Allogeneic hematopoietic SCT in patients with non-malignant diseases, and importance of chimerism

• Published in: Bone marrow transplantation (Basingstoke) Vol. 44; no. 11; pp. 757 - 763
• Main Authors: Svenberg, P, Mattsson, J, Ringdén, O, Uzunel, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-12-2009; Nature Publishing Group
• Subjects: Adjuvants, Immunologic - therapeutic use; Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood diseases; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cell Biology; Child; Child, Preschool; Chimerism; Conditioning; Diseases; Female; Graft rejection; Graft versus host reaction; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Immunologic Factors - therapeutic use; Infant; Infant, Newborn; Internal Medicine; Lymphocytes; Male; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; original-article; Patient outcomes; Public Health; Remission; Retrospective Studies; Risk factors; Stem cell transplantation; Stem Cells; Survival; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Chimera; Transplantation Conditioning; Transplantation, Homologous; Transplants; Transplants & implants; Treatment Outcome; Young Adult; United States; chimerism; donor lymphocyte infusions; non-malignant; SCT; Human; Treatment; Allogeneic hematopoietic stem cell transplantation; Donor; Donor lymphocyte infusion; Stem cell; Hematopoietic cell; Homograft; Chimerism; Hematopoietic stem cell transplantation
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2009.82

In this retrospective study, we evaluated the chimerism status and outcome in 58 patients (64 transplants) with non-malignant diseases. Reduced intensity conditioning (RIC) was given in half of the transplants. Mixed chimerism (MC) was defined as >1% recipient cells. Two consecutive samples showing >30% recipient cells were defined as high chimerism (high MC). Patients with high MC and the management of these patients were analyzed in greater detail. The overall survival rate was 87%. In total, 23 transplants were donor chimerism (DC) and 41 transplants showed some degree of MC. The incidence of MC was 78 and 50% after RIC and myeloablative conditioning, respectively (
P
=0.04). Acute GVHD of grades II–III was more common in patients with DC (39%) than in patients with MC (8%) (
P
=0.002). Owing to high MC, donor lymphocyte infusions were given in 17 cases. The level of MC was reduced in seven cases, unchanged in four cases, increased in one case and there was graft rejection in five cases. A second transplant was carried out in six cases with rejections, five are alive and in remission. We conclude that patients with non-malignant diseases, who develop MC after transplant have less acute GVHD. Despite the high incidence of MC, overall survival is promising.