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Full donor chimerism by day 30 after allogeneic peripheral blood progenitor cell transplantation is associated with a low risk of relapse in pediatric patients with hematological malignancies

Leukemia volume 19, pages 504–506 (2005)Cite this article

Despite the many reports available on chimerism status after allogeneic hematopoietic transplantation, few studies have focused on chimerism using peripheral blood progenitor cell (PBPC) alone as source of hematopoietic stem cells, either adult or children.1, 2, 3 We conducted a retrospective study in 39 children with leukemia assessing whether the achievement of early (day +30 after allogeneic PBPCT) full donor chimerism status would allow us to separate children at high or low risk of relapse. The main characteristics of patients, donors and transplantation are shown in Table 1. Informed consent was obtained according to institutional guidelines for all procedures. The clinical protocols for mobilization, apheresis and transplantation were approved by the Institutional Review Board. Details of mobilization, apheresis and transplantation procedures have been reported elsewhere.4 Chimerism studies were carried out on genomic DNA obtained from peripheral blood (PB) or bone marrow (BM) samples, taken at the time of neutrophil engraftment, on day +30, and 3, 9 and 12 months after transplantation. In addition, PB or BM samples were taken depending on clinical events following transplantation. Samples were amplified by polymerase chain reaction (PCR) with a panel of six single tandem repeat (STR) and variable number of tandem repeat (VNTR) markers.3 Patients were closely followed and clinically evaluated daily. Time to neutrophil and platelet engraftment were recorded. Acute and/or chronic graft-versus-host disease (GVHD) were diagnosed clinically and by pathology examination of a skin biopsy when required. Complete donor chimerism (CC) was defined as the presence of 99% or higher donor DNA as detected by the PCR-STR assay. Mixed chimerism (MC) was defined as at least 1% recipient DNA as detected by the PCR-STR assay.

Table 1 Patients, donor and graft characteristics
Full size table

Chimerism status at day +30 had a predictive value for relapse. We found that patients who were in CC by day +30 had a lower probability of relapse than those who were not (54.5±15% vs 20.8±9.6%; HR: 4.98; 95% CI 2.04–43.57; P=0.004) (Figure 1b). Overall, 10 patients relapsed (25.6%), with a median time of 127 days (range 50–1290). Six of those 10 patients who relapsed did not achieve CC by day +30. The level of MC of relapsing patients was 5% (range 0–17%) on day +30, whereas it was 1% (range 0–7%) in patients who did not relapsed. Six patients who presented MC by day +30 achieved CC during the follow-up. Only one of these six patients did relapse, while only one patient that presented CC by day +30 developed MC during the follow-up, and then relapsed. The pattern of relapse was different depending upon whether patients had or did not have CC by day +30. All leukemic relapses among patients who were MC by day +30 occured during the first year post-transplant, whereas two patients with CC by day +30 relapsed during the first year and two relapsed in the fourth year after transplant (Figure 1b).

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  1. Servicio de Oncohematología y Trasplante Hematopoyético, Hospital Infantil ‘Niño Jesús’, Madrid, Spain

    A Lassaletta, M Ramírez, J M Montero, M González-Vicent, L Madero & M Á Díaz

  2. Centro de Trasfusión Comunidad de Madrid, Madrid, Spain

    A Balas

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  1. A Lassaletta
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  2. M Ramírez
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Correspondence to M Á Díaz.

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Lassaletta, A., Ramírez, M., Montero, J. et al. Full donor chimerism by day 30 after allogeneic peripheral blood progenitor cell transplantation is associated with a low risk of relapse in pediatric patients with hematological malignancies. Leukemia 19, 504–506 (2005). https://doi.org/10.1038/sj.leu.2403692

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