Patterns of hematopoietic chimerism following bone marrow transplantation for childhood acute lymphoblastic leukemia from volunteer unrelated donors

K Molloy, N Goulden, M Lawler, J Cornish, A Oakhill, D Pamphilon, M Potter, C Steward, K Langlands, P Humphries, S R McCann, Mark Lawler

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59 Citations (Scopus)

Abstract

Hematopoietic chimerism was analyzed in serial bone marrow samples taken from 28 children following T-cell depleted unrelated donor bone marrow transplants (UD BMT) for acute lymphoblastic leukemia (ALL). Chimeric status was determined by polymerase chain reaction (PCR) of simple tandem repeat (STR) sequences (maximal sensitivity, 0.1%). At least two serial samples were examined in 23 patients. Of these, two had evidence of complete donor engraftment at all times and eight showed stable low level mixed chimerism (MC) (<1% recipient hematopoiesis). All 10 of these patients remain in remission with a minimum follow-up of 24 months. By contrast, 13 patients demonstrated a progressive return of recipient hematopoiesis. Five of these relapsed (4 to 9 months post BMT), one died of cytomegalovirus pneumonitis and seven remain in remission with a minimum follow-up of 24 months. Five children were excluded from serial analysis as two serial samples were not collected before either relapse (3) or graft rejection (2). We conclude that as with sibling transplants, ex vivo T depleted UD BMT in children with ALL is associated with a high incidence of MC. Stable donor engraftment and low level MC always correlated with continued remission. However, detection of a progressive return of recipient cells did not universally correlate with relapse, but highlighted those patients at greatest risk. Serial chimerism analysis by PCR of STRs provides a rapid and simple screening technique for the detection of relapse and the identification of patients with progressive MC who might benefit from detailed molecular analysis for minimal residual disease following matched volunteer UD BMT for childhood ALL.

Original languageEnglish
Pages (from-to)3027-31
Number of pages5
JournalBlood
Volume87
Issue number7
Publication statusPublished - 01 Apr 1996

Keywords

  • Adolescent
  • Bone Marrow Transplantation
  • Child
  • Child, Preschool
  • Hematopoietic Stem Cells
  • Histocompatibility Testing
  • Humans
  • Infant
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Transplantation Chimera

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