Journal
LEUKEMIA
Volume 26, Issue 3, Pages 509-519Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/leu.2011.244
Keywords
allogeneic stem cell transplantation; lineage-specific leukocyte chimerism; myeloablative conditioning; predictive value; reduced-intensity conditioning; rejection
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Timely diagnosis of impending graft rejection is crucial for effective therapeutic intervention after allogeneic hematopoietic stem cell transplantation (SCT). We have investigated the predictive potential of early leukocyte subset-specific chimerism for graft loss in children undergoing SCT. In total, 192 pediatric patients transplanted for the treatment of malignant and non-malignant diseases after reduced-intensity or myeloablative conditioning were investigated. Surveillance of lineage-specific chimerism was initiated upon first appearance of leukocyte counts amenable to cell sorting. Graft rejection occurred in 23 patients between 24 and 492 days post-transplant (median 63 days). The first chimerism analysis of T and NK cells performed at a median of 20 days after SCT identified three different risk groups that were independent from the conditioning regimen: recipient chimerism (RC) levels in T cells below 50% indicated a very low risk of rejection (1.4%), whereas high levels of RC (>90%) both in T and NK cells heralded graft loss in the majority of patients (90%) despite therapeutic interventions. RC >50% in T cells and <= 90% in NK cells defined an intermediate-risk group in which timely immunotherapy frequently prevented rejection. Early assessment of T-and NK-cell chimerism can therefore be instrumental in the risk assessment and therapeutic management of imminent graft rejection. Leukemia (2012) 26, 509-519; doi:10.1038/leu.2011.244; published online 16 September 2011
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