Chimaerism analyses and subsequent immunological intervention after stem cell transplantation in patients with juvenile myelomonocytic leukaemia
Ayami Yoshimi
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorCharlotte M. Niemeyer
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorViktoria Bohmer
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorUlrich Duffner
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorBrigitte Strahm
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorHermann Kreyenberg
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorDagmar Dilloo
Department of Paediatric Haematology and Oncology, University Children's Hospital, Düsseldorf
Search for more papers by this authorFelix Zintl
Department of Paediatrics, University of Jena, Jena
Search for more papers by this authorAlexander Claviez
Department of Paediatrics and Bone Marrow Transplant Unit, University Children's Hospital, Kiel
Search for more papers by this authorWilli Wössmann
Department of Paediatric Haematology and Oncology, University Children's Hospital, Giessen
Search for more papers by this authorBernhard Kremens
Department of Paediatric Haematology/Oncology, University Children's Hospital, Essen
Search for more papers by this authorWolfgang Holter
Department of Paediatrics, University of Erlangen-Nuremberg, Erlangen
Search for more papers by this authorDietrich Niethammer
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorJames F. Beck
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorUdo Kontny
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorPeter Nöllke
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorThomas Klingebiel
Department of Haematology/Oncology, University Children's Hospital, Frankfurt, Germany
Search for more papers by this authorPeter Bader
Department of Haematology/Oncology, University Children's Hospital, Frankfurt, Germany
Search for more papers by this authorAyami Yoshimi
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorCharlotte M. Niemeyer
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorViktoria Bohmer
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorUlrich Duffner
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorBrigitte Strahm
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorHermann Kreyenberg
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorDagmar Dilloo
Department of Paediatric Haematology and Oncology, University Children's Hospital, Düsseldorf
Search for more papers by this authorFelix Zintl
Department of Paediatrics, University of Jena, Jena
Search for more papers by this authorAlexander Claviez
Department of Paediatrics and Bone Marrow Transplant Unit, University Children's Hospital, Kiel
Search for more papers by this authorWilli Wössmann
Department of Paediatric Haematology and Oncology, University Children's Hospital, Giessen
Search for more papers by this authorBernhard Kremens
Department of Paediatric Haematology/Oncology, University Children's Hospital, Essen
Search for more papers by this authorWolfgang Holter
Department of Paediatrics, University of Erlangen-Nuremberg, Erlangen
Search for more papers by this authorDietrich Niethammer
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorJames F. Beck
Department of Paediatric Haematology and Oncology, University Children's Hospital, Tübingen
Search for more papers by this authorUdo Kontny
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorPeter Nöllke
Department of Paediatrics and Adolescent Medicine, University of Freiburg, Freiburg
Search for more papers by this authorThomas Klingebiel
Department of Haematology/Oncology, University Children's Hospital, Frankfurt, Germany
Search for more papers by this authorPeter Bader
Department of Haematology/Oncology, University Children's Hospital, Frankfurt, Germany
Search for more papers by this authorSummary
Chimaerism analysis was performed by polymerase chain reaction amplification of short-tandem repeat markers in 30 children following haematopoietic stem cell transplantation for juvenile myelomonocytic leukaemia (JMML). Fourteen patients always had complete chimaerism (CC); one of them relapsed after the discontinuation of the study and 13 continued in complete remission (CR). Mixed chimaerism (MC) was noted in 16 patients. Of those 12 patients demonstrated increasing MC (i-MC); 10 relapsed and two achieved CC following discontinuation of immunosuppressive therapy (IST). Four other patients demonstrating only transient MC are alive in CR. MC with up to 20% of autologous cells could be successfully eradicated without induction of severe graft-versus-host disease when IST was reduced or discontinued directly after the first demonstration of MC. At the same time, MC with up to 10% of autologous cells could disappear without intervention. The interval between MC and relapse ranged from 0–320 d (median 38 d). Donor leucocyte infusion was given to six patients with i-MC, but only one patient responded. Peripheral blood seems as valuable as bone marrow for chimaerism studies. In conclusion, serial quantitative chimaerism studies can identify patients with i-MC who are at high risk for relapse of JMML. Immediate withdrawal of IST is advised in these patients.
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