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Comparison of chimerism and minimal residual disease monitoring for relapse prediction after allogeneic stem cell transplantation for adult acute lymphoblastic leukemia

Item Type:Article
Title:Comparison of chimerism and minimal residual disease monitoring for relapse prediction after allogeneic stem cell transplantation for adult acute lymphoblastic leukemia
Creators Name:Terwey, T.H. and Hemmati, P.G. and Nagy, M. and Pfeifer, H. and Goekbuget, N. and Brueggemann, M. and Le Duc, T.M. and le Coutre, P. and Doerken, B. and Arnold, R.
Abstract:Little data are available on the relative merits of chimerism and minimal residual disease (MRD) monitoring for relapse prediction after allogeneic hematopoietic stem cell transplantation (HCT). We performed a retrospective analysis of serial chimerism assessments in 101 adult HCT recipients with acute lymphoblastic leukemia (ALL) and of serial MRD assessments in a subgroup of 22 patients. All patients had received myeloablative conditioning. The cumulative incidence of relapse was significantly higher in the patients with increasing mixed chimerism (in-MC) compared with those with complete chimerism, low-level MC, and decreasing MC, but the sensitivity of in-MC detection with regard to relapse prediction was only modest. In contrast, MRD assessment was highly sensitive and specific. Patients with MRD positivity after HCT had the highest incidence of relapse among all prognostic groups analyzed. The median time from MRD positivity to relapse was longer than the median time from detection of in-MC, but in some cases in-MC preceded MRD positivity. We conclude that MRD assessment is a powerful prognostic tool that should be included in the routine post-transplantation monitoring of patients with ALL, but chimerism analysis may provide additional information in some cases. Integration of these tools and clinical judgment should allow optimal decision making with regard to post-transplantation therapeutic interventions.
Keywords:Chimerism, Minimal Residual Disease, Acute Lymphoblastic Leukemia, Stem Cell Transplantation, Relapse
Source:Biology of Blood and Marrow Transplantation
ISSN:1083-8791
Publisher:Elsevier (U.S.A.)
Volume:20
Number:10
Page Range:1522-1529
Date:October 2014
Official Publication:https://doi.org/10.1016/j.bbmt.2014.05.026
PubMed:View item in PubMed

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