated with CCA and LCA at mean intervals of 24 days (range: 11-116). The median follow-up after myeloablative aHCT was 22 months (range: 4-49). Of 168 patients, 65 experienced a clinical relapse after aHCT. CCA and LCA were comparatively sensitive and specific for relapse at the intervals of chimerism testing employed in this study. Of 32 patients, 10 who were offered donor lymphocyte infusions (DLI) treatment for increasing (n = 29) or stable (n = 3) mixed chimerism (MC) achieved at least transitory CC. The observation that all patients with increasing MC relapsed despite DLI treatment (54%) or withdrawal of immune suppression (24%) indicates that novel strategies to deal with rapidly evolving relapse in AML patients, such as shortening of chimerism monitoring intervals, need to be evaluated.
authors.affiliation: Department of Hematology and Oncology, Freiburg University Medical Center, Albert-Ludwigs University, Freiburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Zeiser
authors.forename: A
authors.initials: A
authors.lastname: Spyridonidis
authors.forename: R
authors.initials: R
authors.lastname: Wäsch
authors.forename: G
authors.initials: G
authors.lastname: Ihorst
authors.forename: C
authors.initials: C
authors.lastname: Grüllich
authors.forename: H
authors.initials: H
authors.lastname: Bertz
authors.forename: J
authors.initials: J
authors.lastname: Finke
mesh_terms: D019070:Cell Lineage / Q000235:genetics; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000379:methods*; D007951:Leukemia, Myeloid / Q000628:therapy*; D017710:Lymphocyte Transfusion / Q000379:methods*; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D012680:Sensitivity and Specificity; D018183:Transplantation Chimera / Q000235:genetics / Q000276:immunology*; D016896:Treatment Outcome