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Tzeng HE, Lee YW, Lin CT, Chuang SS, Li CC, Chuang WH, Hsu CA, Wang YH, Tien HF, Wu SJ. Multicolour and lineage-specific interphase chromosome Flow-FISH: method development and clinical validation. Pathology 2024; 56:671-680. [PMID: 38852040 DOI: 10.1016/j.pathol.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/01/2024] [Accepted: 04/14/2024] [Indexed: 06/10/2024]
Abstract
Flow cytometry can be applied in the detection of fluorescence in situ hybridisation (FISH) signals to efficiently analyse chromosomal aberrations. However, such interphase chromosome (IC) Flow-FISH protocols are currently limited to detecting a single colour. Furthermore, combining IC Flow-FISH with conventional multicolour flow cytometry is difficult because the DNA-denaturation step in FISH assay also disrupts cellular integrity and protein structures, precluding subsequent antigen-antibody binding and hindering concurrent labeling of surface antigens and FISH signals. We developed a working protocol for concurrent multicolour flow cytometry detection of nuclear IC FISH signals and cell surface markers. The protocol was validated by assaying sex chromosome content of blood cells, which was indicative of chimerism status in patients who had received sex-mismatched allogeneic haematopoietic stem cell transplants (allo-HSCT). The method was also adapted to detect trisomy 12 in chronic lymphocytic leukaemia (CLL) subjects. We first demonstrated the feasibility of this protocol in detecting multiple colours and concurrent nuclear and surface signals with high agreement. In clinical validation experiments, chimerism status was identified in clinical samples (n=56) using the optimised IC Flow-FISH method; the results tightly corresponded to those of conventional slide-based FISH (R2=0.9649 for XX cells and 0.9786 for XY cells). In samples from patients who received sex-mismatched allo-HSCT, individual chimeric statuses in different lineages could be clearly distinguished with high flexibility in gating strategies. Furthermore, in CLL samples with trisomy 12, this method could demonstrate that enriched trisomy 12 FISH signal was present in B cells rather than in T cells. Finally, by performing combined labelling of chromosome 12, X chromosome, and surface markers, we could detect rare residual recipient CLL cells with trisomy 12 after allo-HSCT. This adaptable protocol for multicolour and lineage-specific IC Flow-FISH advances the technique to allow for its potential application in various clinical contexts where conventional FISH assays are currently being utilised.
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MESH Headings
- Humans
- In Situ Hybridization, Fluorescence/methods
- Flow Cytometry/methods
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Interphase
- Female
- Male
- Hematopoietic Stem Cell Transplantation
- Trisomy/diagnosis
- Trisomy/genetics
- Middle Aged
- Chromosomes, Human, Pair 12/genetics
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Affiliation(s)
- Huey-En Tzeng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan; Ph.D. Program for Cancer Molecular Biology and Drug Discovery, and Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Yi-Wei Lee
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan; Center of Stem Cell and Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chi-Cheng Li
- Center of Stem Cell and Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wen-Hui Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-An Hsu
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hua Wang
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwei-Fang Tien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Far-East Memorial Hospital, New Taipei City, Taiwan
| | - Shang-Ju Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
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Rathgeber AC, Ludwig LS, Penter L. Single-cell genomics-based immune and disease monitoring in blood malignancies. Clin Hematol Int 2024; 6:62-84. [PMID: 38884110 PMCID: PMC11180218 DOI: 10.46989/001c.117961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/25/2023] [Indexed: 06/18/2024] Open
Abstract
Achieving long-term disease control using therapeutic immunomodulation is a long-standing concept with a strong tradition in blood malignancies. Besides allogeneic hematopoietic stem cell transplantation that continues to provide potentially curative treatment for otherwise challenging diagnoses, recent years have seen impressive progress in immunotherapies for leukemias and lymphomas with immune checkpoint blockade, bispecific monoclonal antibodies, and CAR T cell therapies. Despite their success, non-response, relapse, and immune toxicities remain frequent, thus prioritizing the elucidation of the underlying mechanisms and identifying predictive biomarkers. The increasing availability of single-cell genomic tools now provides a system's immunology view to resolve the molecular and cellular mechanisms of immunotherapies at unprecedented resolution. Here, we review recent studies that leverage these technological advancements for tracking immune responses, the emergence of immune resistance, and toxicities. As single-cell immune monitoring tools evolve and become more accessible, we expect their wide adoption for routine clinical applications to catalyze more precise therapeutic steering of personal immune responses.
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Affiliation(s)
- Anja C Rathgeber
- Berlin Institute for Medical Systems Biology Max Delbrück Center for Molecular Medicine
- Department of Hematology, Oncology, and Tumorimmunology Charité - Universitätsmedizin Berlin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin
| | - Leif S Ludwig
- Berlin Institute for Medical Systems Biology Max Delbrück Center for Molecular Medicine
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin
| | - Livius Penter
- Department of Hematology, Oncology, and Tumorimmunology Charité - Universitätsmedizin Berlin
- BIH Biomedical Innovation Academy Berlin Institute of Health at Charité - Universitätsmedizin Berlin
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3
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Morris AB, Sullivan HC, Wooten MS, Waller EK, Jaye DL. The unnecessary use of short tandem repeat testing on bone marrow samples in patients after 1 year following allogeneic hematopoietic stem cell transplant. Am J Clin Pathol 2024:aqae061. [PMID: 38767053 DOI: 10.1093/ajcp/aqae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVES To determine whether the information provided by short tandem repeat (STR) testing and bone marrow (BM) biopsy specimens following hematopoietic stem cell transplant (HSCT) provides redundant information, leading to test overutilization, without additional clinical benefit. METHODS Cases with synchronous STR and flow cytometric immunophenotyping (FCI) testing, as part of the BM evaluation, were assessed for STR/FCI concordance. RESULTS Of 1199 cases (410 patients), we found the overall concordance between STR and FCI was 93%, with most cases (1063) classified as STR-/FCI-. Of all discordant cases, 75 (6%) were STR+/FCI-, with only 5 (6.7%) cases best explained as identification of disease relapse. Eight cases were STR-/FCI+, representing relapsed/residual disease. Analysis of cases 1 year or more from transplant (54% of all cases) indicated only 9 (1.5%) were STR+/FCI-, and none uniquely identified relapse. CONCLUSIONS These data suggest that STR analysis performed 1 year or more post-HSCT does not identify unknown cases of relapse. Furthermore, while STR testing is critical for identifying graft failure/rejection within the first year posttransplant, FCI appears superior to STR at detecting late relapses with low-level disease. Therefore, STR testing from patients 1 year or more post-HSCT may be unnecessary, as BM biopsy evaluation is sufficient to identify disease relapse.
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Affiliation(s)
- Anna B Morris
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - H Clifford Sullivan
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Melanie S Wooten
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, US
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, US
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, US
| | - David L Jaye
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, US
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, US
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Kakodkar P, Zhao Y, Pan H, Wu F, Pearce T, Webster D, Elemary M, Sabry W, Kwan L, Pelzer L, Bosch M, Sherwood KR, Lan J, Tran J, Liwski R, Keown P, Mostafa A. Validation of next-generation sequencing-based chimerism testing for accurate detection and monitoring of engraftment in hematopoietic stem cell transplantation. Front Genet 2023; 14:1282947. [PMID: 37937195 PMCID: PMC10626454 DOI: 10.3389/fgene.2023.1282947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a life-saving treatment for various hematological disorders. The success of allo-HSCT depends on the engraftment of donor cells and the elimination of recipient cells monitored through chimerism testing. We aimed to validate a next-generation sequencing (NGS)-based chimerism assay for engraftment monitoring and to emphasize the importance of including the most prevalent cell subsets in proficiency testing (PT) programs. We evaluated the analytical performance of NGS-based chimerism testing (AlloSeq-HCT and CareDx) with a panel of targeted 202 informative single-nucleotide polymorphisms (SNPs) (i.e., linearity and precision, analytical sensitivity and specificity, system accuracy, and reproducibility). We further compared the performance of our NGS panel with conventional short tandem repeat (STR) analysis in unfractionated whole blood and cell-subset-enriched CD3 and CD66. Our NGS-based chimerism monitoring assay has an impressive detection limit (0.3% host DNA) for minor alleles and analytical specificity (99.9%). Pearson's correlation between NGS- and STR-based chimerism monitoring showed a linear relationship with a slope of 0.8 and r = 0.973. The concordance of allo-HSCT patients using unfractionated whole blood, CD3, and CD66 was 0.95, 0.96, and 0.54, respectively. Utilization of CD3+ cell subsets for mixed chimerism detection yielded an average of 7.3 ± 7-fold higher donor percentage detection compared to their corresponding unfractionated whole blood samples. The accuracy of the NGS assay achieved a concordance of 98.6% on blinded external quality control STR samples. The reproducibility series showed near 100% concordance with respect to inter-assay, inter-tech, inter-instrument, cell flow kits, and AlloSeq-HCT software versions. Our study provided robust validation of NGS-based chimerism testing for accurate detection and monitoring of engraftment in allo-HSCT patients. By incorporating the cell subsets (CD3 and CD66), the sensitivity and accuracy of engraftment monitoring are significantly improved, making them an essential component of any PT program. Furthermore, the implementation of NGS-based chimerism testing shows potential to streamline high-volume transplant services and improve clinical outcomes by enabling early relapse detection and guiding timely interventions.
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Affiliation(s)
- Pramath Kakodkar
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yayuan Zhao
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Henry Pan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Fang Wu
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Twyla Pearce
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
| | - Destinie Webster
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
| | - Mohamed Elemary
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Waleed Sabry
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Luvinia Kwan
- HLA Laboratory, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Lindsay Pelzer
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Mark Bosch
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Karen R. Sherwood
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - James Lan
- Department of Transplant Nephrology, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Jenny Tran
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Paul Keown
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Ahmed Mostafa
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
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5
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Picard C, Frassati C, Cherouat N, Maioli S, Moskovtchenko P, Cherel M, Chiaroni J, Pedini P. New methods for the quantification of mixed chimerism in transplantation. Front Immunol 2023; 14:1023116. [PMID: 36742303 PMCID: PMC9892455 DOI: 10.3389/fimmu.2023.1023116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Background Quantification of chimerism showing the proportion of the donor in a recipient is essential for the follow-up of hematopoietic stem cell transplantation but can also be useful to document an immune tolerance situation after solid organ transplantation. Historically, chimerism has been quantified from genomic DNA, but with technological advances, chimerism from donor-derived cell-free DNA seems particularly relevant in solid organ transplantation. Methods The reference method was until recently the short tandem repeat technique, but new innovative techniques as digital PCR (dPCR) and NGS, have revolutionized the quantification of chimerism, such as the so-called microchimerism analysis. After a short review of chimerism methods, a comparison of chimerism quantification data for two new digital PCR systems (QIAcuity™ dPCR (Qiagen®) and QuantStudio Absolute Q (ThermoFisher®) and two NGS-based chimerism quantification methods (AlloSeq HCT™ (CareDx®) and NGStrack™ (GenDX®)) was performed. Results These new methods were correlated and concordant to routinely methods (r²=0.9978 and r²=0.9974 for dPCR methods, r²=0.9978 and r²=0.9988 for NGS methods), and had similar high performance (sensitivity, reproductibility, linearity). Conclusion Finally, the choice of the innovative method of chimerism within the laboratory does not depend on the analytical performances because they are similar but mainly on the amount of activity and the access to instruments and computer services.
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Affiliation(s)
- Christophe Picard
- Immunogenetic Laboratory, EFS PACC, Marseille, France,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France
| | - Coralie Frassati
- Immunogenetic Laboratory, EFS PACC, Marseille, France,*Correspondence: Pascal Pedini, ; Coralie Frassati,
| | | | | | | | | | - Jacques Chiaroni
- Immunogenetic Laboratory, EFS PACC, Marseille, France,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France
| | - Pascal Pedini
- Immunogenetic Laboratory, EFS PACC, Marseille, France,CNRS, EFS, ADES, Aix Marseille Université, Marseille, France,*Correspondence: Pascal Pedini, ; Coralie Frassati,
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6
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Morris AB, Bray R, Gebel HM, Cliff Sullivan H. A Primer on Chimerism Analysis: A Straightforward, Thorough Review. Lab Med 2022:6827470. [DOI: 10.1093/labmed/lmac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Short tandem repeat (STR) analysis to assess chimerism is a critical aspect of routine care particularly in patients facing stem cell transplants but is also relevant in other clinical scenarios. STR analysis provides a means to assess donor and recipient cellular origins in a patient, and, as such, can inform engraftment, rejection, and relapse status in stem cell transplant recipients. In this review of STR testing, the most commonly used method to assess chimerism, its background, procedural details, and clinical utility are discussed.
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Affiliation(s)
- Anna B Morris
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Robert Bray
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Howard M Gebel
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - H Cliff Sullivan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
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7
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Hoshino T, Hatsumi N, Iino H, Takada S. Therapy-related myeloid neoplasms of recipient origin after allogeneic hematopoietic stem cell transplantation for acute leukemia. Int J Hematol 2022; 116:902-910. [DOI: 10.1007/s12185-022-03442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
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8
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Lindahl H, Vonlanthen S, Valentini D, Björklund AT, Sundin M, Mielke S, Hauzenberger D. Lineage-specific early complete donor chimerism and risk of relapse after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Bone Marrow Transplant 2022; 57:753-759. [PMID: 35210563 PMCID: PMC9090632 DOI: 10.1038/s41409-022-01615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/10/2022]
Abstract
Recipient–donor chimerism is routinely analyzed after allogeneic hematopoietic stem cell transplantation (HSCT) to monitor engraftment and graft rejection. For malignancies, chimerism can also be used to screen for disease relapse post-HSCT but methodology and interpretation of results are not standardized and likely depend on underlying diagnosis. We have implemented highly sensitive and accurate methodologies for chimerism analysis for the purpose of improving relapse prediction. Here, we report an exploratory retrospective analysis of clinical routine chimerism results from all 154 HSCTs for acute myeloid leukemia (AML) performed at our center during the years 2015–2020 with the aim of suggesting a clinically useful threshold at which risk of relapse is high. Relapse was not reliably predicted based on single elevated chimerism values obtained before time of overt relapse. However, early complete donor chimerism, here defined as recipient DNA < 0.2% in CD33+ cells in any blood or bone marrow sample taken during the first 60 days after HSCT, correlated inversely with relapse during the observation time (log-rank test P = 0.033). We propose that achievement of complete chimerism determined early after HSCT using sensitive methods can be used for risk-stratification of AML patients.
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Affiliation(s)
- Hannes Lindahl
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Sofie Vonlanthen
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Davide Valentini
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | - Andreas T Björklund
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Sundin
- Pediatric Hematology, Immunology and HCT, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Stephan Mielke
- Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Department of Laboratory Medicine (LabMED), Karolinska University Hospital and Institutet, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Dan Hauzenberger
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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Delie A, Verlinden A, Beel K, Deeren D, Mazure D, Baron F, Breems D, De Becker A, Graux C, Lewalle P, Maertens J, Poire X, Schoemans H, Selleslag D, Van Obbergh F, Kerre T. Use of chimerism analysis after allogeneic stem cell transplantation: Belgian guidelines and review of the current literature. Acta Clin Belg 2021; 76:500-508. [PMID: 32362204 DOI: 10.1080/17843286.2020.1754635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment option in both adult and pediatric patients with malignant and non-malignant hematological diseases. Chimerism analysis, which determines the donor or recipient origin of hematopoietic cells in HSCT recipients, is an essential aspect of post-HSCT follow-up.Objectives: To review the current literature and develop Belgian consensus guidelines for the use of chimerism analysis in the standard of care after allogeneic HSCT.Methods: Non-systematic review of the literature in consultancy with the members of the BHS transplantation committee.Results: Clinical application with regards to prediction of graft failure or relapse as well as cell source are reviewed. A consensus guideline on the use of chimerism analysis after HSCT is presented.Conclusion: Monitoring of the dynamics or kinetics of a patient's chimerism status by serial analysis at fixed time points, as well as on suspicion of relapse or graft failure, is needed to monitor engraftment levels, as well as disease control and possible relapse.
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Affiliation(s)
- Anke Delie
- Department of Hematology, University Hospital, Ghent University, Ghent, Belgium
| | - Anke Verlinden
- Department of Hematology, University Hospital, University of Antwerp, Antwerp, Belgium
| | - Karolien Beel
- Department of Hematology, Ziekenhuis Netwerk, Antwerpen, Belgium
| | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Dominiek Mazure
- Department of Hematology, University Hospital, Ghent University, Ghent, Belgium
| | - Frédéric Baron
- Department of Hematology, University Hospital, University of Liège, Liège, Belgium
| | - Dimitri Breems
- Department of Hematology, Ziekenhuis Netwerk, Antwerpen, Belgium
| | - Ann De Becker
- Department of Hematology, University Hospital, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlos Graux
- Department of Hematology, University Hospital Namur, Université Catholique de Louvain, Belgium
| | - Philippe Lewalle
- Department of Hematology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital, KU Leuven, Leuven, Belgium
| | - Xavier Poire
- Department of Hematology, University Hospital Saint Luc, Univeristé Catholique de Louvain, Brussels, Belgium
| | - Helene Schoemans
- Department of Hematology, University Hospital, KU Leuven, Leuven, Belgium
| | | | | | - Tessa Kerre
- Department of Hematology, University Hospital, Ghent University, Ghent, Belgium
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10
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Park S, Kim TY, Lee JH, Lee JY, Min GJ, Park SS, Yahng SA, Shin SH, Yoon JH, Lee SE, Cho BS, Eom KS, Lee S, Kim HJ, Min CK, Lee JW, Kim YJ. Differential effects of donor lymphocyte infusion upon treatment response and GVHD according to relapse level and donor sources in patients with myelodysplastic syndrome. Ther Adv Hematol 2021; 12:20406207211043748. [PMID: 34589195 PMCID: PMC8474341 DOI: 10.1177/20406207211043748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Donor lymphocyte infusion (DLI) is one of the effective options for post-transplant disease control of myelodysplastic syndrome (MDS). Its success or failure depends on the induction of antitumor immune reactions, durability of clinical responses, and severity of unwanted toxicities mainly from graft-versus-host disease (GVHD). METHODS By analyzing 61 patients receiving DLI for post-transplant MDS relapse, we assessed treatment outcomes and affecting factors, especially focusing on the level of relapse (hematological, molecular, and imminent relapse). RESULTS The response rate (42.1%, 36.4%, 72.7%), and overall survival (OS) at 2 years (27.8%, 45.5%, 70.1%) were different for each relapse level with imminent relapse group showing the most promising results. For OS, response to DLI or pre-DLI chemotherapy, and time to relapse were independent prognostic factors. Meanwhile, post-DLI GVHD and time to relapse were independently predictive for DLI response; post-DLI GVHD was predictive for DLI response, but not for OS, suggesting a potential detrimental impact of GVHD on survival. The incidence of GVHD and GVHD-related deaths were 37.7% and 10.0%, respectively, and CD3+ cell doses triggering GVHD tended to be lower in cases with haploidentical donor or imminent relapse. CONCLUSION Despite being limited by small number of cases and its retrospective nature, this study again demonstrated the therapeutic effects of DLI in relapsed MDS, and that earlier detection and intervention at lower level relapse might possibly be associated with better results. Furthermore, we propose that tailored cell dosing schedule based on relapse level and donor source may be helpful in minimizing fatal GVHD.
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Affiliation(s)
- Silvia Park
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Tong Yoon Kim
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Jong Hyuk Lee
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Joon yeop Lee
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Gi June Min
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Sung Soo Park
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Seung-Ah Yahng
- Department of Hematology, Incheon St. Mary’s
Hospital, College of Medicine, The Catholic University of Korea, Incheon,
Korea
| | - Seung-Hwan Shin
- Department of Hematology, Eunpyeong St. Mary’s
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Sung-Eun Lee
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Byung Sik Cho
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary’s
Hematology Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary’s
Hospital, College of Medicine, The Catholic University of Korea, 222
Banpo-Daero, Seocho-Gu, Seoul 06591, Korea
- Leukemia Research Institute, College of
Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Blouin AG, Ye F, Williams J, Askar M. A practical guide to chimerism analysis: Review of the literature and testing practices worldwide. Hum Immunol 2021; 82:838-849. [PMID: 34404545 DOI: 10.1016/j.humimm.2021.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/30/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Currently there are no widely accepted guidelines for chimerism analysis testing in hematopoietic cell transplantation (HCT) patients. The objective of this review is to provide a practical guide to address key aspects of performing and utilizing chimerism testing results. In developing this guide, we conducted a survey of testing practices among laboratories that are accredited for performing engraftment monitoring/chimerism analysis by either the American Society for Histocompatibility & Immunogenetics (ASHI) and/or the European Federation of Immunogenetics (EFI). We interpreted the survey results in the light of pertinent literature as well as the experience in the laboratories of the authors. RECENT DEVELOPMENTS In recent years there has been significant advances in high throughput molecular methods such as next generation sequencing (NGS) as well as growing access to these technologies in histocompatibility and immunogenetics laboratories. These methods have the potential to improve the performance of chimerism testing in terms of sensitivity, availability of informative genetic markers that distinguish donors from recipients as well as cost. SUMMARY The results of the survey revealed a great deal of heterogeneity in chimerism testing practices among participating laboratories. The most consistent response indicated monitoring of engraftment within the first 30 days. These responses are reflective of published literature. Additional clinical indications included early detection of impending relapse as well as identification of cases of HLA-loss relapse.
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Affiliation(s)
- Amanda G Blouin
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Fei Ye
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jenifer Williams
- Department of Pathology & Laboratory Medicine, Baylor University Medical Center, Dallas, TX, United States
| | - Medhat Askar
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Pathology & Laboratory Medicine, Baylor University Medical Center, Dallas, TX, United States; Department of Pathology and Laboratory Medicine, Texas A&M Health Science Center College of Medicine, United States.
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12
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Srour SA, Olson A, Ciurea SO, Desai P, Bashir Q, Oran B, Bose P, Mehta R, Patel KP, Pemmaraju N, Daver N, Verstovsek S, Champlin RE, Popat UR. Mixed myeloid chimerism and relapse of myelofibrosis after allogeneic stem cell transplantation. Haematologica 2021; 106:1988-1990. [PMID: 31296578 PMCID: PMC8252931 DOI: 10.3324/haematol.2019.223503] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/04/2022] Open
Affiliation(s)
| | - Amanda Olson
- The University of Texas MD Anderson Cancer Center
| | | | - Parth Desai
- The University of Texas Health Science Center at San Antonio
| | | | - Betul Oran
- The University of Texas, M.D. Anderson Cancer Center
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13
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Sardou-Cezar I, Lopes BA, Andrade FG, Fonseca TCC, Fernandez TDS, Larghero P, de Souza RQ, Loth G, Ribeiro LL, Bonfim C, Morgado ES, Marschalek R, Meyer C, Pombo-de-Oliveira MS. Therapy-related acute myeloid leukemia with KMT2A-SNX9 gene fusion associated with a hyperdiploid karyotype after hemophagocytic lymphohistiocytosis. Cancer Genet 2021; 256-257:86-90. [PMID: 34034210 DOI: 10.1016/j.cancergen.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 12/14/2022]
Abstract
Therapy-related acute myeloid leukemia (t-AML) following treatment with topoisomerase-II inhibitors has been increasingly reported. These compounds (e.g. etoposide) promote DNA damage and are associated with KMT2A rearrangements. They are widely used as first-line treatment in hemophagocytic lymphohistiocytosis (HLH). Here we describe a newborn who developed t-AML after HLH treatment. We provide detailed clinical, cytogenetic, and molecular characteristics of this patient, including the identification of a novel gene fusion - KMT2A-SNX9 - in t-AML. Considering the dismal outcome of this case, we discuss the side-effects of etoposide administration during HLH treatment in infants.
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Affiliation(s)
- Ingrid Sardou-Cezar
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Bruno A Lopes
- Institute of Pharmaceutical Biology / DCAL, Goethe-University of Frankfurt, Frankfurt/Main, Germany; Laboratory of Molecular Oncohematology, Institute of Health Sciences, Universidade Federal da Bahia, Salvador, Brazil
| | - Francianne Gomes Andrade
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | | | - Teresa de Souza Fernandez
- Cytogenetic Laboratory, Bone Marrow Transplantation Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Patrizia Larghero
- Institute of Pharmaceutical Biology / DCAL, Goethe-University of Frankfurt, Frankfurt/Main, Germany
| | - Regiana Quinto de Souza
- Department of Pediatric-Oncology, Hospital Manoel Novais Santa Casa de Misericórdia de Itabuna, Itabuna, Bahia, Brazil
| | - Gisele Loth
- Department of Pediatric Hematology and Bone Marrow Transplantation, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Lisandro Lima Ribeiro
- Department of Pediatric Hematology and Bone Marrow Transplantation, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Carmen Bonfim
- Department of Pediatric Hematology and Bone Marrow Transplantation, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Elissa Santos Morgado
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology / DCAL, Goethe-University of Frankfurt, Frankfurt/Main, Germany
| | - Claus Meyer
- Institute of Pharmaceutical Biology / DCAL, Goethe-University of Frankfurt, Frankfurt/Main, Germany
| | - Maria S Pombo-de-Oliveira
- Pediatric Hematology-Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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14
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Tozzo P, Delicati A, Zambello R, Caenazzo L. Chimerism Monitoring Techniques after Hematopoietic Stem Cell Transplantation: An Overview of the Last 15 Years of Innovations. Diagnostics (Basel) 2021; 11:diagnostics11040621. [PMID: 33808342 PMCID: PMC8065704 DOI: 10.3390/diagnostics11040621] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 01/14/2023] Open
Abstract
Chimerism analysis is a well-established method for monitoring the state of hematopoietic stem cell transplantation (HSCT) over time by analyzing peripheral blood or bone marrow samples of the recipient in several malignant and non-malignant hematologic diseases. From a clinical point of view, a continuous monitoring is fundamental for an effective early therapeutic intervention. This paper provides a comparative overview of the main molecular biology techniques which can be used to study chimerism after bone marrow transplantation, focusing on their advantages and disadvantages. According to the examined literature, short tandem repeats (STR) analysis through simple PCR coupled with capillary electrophoresis (STR-PCR) is the most powerful method which guarantees a high power of differentiation between different individuals. However, other methods such as real-time quantitative PCR (qPCR), digital PCR (dPCR), and next-generation sequencing (NGS) technology were developed to overcome the technical limits of STR-PCR. In particular, these other techniques guarantee a higher sensitivity, which allows for the detection of chimerism at an earlier stage, hence expanding the window for therapeutic intervention. After a comparative evaluation of the various techniques, it seems clear that STR-PCR still remains the gold standard option for chimerism study, even if it is likely that both dPCR and NGS could supplement or even replace the common methods of STR analysis.
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Affiliation(s)
- Pamela Tozzo
- Department of Molecular Medicine, Laboratory of Forensic Genetics, University of Padova, 35121 Padova, Italy; (A.D.); (L.C.)
- Correspondence: ; Tel.: +39-049-827-2235
| | - Arianna Delicati
- Department of Molecular Medicine, Laboratory of Forensic Genetics, University of Padova, 35121 Padova, Italy; (A.D.); (L.C.)
| | - Renato Zambello
- Department of Medicine (DIMED), Hematology and Clinical Immunology Section, Padova University School of Medicine, 35121 Padova, Italy;
| | - Luciana Caenazzo
- Department of Molecular Medicine, Laboratory of Forensic Genetics, University of Padova, 35121 Padova, Italy; (A.D.); (L.C.)
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15
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Haugaard AK, Kofoed J, Masmas TN, Madsen HO, Marquart HV, Heilmann C, Müller KG, Ifversen M. Is microchimerism a sign of imminent disease recurrence after allogeneic hematopoietic stem cell transplantation? A systematic review of the literature. Blood Rev 2020; 44:100673. [DOI: 10.1016/j.blre.2020.100673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
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16
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Hanusovska E, Sufliarska S. Monitoring of Chimerism in Rare Haematological Malignant Diseases after Allogeneic Haematopoietic Stem Cell Transplantation. Rare Dis 2020. [DOI: 10.5772/intechopen.89845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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17
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Beyond chimerism analysis: methods for tracking a new generation of cell-based medicines. Bone Marrow Transplant 2020; 55:1229-1239. [DOI: 10.1038/s41409-020-0822-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
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18
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Feasibility of salvage cord blood transplantation using a fludarabine, melphalan, and low-dose anti-thymocyte globulin conditioning regimen. Int J Hematol 2019; 109:463-469. [PMID: 30734904 DOI: 10.1007/s12185-019-02610-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
Primary graft failure (PGF) is a lethal complication that occurs early after allogeneic stem cell transplantation (allo-SCT). Cord blood transplantation (CBT) is a potential re-transplantation option. Total body irradiation (TBI) is often incorporated into the pre-salvage CBT conditioning regimen following PGF; however, patients experiencing PGF are not always amenable to TBI, and non-TBI regimens for salvage CBT should be established. Here, we report five patients with hematologic malignancies who received salvage CBT for PGF following a non-TBI regimen using fludarabine (Flu), melphalan (Mel), and low-dose anti-thymocyte globulin (ATG). The median intervals between the failed allo-SCT and salvage CBT, as well as between the diagnosis of PGF and salvage CBT, were 37 days and 8 days, respectively. The median neutrophil recovery period was 21 days (range 18-21 days). Four of five patients achieved neutrophil engraftment following salvage CBT; all four exhibited sustained engraftment with complete donor chimerism. Three of the five patients were alive after a median follow-up time of 907 days (range 315-909 days) post-salvage CBT; two patients died of causes unrelated to recurrence. These data suggest that CBT following the non-TBI regimen described here is feasible in patients with PGF.
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19
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Lejman M, Drabko K, Styka B, Winnicka D, Babicz M, Jaszczuk I, Kowalczyk JR. Usefulness of Post-Transplant Hematopoietic Chimera Monitoring by Use of the Quantitative Fluorescence Polymerase Chain Reaction Method. Transplant Proc 2017; 49:1903-1910. [PMID: 28923646 DOI: 10.1016/j.transproceed.2017.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND In the light of an increasing number of hematopoietic stem cell transplantations and more frequent use of reduced-intensity conditioning as preparative regimens for hematopoietic stem cell transplantation, post-transplant cell chimera monitoring is considered a necessity. METHODS The quantitative fluorescence polymerase chain reaction method, along with the commercial AmpFSTR SGMPlus kit, was applied in research on hematopoietic chimeras. RESULTS The total of 102 patients who had undergone allogenic transplantations were investigated. Chimerism monitoring was commenced on the seventh day after transplantation and lasted up to 12 years in some cases, according to the instituted schedule. CONCLUSIONS The kit has been shown to be fully sufficient for determining genetic profiles of recipients and donors and selecting informative markers. The method has been proven effective and satisfactory for assessing quantitative chimeras.
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Affiliation(s)
- M Lejman
- Department of Pediatric Hematology, Oncology, and Transplantology, University Children's Hospital, Lublin, Poland.
| | - K Drabko
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, Lublin, Poland
| | - B Styka
- Department of Pediatric Hematology, Oncology, and Transplantology, University Children's Hospital, Cytogenetic Laboratory, Lublin, Poland
| | - D Winnicka
- Department of Pediatric Hematology, Oncology, and Transplantology, Medical University of Lublin, Lublin, Poland
| | - M Babicz
- Department of Pediatric Hematology, Oncology, and Transplantology, University Children's Hospital, Cytogenetic Laboratory, Lublin, Poland
| | - I Jaszczuk
- Department of Pediatric Hematology, Oncology, and Transplantology, University Children's Hospital, Lublin, Poland
| | - J R Kowalczyk
- Department of Pediatric Hematology, Oncology, and Transplantology, University Children's Hospital, Lublin, Poland
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20
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Pereira TDM, Danby R, Rocha V. Donor lymphocyte infusion after allogeneic hematopoietic stem cell transplantation. Int J Hematol Oncol 2015. [DOI: 10.2217/ijh.15.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Donor lymphocyte infusion, a rescue therapy after hematopoietic stem cell transplantation, has been increasingly adopted, as modalities of stem cell transplantation have widened. First described as donor lymphocyte transfusion or cell therapy, it consists of infusion of donor lymphocytes, collected in steady state or after growth factor enhancement. As in literature the most used name is donor lymphocyte infusion, we'll adopt it here. Its most striking efficacy is observed in patients with chronic myelogenous leukemia, who relapsed after allogeneic stem cells transplantation. However, graft-versus-host disease, its main complication, may still hamper its feasibility.
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Affiliation(s)
- Thales Dalessandro Meneguin Pereira
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Robert Danby
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | - Vanderson Rocha
- Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Level 2, Cancer & Haematology Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
- BRC Blood Theme, NIHR Oxford Biomedical Centre, Oxford University Hospital, Oxford, OX3 9DS, UK
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21
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Lee HC, Saliba RM, Rondon G, Chen J, Charafeddine Y, Medeiros LJ, Alatrash G, Andersson BS, Popat U, Kebriaei P, Ciurea S, Oran B, Shpall E, Champlin R. Mixed T Lymphocyte Chimerism after Allogeneic Hematopoietic Transplantation Is Predictive for Relapse of Acute Myeloid Leukemia and Myelodysplastic Syndromes. Biol Blood Marrow Transplant 2015; 21:1948-54. [PMID: 26183077 DOI: 10.1016/j.bbmt.2015.07.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/06/2015] [Indexed: 12/15/2022]
Abstract
Chimerism testing after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) represents a promising tool for predicting disease relapse, although its precise role in this setting remains unclear. We investigated the predictive value of T lymphocyte chimerism analysis at 90 to 120 days after allo-HSCT in 378 patients with AML/MDS who underwent busulfan/fludarabine-based myeloablative preparative regimens. Of 265 (70%) patients with available T lymphocyte chimerism data, 43% of patients in first or second complete remission (CR1/CR2) at the time of transplantation had complete (100%) donor T lymphocytes at day +90 to +120 compared with 60% of patients in the non-CR1/CR2 cohort (P = .005). In CR1/CR2 patients, donor T lymphocyte chimerism ≤ 85% at day +90 to +120 was associated with a higher frequency of 3-year disease progression (29%; 95% confidence interval [CI], 18% to 46% versus 15%; 95% CI, 9% to 23%; hazard ratio [HR], 2.1; P = .04). However, in the more advanced, non-CR1/CR2 cohort, mixed T lymphocyte chimerism was not associated with relapse (37%; 95% CI, 20% to 66% versus 34%; 95% CI, 25% to 47%; HR, 1.3; P = .60). These findings demonstrate that early T lymphocyte chimerism testing at day +90 to +120 is a useful approach for predicting AML/MDS disease recurrence in patients in CR1/CR2 at the time of transplantation.
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Affiliation(s)
- Hans C Lee
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasmeen Charafeddine
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Borje S Andersson
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas.
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22
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Stahl T, Böhme MU, Kröger N, Fehse B. Digital PCR to assess hematopoietic chimerism after allogeneic stem cell transplantation. Exp Hematol 2015; 43:462-8.e1. [DOI: 10.1016/j.exphem.2015.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 12/20/2022]
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23
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Willasch AM, Kreyenberg H, Shayegi N, Rettinger E, Meyer V, Zabel M, Lang P, Kremens B, Meisel R, Strahm B, Rossig C, Gruhn B, Klingebiel T, Niemeyer CM, Bader P. Monitoring of Hematopoietic Chimerism after Transplantation for Pediatric Myelodysplastic Syndrome: Real-Time or Conventional Short Tandem Repeat PCR in Peripheral Blood or Bone Marrow? Biol Blood Marrow Transplant 2014; 20:1918-25. [DOI: 10.1016/j.bbmt.2014.07.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/29/2014] [Indexed: 10/25/2022]
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24
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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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25
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Borchers S, Weissinger E, Pabst B, Ganzenmueller T, Dammann E, Luther S, Diedrich H, Ganser A, Stadler M. Expansion of recipient-derived antiviral T cells may influence donor chimerism after allogeneic stem cell transplantation. Transpl Infect Dis 2013; 15:627-33. [DOI: 10.1111/tid.12101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/13/2012] [Accepted: 12/23/2012] [Indexed: 11/29/2022]
Affiliation(s)
- S. Borchers
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - E.M. Weissinger
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - B. Pabst
- Department of Human Genetics; Hannover Medical School; Hannover Germany
| | - T. Ganzenmueller
- Department of Virology; Hannover Medical School; Hannover Germany
| | - E. Dammann
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - S. Luther
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - H. Diedrich
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - A. Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
| | - M. Stadler
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation; Hannover Medical School (MHH); Hannover Germany
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26
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective therapeutic approach for several hematological diseases. Chimerism studies can be helpful to assess donor engraftment, detect early signs of graft rejection, and monitor minimal residual disease. Currently the most common method for monitoring chimerism following HSCT is by PCR amplification of STR loci followed by capillary electrophoresis. Prior to transplantation, multiple STR loci in both the donor and recipient are analyzed in order to identify loci that differentiate the two individuals. Informative loci are selected to calculate the percent donor and recipient present in post-transplant specimens. This is a rapid, sensitive, and cost-effective method for monitoring chimerism in patients following HSCT.
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27
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Kletzel M, Huang W, Olszewski M, Khan S. Validation of chimerism in pediatric recipients of allogeneic hematopoietic stem cell transplantation (HSCT) a comparison between two methods: real-time PCR (qPCR) vs. variable number tandem repeats PCR (VNTR PCR). CHIMERISM 2012; 4:1-8. [PMID: 23238335 DOI: 10.4161/chim.23158] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Post-hematopoietic stem cell transplantation (HSCT) chimerism monitoring is important to assess relapse and therapeutic intervention. The purpose of our study is to compare two methods variable number tandem repeats (VNTR) vs. quantitative real- time polymerase chain reaction (qPCR) in terms of determining chimerism. 127 (peripheral blood n=112, bone marrow n=15) samples were simultaneously tested by VNTR using APO-B, D1S80, D1S111, D17S30, gene loci SRY and ZP3 and qPCR using 34 assays (CA001-CA034) that are designed to a bi-allelic insertion/deletion (indel) polymorphism in the human genome. Samples were separated in three subsets: total WBC, T-cell and Myeloid cells. Extraction of DNA was performed then quantified. We analyzed column statistics, paired t-test and regression analysis for both methods. There was complete correlation between the two methods. The simplicity and rapidity of the test results from the qPCR method is more efficient and accurate to assess chimerism.
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Affiliation(s)
- Morris Kletzel
- Stem Cell Transplant Chimerism Laboratory, Department of Hematology-Oncology Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Rauwerdink CA, Tsongalis GJ, Tosteson TD, Hill JM, Meehan KR. The practical application of chimerism analyses in allogeneic stem cell transplant recipients: Blood chimerism is equivalent to marrow chimerism. Exp Mol Pathol 2012; 93:339-44. [DOI: 10.1016/j.yexmp.2012.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/20/2012] [Indexed: 11/15/2022]
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Lin MT, Tseng LH, Beierl K, Harada S, Hafez MJ, Eshleman JR, Gocke CD. Analysis of hematopoietic stem cell transplant engraftment: use of loss or gain of microsatellite alleles to identify residual hematopoietic malignancy. ACTA ACUST UNITED AC 2012; 20:194-202. [PMID: 22089346 DOI: 10.1097/pdm.0b013e31821dac16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymorphic short tandem repeat (STR), or microsatellite, loci have been widely used to analyze chimerism status after allogeneic hematopoietic stem cell transplantation. The presence of a patient's DNA, as identified by STR analysis, may indicate residual or recurrent malignant disease or may represent normal hematopoiesis of patient origin. The ratio of patient-derived to donor-derived alleles is used to calculate the relative amount of patient cells (both benign and malignant) to donor cells. STRs on chromosomes known to be gained or lost in a patient's tumor are generally ignored because it is difficult to perform meaningful calculations of mixed chimerism. However, in this study, we present evidence that STR loci on gained or lost chromosomes are useful in distinguishing the benign or malignant nature of chimeric DNA. In the peripheral blood or bone marrow of 4 hematopoietic stem cell transplantation patients with leukemia or lymphoma, we identified tumor DNA on the basis of STR loci showing copy number alteration. We propose that a targeted evaluation of STR loci showing altered copy number in posttransplant chimerism analysis can provide evidence of residual cancer cells.
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Affiliation(s)
- Ming-Tseh Lin
- Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Platzbecker U, Wermke M, Radke J, Oelschlaegel U, Seltmann F, Kiani A, Klut IM, Knoth H, Röllig C, Schetelig J, Mohr B, Graehlert X, Ehninger G, Bornhäuser M, Thiede C. Azacitidine for treatment of imminent relapse in MDS or AML patients after allogeneic HSCT: results of the RELAZA trial. Leukemia 2011; 26:381-9. [PMID: 21886171 PMCID: PMC3306138 DOI: 10.1038/leu.2011.234] [Citation(s) in RCA: 302] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study evaluated azacitidine as treatment of minimal residual disease (MRD) determined by a sensitive donor chimerism analysis of CD34+ blood cells to pre-empt relapse in patients with CD34+ myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (HSCT). At a median of 169 days after HSCT, 20/59 prospectively screened patients experienced a decrease of CD34+ donor chimerism to <80% and received four azacitidine cycles (75 mg/m2/day for 7 days) while in complete hematologic remission. A total of 16 patients (80%) responded with either increasing CD34+ donor chimerism to ⩾80% (n=10; 50%) or stabilization (n=6; 30%) in the absence of relapse. Stabilized patients and those with a later drop of CD34+ donor chimerism to <80% after initial response were eligible for subsequent azacitidine cycles. A total of 11 patients (55%) received a median of 4 (range, 1–11) additional cycles. Eventually, hematologic relapse occurred in 13 patients (65%), but was delayed until a median of 231 days (range, 56–558) after initial decrease of CD34+ donor chimerism to <80%. In conclusion, pre-emptive azacitidine treatment has an acceptable safety profile and can substantially prevent or delay hematologic relapse in patients with MDS or AML and MRD after allogeneic HSCT.
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Affiliation(s)
- U Platzbecker
- Medical Clinic and Polyclinic I, University Hospital Carl Gustav Carus Technical University of Dresden, Dresden, Germany.
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Chen DP, Tseng CP, Wang WT, Wang MC, Tsai SH, Sun CF. Real-time biallelic polymorphism-polymerase chain reaction for chimerism monitoring of hematopoietic stem cell transplantation relapsed patients. Clin Chim Acta 2010; 412:625-30. [PMID: 21185273 DOI: 10.1016/j.cca.2010.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/15/2010] [Accepted: 12/15/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND An accurate analysis of chimerism kinetics permits early detection of hematopoietic stem cell transplantation (HSCT) in patients with high risks of graft-versus-host disease or those liable to relapse. Although short tandem repeats-PCR (STR-PCR) is the golden standard for quantitative chimerism analysis in most of the clinical laboratories, it has a relatively low sensitivity of 5% and the detection of low percentage in mixed chimerism is usually delayed. In this study, we developed a real-time PCR for chimerism analysis based on the informative biallelic polymorphisms (BP). METHODS The allele frequencies of 19 selective biallelic polymorphic markers were analyzed using the genomic DNA from 100 healthy Taiwanese volunteers. The informative biallelic polymorphic markers with high discrimination power in the Taiwanese population were identified. The TaqMan probe-based real-time BP-PCR for amplification of the informative loci was designed and the detection sensitivity was determined. Clinical application of real-time BP-PCR in chimerism monitoring was evaluated and was compared with the conventional STR-PCR by analyzing the DNA samples obtained at different time points post-HSCT from 4 relapsed and 10 non-relapsed patients. RESULTS Allele distribution analysis revealed that the loci of S01a, S03, S04a, S05b, S06, S07b, S08b, S09b, S10b and S11a had a relatively high discrimination power and were the informative BP for chimerism monitoring in the Taiwanese population. Real-time BP-PCRs for these 10 BP loci were set up with the detection sensitivity equivalent to 0.003-0.006%. Real-time BP-PCR of the 4 HSCT patients revealed the presence of recipient-specific DNA at early time point than STR-PCR for 3 of the patients, whereas real-time BP-PCR was as effective as STR-PCR in uncovering the sign of relapse for one of the patients. In addition, the baseline value for the patients with no sign of relapse was 0.127 ± 0.193% of recipient DNA. CONCLUSION We conclude that real-time BP-PCR is a sensitive and reliable method for chimerism monitoring and is superior to the STR-PCR in identifying patients who are at high risk for relapse after transplantation.
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Affiliation(s)
- Ding-Ping Chen
- Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Taoyuan County, Taiwan
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5-azacytidine as salvage treatment in relapsed myeloid tumors after allogeneic bone marrow transplantation. Biol Blood Marrow Transplant 2010; 17:754-8. [PMID: 20951817 DOI: 10.1016/j.bbmt.2010.10.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 10/11/2010] [Indexed: 12/30/2022]
Abstract
Relapse after allogeneic blood or marrow transplantation carries a very poor prognosis. Current strategies for management that include donor lymphocyte infusions (DLIs) and salvage chemotherapies are usually toxic and ineffective. Here we report the outcome of 10 patients with myeloid malignancies that received 5-azacytidine after a failed allogeneic bone marrow transplant. Of the 10 patients, 6 achieved a complete remission, 1 had stable disease, and 3 progressed after a median of 6 cycles administered. Only 1 patient has died (of disease progression), and no flares of graft-versus-host disease (GVHD) were observed with 5-azacytidine. As of latest follow-up, the median overall survival (OS) for the group was 422.5 days (127-1411). These results further suggest that 5-azacytidine is an active agent after failing an allogeneic bone marrow transplant, and prospective studies are warranted.
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Stahl T, Badbaran A, Kröger N, Klyuchnikov E, Zabelina T, Zeschke S, Schafhausen P, Schultz W, Asenova S, Smirnova A, Wolschke C, Ayuk F, Zander AR, Fehse B, Bacher U. Minimal residual disease diagnostics in patients with acute myeloid leukemia in the post-transplant period: comparison of peripheral blood and bone marrow analysis. Leuk Lymphoma 2010; 51:1837-43. [DOI: 10.3109/10428194.2010.508822] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Feasibility of reduced-intensity cord blood transplantation as salvage therapy for graft failure: results of a nationwide survey of adult patients. Biol Blood Marrow Transplant 2010; 17:841-51. [PMID: 20849969 DOI: 10.1016/j.bbmt.2010.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 09/06/2010] [Indexed: 11/21/2022]
Abstract
To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 10(7)/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 10(7)/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.
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Willasch A, Eing S, Weber G, Kuçi S, Schneider G, Soerensen J, Jarisch A, Rettinger E, Koehl U, Klingebiel T, Kreyenberg H, Bader P. Enrichment of cell subpopulations applying automated MACS technique: purity, recovery and applicability for PCR-based chimerism analysis. Bone Marrow Transplant 2009; 45:181-9. [DOI: 10.1038/bmt.2009.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Minimal residual disease diagnostics in myeloid malignancies in the post transplant period. Bone Marrow Transplant 2008; 42:145-57. [PMID: 18587431 DOI: 10.1038/bmt.2008.185] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Allogeneic SCT is important in myelodysplastic syndrome, the BCR-ABL-negative chronic myeloproliferative diseases (CMPDs) and in poor-risk AML. Techniques to monitor the minimal residual disease, for example, by PCR or immunophenotyping gain increasing importance in the post transplantation period as basis for improved and earlier therapeutic interventions in impending relapse. Recent markers such as the NPM1 mutations in AML or the JAK2V617F mutation in the CMPD can be exactly quantified by real-time PCR and were evaluated for their prognostic value in the post transplantation phase and for their utility to plan adoptive immunotherapy in case of molecular relapse. With respect to chimerism, new and very sensitive methods were introduced, for example, quantitative assessment of genetic polymorphisms by real-time PCR, but also methods here are still highly individualized. Only in CML, where SCT focuses now on poor-risk cases or cases of tyrosine kinase inhibitor failure, follow-up schedules are standardized. Standardization of the different diagnostic techniques and of the intervals in the post transplantation period is urgently needed also in other myeloid malignancies and should be focus of future studies.
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37
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Willasch A, Schneider G, Reincke BS, Shayegi N, Kreyenberg H, Kuci S, Weber G, Van Der Reijden B, Niethammer D, Klingebiel T, Bader P. Sequence Polymorphism Systems for Quantitative Real-Time Polymerase Chain Reaction to Characterize Hematopoietic Chimerism—High Informativity and Sensitivity As Well As Excellent Reproducibility and Precision of Measurement. ACTA ACUST UNITED AC 2007; 13:73-84. [DOI: 10.1532/lh96.07004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Huisman C, de Weger RA, de Vries L, Tilanus MGJ, Verdonck LF. Chimerism analysis within 6 months of allogeneic stem cell transplantation predicts relapse in acute myeloid leukemia. Bone Marrow Transplant 2007; 39:285-91. [PMID: 17262061 DOI: 10.1038/sj.bmt.1705582] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The role of chimerism analysis as a prognostic indicator of relapse after hematopoietic stem cell transplantation (SCT) is controversial. We monitored chimerism status by short tandem repeat-based polymerase chain reaction (PCR) in T- and non-T-cell subsets and retrospectively evaluated clinical outcome in 96 patients with acute myeloid leukemia after myeloablative (MA) or reduced-intensity conditioning SCT. Fifty-six percent of 80 patients in the MA group demonstrated complete donor chimerism (CC) at all time points, whereas 6% had decreasing mixed chimerism (MC), 8% stable MC, 25% increasing MC and 3% increasing and decreasing MC. In 16 RIC patients, these percentages were 12, 50, 6, 6 and 19, respectively, together with 6% nonengraftment. Forty-three out of 96 patients experienced relapse. The last chimerism evaluation before relapse revealed increasing MC in only eight patients. In samples taken between 1 and 6 months post SCT, CC/decreasing MC was significantly related with a lower risk of relapse (31 versus 83%, P<0.000) and mortality (38 versus 83%, P<0.000) than with MC/increasing MC. However, the development of relapse was very rapid. Only very frequent monitoring of chimerism status by highly sensitive methods might identify impending relapse and allow early immunological intervention.
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Affiliation(s)
- C Huisman
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Huff CA, Fuchs EJ, Smith BD, Blackford A, Garrett-Mayer E, Brodsky RA, Flinn IW, Ambinder RF, Borrello IM, Matsui WH, Vogelsang GB, Griffin CA, Luznik L, Jones RJ. Graft-versus-host reactions and the effectiveness of donor lymphocyte infusions. Biol Blood Marrow Transplant 2006; 12:414-21. [PMID: 16545725 DOI: 10.1016/j.bbmt.2005.11.520] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 11/28/2005] [Indexed: 12/01/2022]
Abstract
We retrospectively analyzed 83 consecutive recipients of donor lymphocyte infusions (DLI) after allogeneic transplantation for factors associated with disease response and graft-versus-host disease (GVHD). DLI was highly effective in relapsed chronic phase chronic myeloid leukemia (CML), with 71% of patients achieving durable complete remissions (CR). In relapsed acute myeloid leukemia, DLI led to durable CRs in 31% of patients; the rate was <20% in all other diseases. Achieving full donor chimerism and GVHD were predictive of CR. Grade II or higher acute or chronic GVHD occurred in 36 (43%) patients and contributed to death in 13 (16%). Even more patients, 33 (40%), died of their underlying malignancy, including 10 who developed active GVHD. In relapsed CML, most durable CRs occurred without clinically apparent GVHD, yet all responders achieved full donor chimerism, including 6 with coincident normal host hematopoiesis at the time of DLI. Thus, in CML, potent lymphohematopoietic graft-versus-host reactions occurred even in the absence of clinically apparent GVHD; this confirms the ability to dissociate these processes and argues against a leukemia-specific immunologic effect. DLI clearly has efficacy in the treatment of relapsed disease after allogeneic transplantation. However, with the exception of CML, most patients die of their underlying disease because of insufficient antitumor activity even with active GVHD.
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Affiliation(s)
- Carol Ann Huff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University, Baltimore, MD 21231, USA.
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Koldehoff M, Steckel NK, Hlinka M, Beelen DW, Elmaagacli AH. Quantitative analysis of chimerism after allogeneic stem cell transplantation by real-time polymerase chain reaction with single nucleotide polymorphisms, standard tandem repeats, and Y-chromosome-specific sequences. Am J Hematol 2006; 81:735-46. [PMID: 16838323 DOI: 10.1002/ajh.20693] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We compared the results of chimerism analyses with real-time SNP-PCR to those obtained by the classical STR-PCR method in 135 hematopoietic stem cell transplantation recipients. Using 10 different SNP gene loci, the SNP-PCR method was able to discriminate patient from donor cells in 125 of 135 cases (93%), whereas the use of 11 different STR gene loci with the STR-PCR analysis using agarose or polyacrylamide gel resolution resulted in accurate donor-host discrimination in all patients. Of the 470 analyzed samples we found in 74% concordant results for both chimerism methods. In all 26% discordant cases the SNP-chimerism method showed mixed chimerism (MC), whereas the STR-method found complete chimerism (CC). As a consequence, the SNP-PCR chimerism analysis method detected a MC prior to the occurrence of relapse significantly earlier than the STR-PCR chimerism method (120 vs. 30 days, P < 0.007). The probability of relapses was significantly higher in patients with increasing MC (70%) compared to 30% in patients with CC (P < 0.00001) associated with a significantly shorter overall survival in patients with increasing MC. The multivariate Cox model showed that chimerism analsis with SNP-PCR was the only significant risk factor predicting relapse (RR 6.08, P < 0.0001).Furthermore, we analyzed the chimerism status in male recipients with a female donor in 580 samples of 134 patients using quantitative real-time PCR of Y-chromosome-specific sequences and compared the results with interphase XY-fluorescent in situ hybridization (FISH). MC without signs of relapse was detected in 35% of samples using quantitative real-time PCR of Y-chromosome-specific sequences. The detected Y-DNA amounts were low compared to the amounts detected in 104 samples of 42 patients with leukemic relapse at the time of analysis (P < 0.0001). Quantitative real-time PCR of Y-chromosome-specific sequences detected therefore an increasing MC with high residual host DNA amounts approximately 143 days (mean) prior to the occurrence of relapse. By comparing the results of Y-chromosome PCR with the XY-FISH analysis we found concordant results in 73% in patients with myeloablative regimens. The XY-FISH could detect 12 relapses, whereas the Y-chromosome PCR detect 36 relapses by MC (P < 0.005). Residual host cells gradually decreased during the posttransplant period from a mean of 5.4 ng (first months) to 0.5 ng (above 5 years) without evidence of relapses. The probability of relapses was significantly higher in patients with increasing MC (100%) compared to 8% in patients with CC (P < 0.00001) associated with a significantly shorter overall survival in patients with increasing MC. The multivariate Cox model showed that chimerism analysis of Y-chromosome-specific sequences is an important risk factor for relapse (RR 17.0, P < 0.0001). We conclude that the use of real-time SNP or Y-PCR may be superior to the STR-PCR or interphase XY-FISH methods in detecting patients who are at high risk for relapse after transplant.
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Affiliation(s)
- Michael Koldehoff
- Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany.
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41
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Netto GJ, Saad RD. Diagnostic Molecular Pathology: An Increasingly Indispensable Tool for the Practicing Pathologist. Arch Pathol Lab Med 2006; 130:1339-48. [PMID: 16948522 DOI: 10.5858/2006-130-1339-dmpaii] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Diagnostic molecular pathology is rapidly becoming an indispensable tool for anatomic pathologists. Familiarity with some of the technologic principles and current, as well as upcoming, molecular diagnostic applications is greatly advantageous for today's practice of pathology.
Objectives.— To provide a discussion of the most common techniques currently used in molecular pathology laboratories and review their essential applications to diagnosis and management of neoplastic diseases.
Data Sources.—A literature review and illustrative cases from the authors' molecular diagnostic practices.
Conclusions.—Applications such as clonality assays, molecular cytogenetics, and chimerism analysis are providing us with accurate tools to resolve difficult diagnostic and management decisions in hemato-oncology. This should serve as a future model to expand molecular applications into the wider field of solid tumors.
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Affiliation(s)
- George J Netto
- Department of Pathology, Johns Hopkins University, Baltimore, Md, USA.
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Beck O, Seidl C, Lehrnbecher T, Kreyenberg H, Schwabe D, Klingebiel T, Seifried E, Bader P, Koehl U. Quantification of chimerism within peripheral blood, bone marrow and purified leukocyte subsets: comparison of singleplex and multiplex PCR amplification of short tandem repeat (STR) loci. Eur J Haematol 2006; 76:237-44. [PMID: 16451397 DOI: 10.1111/j.1600-0609.2005.00588.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND METHODS Chimerism analysis has become a routine diagnostic procedure after haematopoietic allogeneic stem cell transplantation for early detection of relapse of disease or graft failure. Whereas some centres developed individual in-house short tandem repeat (STR) systems, others prefer commercial multiplex PCR systems. However, little is known about inter-assay variation, which could have a significant impact on treatment decision. We therefore compared two commercial multiplex PCR kits with our in-house STR system using different sample sources, such as peripheral blood (PB), bone marrow (BM) and specific leukocyte subsets. RESULTS Fifty samples of eighteen paediatric patients were analysed. For neither material, PB, BM and leukocyte subtypes, a significant difference between the STR systems tested was observed. Chimerism analyses of each single STR primer, which is component of both the in-house and the commercial STR system, did not reveal significant differences. CONCLUSION Our analysis demonstrates that similar results can be obtained with both assays, even when using various sample sources. Further evaluation of different test systems will help to increase interlaboratory standardisation of chimerism analyses for early clinical intervention.
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Affiliation(s)
- O Beck
- Paediatric Haematology and Oncology, J.W. Goethe University Frankfurt/Main, Germany
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43
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Havelange V, Antoine-Poirel H, Saussoy P, Van Den Neste E, Ferrant A. Donor cell leukemia developing after hematopoietic stem cell transplantation for multiple myeloma. Acta Clin Belg 2006; 61:82-6. [PMID: 16792340 DOI: 10.1179/acb.2006.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The development of secondary leukemia in donor cells after allogeneic stem cell transplantation is a rare event. We describe the occurrence of acute myeloid leukemia in donor cells 4 years after a stem cell transplantation for multiple myeloma. The multiple myeloma was relapsing at the time of the onset of acute myeloid leukemia. Secondary leukemia in donor cells after transplantation for multiple myeloma has not yet been reported.
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Affiliation(s)
- V Havelange
- Service d'Hématologie, Centre de Génétique, Secteur Hématologie, Cliniques universitaires Saint-Luc, 1200 Bruxelles
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Eshel R, Vainas O, Shpringer M, Naparstek E. Highly Sensitive Patient-Specific Real-Time PCR SNP Assay for Chimerism Monitoring after Allogeneic Stem Cell Transplantation. ACTA ACUST UNITED AC 2006; 12:39-46. [PMID: 16513545 DOI: 10.1532/lh96.05034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chimerism analysis after allogeneic stem cell transplantation (allo-SCT) is an important diagnostic tool for the documentation of engraftment, early detection of graft failure, and recurrence of the disease. Current assays rely on the genetic polymorphism between the donor and the recipient, and allow semiquantitative or quantitative analysis of chimerism. The most common method in use is based on the amplification of the short tandem repeats (STR). This method, with 1% to 5 sensitivity, is useful for the documentation of engraftment, but is insufficient for the detection of minimal residual disease or early relapse, when medical intervention is urgently needed. Recently, single-nucleotide polymorphism (SNP) has been suggested as an alternative, more accurate system to monitor chimerism. The purpose of our study was to develop an easy, economical, and sensitive method for the detection of chimerism following allo-SCT using the SNP technology. Our approach is based on SNP patient-specific quantitative real-time polymerase chain reaction (PCR) using nonlabeled primers. Our results show that this allele-specific SNP real-time PCR approach is sensitive, relatively cheap, and offers a fast and reliable assay for the monitoring of hematopoietic engraftment and for the detection of minimal residual disease in patients after allo-SCT.
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Affiliation(s)
- Rinat Eshel
- Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Netto GJ, Saad R. Diagnostic molecular pathology, part 2: proteomics and clinical applications of molecular diagnostics in hematopathology. Proc (Bayl Univ Med Cent) 2005; 18:7-12. [PMID: 16200142 PMCID: PMC1200694 DOI: 10.1080/08998280.2005.11928025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Georges J Netto
- Department of Pathology, Baylor University Medical Center, Dallas, Texas, USA.
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Swierczynski SL, Hafez MJ, Philips J, Higman MA, Berg KD, Murphy KM. Bone marrow engraftment analysis after granulocyte transfusion. J Mol Diagn 2005; 7:422-6. [PMID: 16049315 PMCID: PMC1867546 DOI: 10.1016/s1525-1578(10)60572-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present the case of a 6-year-old male who received an allogeneic bone marrow transplant as part of treatment for acute lymphoblastic leukemia. The patient relapsed 5 months after transplantation and received additional chemotherapy. He acquired an angioinvasive fungal infection that required transfusion of granulocytes. Approximately 5 weeks after relapsing (181 days after transplant), a bone marrow specimen was taken for molecular engraftment analysis and flow cytometry to assess graft loss as well as residual disease. The engraftment results generated by the multiple short tandem repeat loci tested were inconsistent, and alleles were present at several loci that were of neither patient nor donor origin. An error in specimen identification was initially considered. Further investigation into the circumstances surrounding procurement of the patient's bone marrow aspirate revealed that the patient had received a granulocyte transfusion approximately 10 hours before the bone marrow specimen was taken. In addition, morphological and flow cytometric analyses of the same bone marrow aspirate demonstrated a significant degree of peripheral blood contamination. We determined that the unknown alleles in the bone marrow engraftment specimen were derived from the donor of the transfused granulocytes. This case illustrates that white cell transfusion can lead to erroneous bone marrow engraftment results, particularly if only one microsatellite locus is used to monitor engraftment.
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Affiliation(s)
- Sharon L Swierczynski
- Department of Pathology, Johns Hopkins Medical Institutions, Park Building, Room SB202, 600 North Wolfe St., Baltimore, MD 21287, USA
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Bader P, Niethammer D, Willasch A, Kreyenberg H, Klingebiel T. How and when should we monitor chimerism after allogeneic stem cell transplantation? Bone Marrow Transplant 2004; 35:107-19. [PMID: 15502849 DOI: 10.1038/sj.bmt.1704715] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
SUMMARY Chimerism analysis has become an important tool for the peri-transplant surveillance of engraftment. It offers the possibility to realize impending graft rejection and can serve as an indicator for the recurrence of the underlying malignant or nonmalignant disease. Most recently, these investigations have become the basis for treatment intervention, for example, to avoid graft rejection, to maintain engraftment and to treat imminent relapse by pre-emptive immunotherapy. This invited review focuses on the clinical implications of characterization of hematopoietic chimerism in stem cell transplantation.
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Affiliation(s)
- P Bader
- University Children's Hospital, Department of Pediatric Hematology and Oncology, Hoppe-Seyler-Strasse 1, D-72070 Tübingen, Germany.
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