Prognostic Utility of Routine Chimerism Testing at 2 to 6 Months after Allogeneic Hematopoietic Cell Transplantation
Abstract The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months a...
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| Veröffentlicht in: | Biology of blood and marrow transplantation 2009-03, Vol.15 (3), p.352-359 |
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| creator | Mossallam, Ghada I Kamel, Azza M Storer, Barry Martin, Paul J |
| description | Abstract The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice. |
| doi_str_mv | 10.1016/j.bbmt.2008.12.496 |
| format | Article |
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To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice.</description><identifier>ISSN: 1083-8791</identifier><identifier>EISSN: 1523-6536</identifier><identifier>DOI: 10.1016/j.bbmt.2008.12.496</identifier><identifier>PMID: 19203726</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Allogeneic hematopoietic cell transplantation ; Bone Marrow Cells - immunology ; Child ; Child, Preschool ; Chimerism analysis ; Cohort Studies ; Female ; Follow-Up Studies ; Graft vs Host Disease - immunology ; Hematology, Oncology and Palliative Medicine ; Hematopoietic Stem Cell Transplantation - methods ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Mixed chimerism ; Survival Analysis ; T-Lymphocytes - immunology ; Transplantation Chimera - immunology ; Transplantation Conditioning - methods ; Treatment Outcome ; Young Adult</subject><ispartof>Biology of blood and marrow transplantation, 2009-03, Vol.15 (3), p.352-359</ispartof><rights>American Society for Blood and Marrow Transplantation</rights><rights>2009 American Society for Blood and Marrow Transplantation</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-9e152ba906d0fe766479974569b7ef8e6b3f8087e8a523afd40b456ecbd1531f3</citedby><cites>FETCH-LOGICAL-c508t-9e152ba906d0fe766479974569b7ef8e6b3f8087e8a523afd40b456ecbd1531f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bbmt.2008.12.496$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19203726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mossallam, Ghada I</creatorcontrib><creatorcontrib>Kamel, Azza M</creatorcontrib><creatorcontrib>Storer, Barry</creatorcontrib><creatorcontrib>Martin, Paul J</creatorcontrib><title>Prognostic Utility of Routine Chimerism Testing at 2 to 6 Months after Allogeneic Hematopoietic Cell Transplantation</title><title>Biology of blood and marrow transplantation</title><addtitle>Biol Blood Marrow Transplant</addtitle><description>Abstract The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Allogeneic hematopoietic cell transplantation</subject><subject>Bone Marrow Cells - immunology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chimerism analysis</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft vs Host Disease - immunology</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mixed chimerism</subject><subject>Survival Analysis</subject><subject>T-Lymphocytes - immunology</subject><subject>Transplantation Chimera - immunology</subject><subject>Transplantation Conditioning - methods</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1083-8791</issn><issn>1523-6536</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk2LFDEUbERx19U_4EFy8tZjPrrTCcjCMqgrrCg6ew7p9OuZjOlkTNIL8-9NM4NfB08JvKpKqupV1UuCVwQT_ma_6vspryjGYkXoqpH8UXVJWspq3jL-uNyxYLXoJLmonqW0xxh3jZBPqwsiKWYd5ZdV_hLD1oeUrUH32TqbjyiM6GuYs_WA1js7QbRpQhsoGL9FOiOKckAcfQo-7xLSY4aIbpwLW_BQZG5h0jkcgoVFdA3OoU3UPh2c9llnG_zz6smoXYIX5_Oqun__brO-re8-f_i4vrmrTYtFriUUM72WmA94hI7zppOya1ou-w5GAbxno8CiA6GLaT0ODe7LFEw_kJaRkV1V1yfdw9xPMBjwOWqnDtFOOh5V0Fb9PfF2p7bhQVHOKWFtEXh9Fojhx1wSUJNNpjjSHsKcFOcSN4QsQHoCmhhSijD-eoRgtZSl9mopSy1lKUJVKauQXv35vd-UczsF8PYEgBLSg4WokrHgDQw2gslqCPb_-tf_0I2z3hrtvsMR0j7M0Zf4FVGJKqy-LeuybAsWmBDMGfsJYfa9UA</recordid><startdate>20090301</startdate><enddate>20090301</enddate><creator>Mossallam, Ghada I</creator><creator>Kamel, Azza M</creator><creator>Storer, Barry</creator><creator>Martin, Paul J</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090301</creationdate><title>Prognostic Utility of Routine Chimerism Testing at 2 to 6 Months after Allogeneic Hematopoietic Cell Transplantation</title><author>Mossallam, Ghada I ; Kamel, Azza M ; Storer, Barry ; Martin, Paul J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-9e152ba906d0fe766479974569b7ef8e6b3f8087e8a523afd40b456ecbd1531f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Allogeneic hematopoietic cell transplantation</topic><topic>Bone Marrow Cells - immunology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Chimerism analysis</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft vs Host Disease - immunology</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mixed chimerism</topic><topic>Survival Analysis</topic><topic>T-Lymphocytes - immunology</topic><topic>Transplantation Chimera - immunology</topic><topic>Transplantation Conditioning - methods</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>online_resources</toplevel><creatorcontrib>Mossallam, Ghada I</creatorcontrib><creatorcontrib>Kamel, Azza M</creatorcontrib><creatorcontrib>Storer, Barry</creatorcontrib><creatorcontrib>Martin, Paul J</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Biology of blood and marrow transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mossallam, Ghada I</au><au>Kamel, Azza M</au><au>Storer, Barry</au><au>Martin, Paul J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Utility of Routine Chimerism Testing at 2 to 6 Months after Allogeneic Hematopoietic Cell Transplantation</atitle><jtitle>Biology of blood and marrow transplantation</jtitle><addtitle>Biol Blood Marrow Transplant</addtitle><date>2009-03-01</date><risdate>2009</risdate><volume>15</volume><issue>3</issue><spage>352</spage><epage>359</epage><pages>352-359</pages><issn>1083-8791</issn><eissn>1523-6536</eissn><abstract>Abstract The utility of routine chimerism analysis as a prognostic indicator of subsequent outcomes after allogeneic hematopoietic cell transplantation (HCT) with myeloablative conditioning regimens remains controversial. To address this controversy, routine chimerism test results at 2 to 6 months after HCT with myeloablative conditioning regimens were evaluated for association with subsequent risk of chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, and overall mortality. Only 70 of 1304 patients (5%) had < 95% donor-derived cells in the marrow. Low donor chimerism in the marrow occurred more often in patients with low-risk diseases compared with those with higher-risk diseases and was significantly associated with a reduced risk of chronic GVHD. Among 673 patients evaluated, 164 (24%) had < 85% donor-derived T cells in the blood. Low donor T cell chimerism was more frequent in patients with low-risk diseases compared with those with higher-risk diseases, in those who received conditioning with busulfan compared with those who received conditioning with total body irradiation, and in those with lower-grade acute GVHD. Low donor T cell chimerism in the blood was significantly associated with a reduced risk of chronic GVHD but not with a reduced risk of relapse, NRM, or overall mortality. Routine testing of chimerism in the marrow and blood at 2 to 6 months after HCT with myeloablative conditioning regimens may be helpful in documenting engraftment in clinical trials, but provides only limited prognostic information in clinical practice.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19203726</pmid><doi>10.1016/j.bbmt.2008.12.496</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Allogeneic hematopoietic cell transplantation Bone Marrow Cells - immunology Child Child, Preschool Chimerism analysis Cohort Studies Female Follow-Up Studies Graft vs Host Disease - immunology Hematology, Oncology and Palliative Medicine Hematopoietic Stem Cell Transplantation - methods Humans Infant Infant, Newborn Male Middle Aged Mixed chimerism Survival Analysis T-Lymphocytes - immunology Transplantation Chimera - immunology Transplantation Conditioning - methods Treatment Outcome Young Adult |
| title | Prognostic Utility of Routine Chimerism Testing at 2 to 6 Months after Allogeneic Hematopoietic Cell Transplantation |
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