Donor/recipient mixed chimerism does not predict graft failure in children with beta-thalassemia given an allogeneic cord blood transplant from an HLA-identical sibling.

Abstract

BACKGROUND:

Donor/recipient mixed chimerism has been reported to be associated with an increased risk of graft failure in patients with beta-thalassemia given a bone marrow transplant. We investigated the relationship between the degree of mixed chimerism over time and clinical outcome of children undergoing cord blood transplantation for beta-thalassemia.

DESIGN AND METHODS:

Twenty-seven consecutive children given a cord blood transplant from a related donor were analyzed by short tandem repeat polymerase chain reaction and their chimerism results were compared with those of 79 consecutive patients who received a bone marrow transplant from either a relative (RD-BMT, n=42) or an unrelated donor (UD-BMT, n=37). Cord blood and bone marrow recipients received comparable preparative regimens.

RESULTS:

All cord blood recipients engrafted and displayed mixed chimerism early after transplantation; 13/27 converted to full donor chimerism over time, while 14 maintained stable mixed chimerism; all patients are alive and transfusion-independent. Twenty-four of the 79 bone marrow-recipients (12 UD- and 12 RD-BMT) exhibited full donor chimerism at all time points examined, 4/79 (2 UD- and 2 RD-BMT) did not engraft and 51/79 (23 UD- and 28 RD-BMT) displayed mixed chimerism at the time of hematologic reconstitution. Forty of 51 bone marrow recipients with mixed chimerism converted to full donor chimerism (17 UD- and 23 RD-BMT), 3/51 maintained stable mixed chimerism (1 UD- and 2 RD-BMT), while 8/51 (5 UD- and 3 RD-BMT) progressively lost the graft, and became transfusion-dependent again.

CONCLUSIONS:

Mixed chimerism is a frequent event and does not predict the occurrence of graft failure in children with beta-thalassemia given a cord blood transplant from a relative.

• Authors: Daniela Lisini, Marco Zecca, Giovanna Giorgiani, Daniela Montagna, Rosaria Cristantielli, Massimo Labirio, Pierangela Grignani, Carlo Previderè, Alessandra Di Cesare-Merlone, Giovanni Amendola, Elena Bergami, Angela Mastronuzzi, Rita Maccario, Franco Locatelli
• Journal: Haematologica (Haematologica) Vol. 93 Issue 12 Pg. 1859-67 (Dec 2008) ISSN: 1592-8721 [Electronic] Italy
• PMID: 18945748 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HLA Antigens

Topics

• Adolescent
• Child
• Child, Preschool
• Cord Blood Stem Cell Transplantation
• Female
• Graft Rejection (diagnosis, immunology)
• HLA Antigens (immunology)
• Humans
• Infant
• Male
• Predictive Value of Tests
• Retrospective Studies
• Siblings
• Tissue Donors
• Transplantation Chimera
• Transplantation, Homologous
• Young Adult
• beta-Thalassemia (therapy)