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Guidotti S, Bassi S, Rossi A, Borotti E, Cortellazzi P, Ferrarese D, Ronda E, Scarpa A, Schiro A, Merli F, Prezioso L, Bonifazi F, Narni F, Fabrizi E, Vallisa D. Mixed T cell CHIMERISM in bone marrow at day+30 after allogeneic stem cell transplantation: Correlation with acute GVHD grades III-IV and no impact on relapse and overall survival. Eur J Haematol 2022; 109:83-89. [PMID: 35389543 DOI: 10.1111/ejh.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early chimerism analysis is important to assess engraftment in allogeneic hematopoietic stem cell transplantations. METHODS We retrospectively investigated the impact of T-cell chimerism at day 30 in bone marrow on acute graft-versus-host disease (aGVHD), relapse, and overall survival in 142 adult allo-transplanted patients. RESULTS The majority of patients (89%) received myeloablative conditioning and 90% have undergone T-cell replete donor graft. At day 30, 103 patients showed T-complete chimerism with prevalence in haploidentical transplants, whereas 39 cases had CD3+ mixed chimerism, including 30 patients transplanted with HLA identical donors, and 21 with T-cell donors<90%. T-cell chimerism at day 30 was weakly inversely related to aGVHD grades II-IV (p = .078) with no cases of grades III-IV aGVHD in patients with CD3+ <95%. Mixed T-cell chimerism did not impact on relapse (p = .448) and five of the seven patients who relapsed had T-cell chimerism ≤90%. Older age and active disease at transplant had a statistically significant negative effect on overall survival (p = .01 and p = .0001, respectively), whereas mixed CD3+ chimerism did not. CONCLUSIONS T lymphocyte chimerism analysis at day +30 in bone marrow could identify allo-transplanted patients at major risk of aGVHD grades III-IV (CD3+ donors >95%) mainly post-myeloablative conditioning regimen.
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Affiliation(s)
- Samantha Guidotti
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Simona Bassi
- Department of Hematology, Azienda USL di Piacenza, Piacenza, Italy
| | - Angela Rossi
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Elena Borotti
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Pilade Cortellazzi
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Diego Ferrarese
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Elena Ronda
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Alice Scarpa
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Alice Schiro
- Bone Marrow Transplant Laboratory, Azienda USL di Piacenza, Piacenza, Italy
| | - Francesco Merli
- Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesca Bonifazi
- Department of Hematology, IRCCS Azienda-Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franco Narni
- Department of Hematology, AOU di Modena, Modena, Italy
| | - Enrico Fabrizi
- Dipartimento di Scienze Economiche e Sociale e Dipartimento di Scienze Statistiche, Università Cattolica del Sacro Cuore, Italy
| | - Daniele Vallisa
- Department of Hematology, Azienda USL di Piacenza, Piacenza, Italy
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Lejman M, Zaucha-Prażmo A, Zawitkowska J, Mroczkowska A, Grabowski D, Kowalczyk JR, Drabko K. Impact of early chimerism status on clinical outcome in children with acute lymphoblastic leukaemia after haematopoietic stem cell transplantation. BMC Cancer 2019; 19:1141. [PMID: 31771553 PMCID: PMC6878687 DOI: 10.1186/s12885-019-6360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/12/2019] [Indexed: 12/26/2022] Open
Abstract
Background The significance of very early chimerism assessment before day + 28, which is considered the moment of engraftment, is still unclear. In this retrospective study, we evaluated the clinical impact of very early chimerism on the clinical outcome after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in children with acute lymphoblastic leukaemia (ALL). Methods The study group included 38 boys and 18 girls. Very early chimerism was evaluated on days + 7, + 14, + 21 and + 28 after the transplant. Short tandem repeat polymerase chain reaction (STR PCR) was used to analyse chimerism. Results Overall survival (OS) and event-free survival (EFS) were 84 and 80%, respectively. The OS in the group of 24 patients with complete donor chimerism on day + 14 was 83%, and it did not differ statistically compared to the 32 patients with mixed chimerism on day + 14 (OS was 84%). In our cohort of patients, the matched unrelated donor, male gender of donor, number of transplanted cells above 4.47 × 106 kg and no serotherapy with anti-thymocyte globulin (ATG) were statistically related to a higher level of donor chimerism. The immunophenotypes of disease, age of patient at time HSCT, recipient sex, stem cell source (peripheral blood/bone marrow) and conditioning regimen had no impact on early chimerism. Acute graft versus host disease grades II-IV was diagnosed in 23 patients who presented with donor chimerism levels above 60% on day 7. Conclusions The data presented in this study provide valuable insight into the analysis of very early chimerism in children with ALL treated with HSCT.
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Affiliation(s)
- Monika Lejman
- Laboratory of Genetic Diagnostics, Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland.
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
| | - Aleksandra Mroczkowska
- Laboratory of Genetic Diagnostics, Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
| | - Dominik Grabowski
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
| | - Jerzy R Kowalczyk
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, A. Gebali 6, 20-093, Lublin, Poland
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Minculescu L, Madsen HO, Sengeløv H. T-cell chimerism is valuable in predicting early mortality in steroid-resistant acute graft-versus-host disease after myeloablative allogeneic cell transplantation. Acta Haematol 2014; 132:187-92. [PMID: 24603448 DOI: 10.1159/000357728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022]
Abstract
The main aim of this study was to evaluate the impact of early T-cell chimerism status on the incidence and clinical course of acute graft-versus-host disease (aGVHD) in allogeneic transplant recipients after myeloablative conditioning. Of 62 patients, 38 (61%) had complete T-cell donor chimerism (DC), and 24 (39%) had mixed T-cell chimerism (MC). The incidence of early death (before day 100) with steroid-resistant aGVHD was significantly higher in patients with complete DC compared to patients with MC (6/38 vs. 0/24, p = 0.04). The time from aGVHD diagnosis to nonrelapse death was markedly different in patients with complete DC versus MC [53 days (range 12–183) vs. 238 days (range 135– 550), p = 0.005]. Conditioning with Etopophos/total body irradiation (TBI) resulted in significantly more patients with MC compared to conditioning with cyclophosphamide/TBI. In conclusion, early complete T-cell DC was associated with a high incidence of early death in patients receiving highdose steroids for the treatment of aGVHD.
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4
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Chimerism status is correlated to acute graft-versus-host disease after allogeneic stem cell transplantation. Int J Hematol 2014; 99:323-8. [DOI: 10.1007/s12185-014-1510-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 01/09/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Gendzekhadze K, Gaidulis L, Senitzer D. Chimerism testing by quantitative PCR using Indel markers. Methods Mol Biol 2013; 1034:221-237. [PMID: 23775739 DOI: 10.1007/978-1-62703-493-7_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Engraftment monitoring is critical for patients after Hematopoietic Stem Cell Transplantation (HSCT). Complete donor chimerism is the goal; therefore, early detection of rejection and relapse is crucial for guiding the patient post HSCT treatment. Quantitative PCR for chimerism testing has been reported to be highly sensitive. In this chapter we discuss the quantitative PCR (qPCR) method using 34 Indel (Insertion and Deletion) genetic markers spread over 20 different chromosomes.
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Correlation Between the Kinetics of CD3+ Chimerism and the Incidence of Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Proc 2011; 43:1915-23. [DOI: 10.1016/j.transproceed.2011.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 01/20/2011] [Accepted: 02/02/2011] [Indexed: 11/20/2022]
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Souza LN, Faria DR, Dutra WO, Gomes CC, Gomez RS. Microchimerism in labial salivary glands of hematopoietic stem cell transplanted patients. Oral Dis 2010; 17:484-8. [PMID: 21504513 DOI: 10.1111/j.1601-0825.2010.01779.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Microchimerism has been extensively investigated in autoimmune diseases, which display similarities with graft-vs-host disease. This study was conducted to investigate the presence of microchimerism in minor salivary glands of hematopoietic stem cell transplanted patients, one of the targets of graft-vs-host disease. METHODS Labial salivary glands biopsy specimens from 11 stem cell transplanted patients were analysed. The samples were grouped in control (five specimens from a female-to-female transplantation) and study group (five glands from male-to-female transplantation). One male transplanted patient was used as a positive control. Fluorescence in situ hybridization with Y-chromosome probe and immunofluorescence with anticytokeratin AE1/AE3 and CD45 were used to identify Y-chromosome positive glandular epithelial cells from allogeneic hematopoietic stem cell transplanted patients. RESULTS In the study group, all samples were positive to Y-chromosome and cytokeratin AE1/AE3, in agreement with the pattern exhibited by male labial salivary gland. None of the samples from control group were positive to Y-chromosome despite being positive to cytokeratin AE1/AE3. Positivity to CD45 was not relevant. CONCLUSION Microchimerism in the labial salivary glands of sex-mismatched stem cell transplanted patients is a real phenomenon. Further studies are necessary to elucidate the impact of this phenomenon on the clinical status of stem cell transplanted patients.
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Affiliation(s)
- L N Souza
- Molecular Biology Laboratory, Dentistry School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Berglund S, Okas M, Gertow J, Uhlin M, Mattsson J. Stable mixed donor-donor chimerism after double cord blood transplantation. Int J Hematol 2009; 90:526-531. [PMID: 19697099 DOI: 10.1007/s12185-009-0398-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 07/08/2009] [Accepted: 07/21/2009] [Indexed: 11/25/2022]
Abstract
Double cord blood transplantation (DCBT) has been used increasingly and has proven to be both safe and efficacious. In chimerism analysis, previous studies have indicated single unit predominance early after DCBT. In the present study, we evaluated the chimeric pattern in T-, B- and myeloid cells using PCR-based chimerism analysis in seven patients after DCBT: five patients had acute leukemia and two had lymphoma. Five patients received myeloablative conditioning and two patients were given reduced intensity conditioning. All patients received anti-thymocyte globulin (ATG) before DCBT. Three of the six evaluable patients showed donor-donor mixed chimerism in all cell lineages at 90 days after DCBT. Interestingly, two patients in long-term follow-up showed mixed donor chimerism in all cell lineages at 25 and 35 months after DCBT, respectively. Both patients are doing clinically well. Neither of the two developed GVHD after DCBT. In conclusion, in this study donor-donor mixed chimerism was common after high dose ATG and DCBT. Further studies are warranted concerning the immunological consequences of the phenomenon of donor-donor mixed chimerism after DCBT.
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Affiliation(s)
- Sofia Berglund
- Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Mantas Okas
- Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Jens Gertow
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Michael Uhlin
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Jonas Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Influence of conditioning regimens and stem cell sources on donor-type chimerism early after stem cell transplantation. Ann Hematol 2008; 87:1003-8. [DOI: 10.1007/s00277-008-0542-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 06/18/2008] [Indexed: 11/26/2022]
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Omazic B, Näsman-Björk I, Permert J, Lundkvist I. Insulin-like growth factor-1 receptor RNA expression in hematopoietic stem cell transplanted patients does not correlate with graft-versus-host disease. Immunol Invest 2007; 36:493-506. [PMID: 17691028 DOI: 10.1080/08820130701266526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In vivo activated T lymphocytes exhibit altered expression of insulin-like growth factor-1 receptor (IGF-1R) compared to the naïve T lymphocyte pool. The objective of this study was to investigate the expression of IGF-1R RNA in CD4 and CD8 positive cells after allogeneic hematopoietic stem cell transplantation (HSCT) in patients with and without GVHD. For this purpose we isolated RNA from CD4 and CD8 positive cells, sorted with immunomagnetic beads. We used real-time PCR for RNA quantification. We demonstrate a significantly decreased expression of IGF-1R RNA in both CD4 and CD8 positive cells up to 12 months after HSCT. We could not demonstrate a correlation between the IGF-1R RNA expression and T cell activating processes like GVHD, expansion of CD4 or CD8 populations or virus infections.
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Affiliation(s)
- Brigitta Omazic
- Arvid Wretlind Laboratory at the Center for Surgical Sciences, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Kristt D, Stein J, Yaniv I, Klein T. Assessing quantitative chimerism longitudinally: technical considerations, clinical applications and routine feasibility. Bone Marrow Transplant 2007; 39:255-68. [PMID: 17262064 DOI: 10.1038/sj.bmt.1705576] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this review, we describe the current laboratory approach to quantitative chimerism testing based on short tandem repeats (STRs), focusing on a longitudinal analysis. The latter is based on relative changes appearing in the course of sequential samples, and as such exploits the ultimate potential of this intrinsically semiquantitative platform. Such an analysis is more informative than single static values, less likely to be confused with platform artifacts, and is individualized to the particular patient. It is particularly useful with non-myeloablative conditioning, where mixed chimerism is common. Importantly, longitudinal monitoring is a routinely feasible laboratory option because multiplex STR-polymerase chain reaction kits are available commercially, and modern software can be used to perform computation, reliability testing and longitudinal tracking in a rapid, easy to use format. The ChimerTrack application, a shareware, user friendly program developed for this purpose, produces a report that automatically summarizes and illustrates the quantitative temporal course of the patient's chimeric status. Such a longitudinal perspective enhances the value of quantitative chimerism monitoring for decisions regarding immunomodulatory post transplant therapy. This information also provides unique insights into the biological dynamics of engraftment underlying the fluctuations in the temporal course of a patient's chimeric status.
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Affiliation(s)
- D Kristt
- Laboratory of Histocompatibility and Immunogenetics, Department of Pathology, Sackler School of Medicine, Rabin Medical Center, Tel-Aviv University, Petach Tikvah, Israel.
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Abstract
PURPOSE OF REVIEW With improved methods for detecting chimeras and growing numbers of stem cell transplantations, blood group and other forms of chimerism are observed with increasing frequency. This review will focus on the state of science and new insights into the multifaceted subject of blood group chimerism. RECENT FINDINGS Recognition that the immune system tolerates chimeric cells under certain conditions has led to efforts to elucidate related immune-modulating processes. The chimeric state following transplantation of hematopoietic stem cells, as well as after solid organ transplantation, is of special interest. Also, chimerism is considered to be a potential trigger for certain autoimmune diseases. Natural chimerism is more frequent than previously recognized. Using improved laboratory techniques, investigators can often trace chimeric tissues to their origin. New therapeutic strategies have been applied after stem cell transplantation depending on the chimeric state. Also, recent research has resulted in methods for determining chimerism in maternal peripheral blood that reflect fetal blood type and certain congenital diseases. SUMMARY The subject of human chimerism has evolved from a curiosity of nature to an important field of research and, potentially, holds the key to advancing our understanding of the fundamental mechanisms of immune tolerance.
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Affiliation(s)
- Camilla Drexler
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
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