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Long-term lymphoid-restricted split chimerism after myeloablative allogeneic BMT for bcr-abl+ ALL

Bone Marrow Transplantation volume 42, pages 829–831 (2008)Cite this article

Allogeneic BMT results in true biological chimeras. In most cases, the procedure leads to complete donor chimerism, which refers to complete replacement of host by donor lympho-hematopoiesis. Mixed chimerism (MC) indicates the presence of both donor and recipient hematopoietic cells, and its presence depends on several factors such as intensity of the conditioning regimen, T-cell content of the graft, GVHD prophylaxis and underlying disease.1 MC may be efficiently induced in non-malignant genetic disorders, such as marrow failure syndromes and hemoglobinopathies, and this may be enough to reverse the clinical consequences of inborn errors. MC in leukemia patients is a strong indicator of relapse, especially when it is observed after myeloablative conditioning and when MC reveals an increasing number of recipient cells over time.2 However, long-term MC without relapse has also been described in leukemia patients treated with myeloablative conditioning.3, 4, 5 Schaap et al.3 identified 19 leukemia patients with persisting (>2 years) MC among 231 transplanted patients. The number of recipient cells in peripheral blood did not exceed 15% in a group of 10 patients, whereas the other 9 patients had a relatively high percentage of persisting autologous cells for a median of 12 years.

The pattern of long-term MC after BMT in leukemia patients usually reveals the presence of both recipient and donor cells in all, or in a given cellular compartment (myeloid, erythroid, lymphoid), indicating that both residual recipient and engrafted donor hematopoiesis exist and are immunotolerant to each other.1, 3, 4, 5 In contrast, compartmental or split chimerism indicating that the hematopoietic compartments are wholly derived from either donor or recipient has never been described in leukemia patients.1 Split chimerism is mainly found in cases of SCID for which no myeloablative therapy has been used.6 In the absence of myeloablation, there is no engraftment of donor stem cells but only a compartmental engraftment of T-cell progenitors resulting in split chimerism in which myeloid and erythroid cells are of host origin, and all T-cells (and NK cells if host NK cells were defective) are of donor origin. In contrast, myeloablative BMT in SCID patients results in complete myeloid, erythroid and lymphoid donor engraftment.

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Acknowledgements

This work was supported in part by a grant from the Landesstiftung Baden Württemberg to AS and JF.

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  1. A Spyridonidis

    Present address: 2Current address: Hematology Division, Patras University Hospital, Rio/Patras, Greece,

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  1. Department of Haematology/Oncology, Albert-Ludwigs University Medical Center, Freiburg, Germany

    A Spyridonidis, H Bertz, M Waterhouse & J Finke

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Correspondence to A Spyridonidis.

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Spyridonidis, A., Bertz, H., Waterhouse, M. et al. Long-term lymphoid-restricted split chimerism after myeloablative allogeneic BMT for bcr-abl+ ALL. Bone Marrow Transplant 42, 829–831 (2008). https://doi.org/10.1038/bmt.2008.256

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