Korean J Hematol.  2011 Dec;46(4):258-264. 10.5045/kjh.2011.46.4.258.

Clinical implications of chimerism after allogeneic hematopoietic stem cell transplantation in children with non-malignant diseases

• Park M
• Koh KN
• Seo JJ
• Im HJ

• KMID: 2251987
• DOI: http://doi.org/10.5045/kjh.2011.46.4.258

Abstract

BACKGROUND
The effects of chimerism on outcomes following allogeneic hematopoietic stem cell transplantation (HSCT) are unclear and may differ between diseases. We retrospectively evaluated the association between chimerism and transplant outcomes in children with nonmalignant diseases.
METHODS
Chimerism was evaluated using short-tandem repeat polymerase chain reaction (STR-PCR) in 48 patients, with mixed chimerism (MC) defined as greater than 1% recipient cells.
RESULTS
The only variable exerting a significant influence on patients' chimerism status was the number of infused CD34+ cells. MC was detected in 23 transplants (9 showing transient MC; 10 with sustained low levels [< or =30%] of autologous cells; and 4 with high-level MC [>30%]). The degree of STR-PCR at 28 days after HSCT was significantly higher in patients with high-level MC than those with transient or low-level MC. All patients with transient or low-level MC successfully maintained engraftment and showed a clinical response to HSCT, whereas 2 of the 4 patients with high-level MC experienced graft failure. The incidences of grades II-IV acute and chronic graft-versus-host disease (GVHD) were significantly higher in patients with complete donor chimerism (CC) than MC. We observed no significant survival differences between CC and MC groups. However, the survival rate was lower in patients with high MC than those with low-level or transient MC (P=0.03).
CONCLUSION
In non-malignant diseases, MC may indicate a tolerant state with a decreased incidence of GVHD. However, high-level MC may signify an increased risk of graft failure and a lower survival rate.

Keyword

Non-malignant disease; Allogeneic hematopoietic stem cell transplantation; Chimerism

MeSH Terms

Child
Chimerism
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Incidence
Polymerase Chain Reaction
Retrospective Studies
Survival Rate
Tissue Donors
Transplants

Figure

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  Fig. 1 Chimeric status of patients with high-level mixed chimerism.

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  Fig. 2 Receiver operating characteristic curve used to determine the optimal CD34+ cell number cut-off value for predicting chimerism.

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  Fig. 3 Kaplan-Meier curves showing overall survival in high-level mixed chimerism and transient or low-level mixed chimerism groups.

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  Fig. 4 Kaplan-Meier curves showing event-free survival in high-level mixed chimerism and transient or low-level mixed chimerism groups.

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