Comparison of donor chimerism following myeloablative and nonmyeloablative allogeneic hematopoietic SCT

Bone Marrow Transplant. 2011 Jan;46(1):84-9. doi: 10.1038/bmt.2010.55. Epub 2010 Mar 22.

Abstract

Surveillance of hematopoietic chimerism following hematopoietic SCT (HSCT) with nonmyeloablative (NMA) preparative regimens is standard to assess the need for clinical intervention. Monitoring of donor chimerism following HSCT with myeloablative (MA) preparative regimens is, however, not considered useful because engraftment is thought to occur rapidly and consistently. This study compares the timing of donor hematopoietic cell engraftment in patients undergoing NMA conditioning with fludarabine and TBI with those receiving MA conditioning with BU- or TBI-based regimens. Achievement of ≥ 90% donor leukocyte chimerism occurred rapidly and consistently in all three groups and time to achievement of ≥ 90% donor T cells was similar among the three groups (P = 0.57). Achievement of ≥ 90% donor leukocyte chimerism was not associated with risk of acute or chronic GVHD, graft rejection, relapse or all cause mortality in multivariate analyses. Donor T-cell chimerism of ≥ 90% was significantly associated with development of extensive chronic GVHD. The value of routine surveillance of chimerism following any of the preparative regimens used in this study should be reevaluated.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Busulfan / adverse effects
  • Busulfan / therapeutic use
  • Chimerism*
  • Combined Modality Therapy / adverse effects
  • Female
  • Graft Survival / drug effects
  • Graft Survival / immunology
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Kinetics
  • Male
  • Middle Aged
  • Myeloablative Agonists / adverse effects
  • Myeloablative Agonists / therapeutic use
  • T-Lymphocytes / drug effects*
  • T-Lymphocytes / immunology*
  • T-Lymphocytes / metabolism
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods*
  • Transplantation, Heterologous
  • Vidarabine / adverse effects
  • Vidarabine / analogs & derivatives
  • Vidarabine / therapeutic use
  • Whole-Body Irradiation / adverse effects
  • Young Adult

Substances

  • Antineoplastic Agents
  • Myeloablative Agonists
  • Vidarabine
  • Busulfan
  • fludarabine