Effect of mixed chimerism on graft-versus-host disease, disease recurrence and survival after HLA-identical marrow transplantation for aplastic anemia or chronic myelogenous leukemia.

摘要: The association of mixed (donor/host) chimerism with graft-versus-host disease (GVHD), graft rejection, recurrence and survival was investigated in 116 patients aplastic anemia 197 chronic myelogenous leukemia (CML) transplanted unmodified marrow from an HLA-identical sibling donor opposite sex. Patients were conditioned cyclophosphamide (CY), CML a combination CY total body irradiation (TBI) or busulfan. Sixty-three the (54%) 100 (51%) categorized as chimeras based on concurrent presence host lymphohematopoietic cells 14 days later after transplantation. TBI dose used for conditioning inversely correlated development (P < 0.0001) among patients. No other patient- transplant-related parameter identified which contributed significantly to chimerism. incidence rejection higher but not so who chimeras. leukemic relapse increased only if occurred day = 0.015). acute GVHD (grades II-IV) lower than complete chimeras, this difference statistically significant given single-agent prophylaxis 0.0008). Mixed that group also had better while no observed drug combinations prophylaxis. Among CML, both overall 0.03) relapse-free 0.04) superior Thus, frequent uniformly associated failure relapse. interaction between regimen, are complex. advantage is part related factors likely contribute.