title: Early complete donor hematopoietic chimerism in peripheral blood indicates the risk of extensive graft-versus-host disease.
abstract: Achievement of complete donor hematopoietic chimerism (CC) is the goal of allogeneic stem cell transplantation (allo-SCT). Persistence of recipient hematopoiesis augments the risk of relapse, which is one of the main reasons for mortality after allo-SCT. Another main reason for morbidity and mortality is severe extensive chronic graft-versus-host disease (cGvHD). We examined chimerism in peripheral blood of 54 allogeneic stem cell recipients using multiplex STR-PCR method and compared it with the timing and severity of cGvHD. In total, 25 patients achieved early CC (by day 100 post transplant) at a median time of 60 days. In total, 21 of them developed extensive cGvHD. In those patients CC uniformly preceded emergence of cGvHD by a mean of 85 days. A total of 26 patients obtained late CC at a median time of 270 days post transplant. Of this group, only eight patients developed extensive disease. Development of cGvHD in those patients preceded achievement of CC in 10 of 13 cases by a mean of 100 days. The difference between early and late CC groups as to the frequency of the extensive cGvHD was statistically significant (P<0.001). Also, there was a significant correlation of the time of CC and time between CC and cGvHD. Additionally, patients with early CC developed significantly more severe cGvHD measured by the need of three-drug treatment to control the disease (P<0.005). It can be concluded that achievement of early complete donor hematopoietic chimerism in peripheral blood is strongly predictive of severe extensive GvHD.
authors.affiliation: Department of Haematology, Medical University School of Gdańsk, Ul Debinki 7, 80-952 Gdańsk, Poland. klhem@amg.gda.pl
authors.forename: J
authors.initials: J
authors.lastname: Balon
authors.forename: K
authors.initials: K
authors.lastname: Hałaburda
authors.forename: M
authors.initials: M
authors.lastname: Bieniaszewska
authors.forename: M
authors.initials: M
authors.lastname: Reichert
authors.forename: L
authors.initials: L
authors.lastname: Bieniaszewski
authors.forename: A
authors.initials: A
authors.lastname: Piekarska
authors.forename: R
authors.initials: R
authors.lastname: Pawłowski
authors.forename: A
authors.initials: A
authors.lastname: Hellmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D017252:CD3 Complex / Q000096:biosynthesis; D002648:Child; D046528:Chimerism; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D007962:Leukocytes / Q000166:cytology; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012306:Risk; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D013997:Time Factors; D018183:Transplantation Chimera; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D017252:CD3 Complex; D016572:Cyclosporine; D008727:Methotrexate