Choi S J, Lee K H, Lee J H, Kim S, Chung H J, Lee J S, Kim S H, Park C J, Chi H S, Kim W K
Department of Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
Bone Marrow Transplant. 2000 Aug;26(3):327-32. doi: 10.1038/sj.bmt.1702504.
Hematopoietic chimerism as a predictive marker for the relapse of acute leukemia after allogeneic BMT was evaluated in a prospective study. Monthly assays of hematopoietic chimerism were performed from peripheral blood samples by PCR amplification of short tandem repeats or amelogenin loci. Between December 1997 and June 1999, 33 patients enrolled and 30 were evaluable (two early deaths, one lack of informative bands for chimerism evaluation). There were 14 male and 16 female patients (15 AML and 15 ALL) with a median age of 31 years (range 16-46). Mixed chimerism (MC) was observed at least once in 14 of 30 patients (47%). There was no significant difference between 14 patients who showed MC (MC group) and 16 patients who did not show MC (complete chimerism (CC) group) in terms of age, sex, disease status at BMT, donor type, and the number of bone marrow cells infused. There was no significant difference in the neutrophil and platelet engraftment rates between the two groups. After a median follow up of 10.9 months (range 4.3-22.4), five patients in the CC group and two patients in the MC group relapsed (P = 0.27). All five patients who relapsed in the CC group maintained CC up to 1 month prior to clinical relapse. Our study demonstrated that the patients who showed MC post BMT did not have higher risk of relapse of acute leukemia when compared to patients who did not show MC. Sensitive PCR-based assays for hematopoietic chimerism applied on a monthly basis after allogeneic BMT could not predict relapse of acute leukemia.
在一项前瞻性研究中，评估了造血嵌合现象作为异基因骨髓移植后急性白血病复发的预测标志物。通过对短串联重复序列或牙釉蛋白基因座进行PCR扩增，每月对外周血样本进行造血嵌合现象检测。1997年12月至1999年6月，33例患者入组，30例可评估（2例早期死亡，1例缺乏用于嵌合现象评估的信息条带）。有14例男性和16例女性患者（15例急性髓系白血病和15例急性淋巴细胞白血病），中位年龄31岁（范围16 - 46岁）。30例患者中有14例（47%）至少有一次观察到混合嵌合（MC）。在年龄、性别、骨髓移植时的疾病状态、供体类型以及输入的骨髓细胞数量方面，14例出现MC的患者（MC组）与16例未出现MC的患者（完全嵌合（CC）组）之间无显著差异。两组中性粒细胞和血小板植入率无显著差异。中位随访10.9个月（范围4.3 - 22.4个月）后，CC组有5例患者复发，MC组有2例患者复发（P = 0.27）。CC组复发的所有5例患者在临床复发前1个月一直保持CC状态。我们的研究表明，与未出现MC的患者相比，骨髓移植后出现MC的患者急性白血病复发风险并未更高。异基因骨髓移植后每月应用基于PCR的敏感造血嵌合现象检测方法无法预测急性白血病的复发。
