Gonzalez-Vicent Marta, Diaz Miguel Angel
Department of Pediatrics, Division of Hematopoietic Stem Cell Transplantation, Hospital Infantil Niño Jesus, Madrid, Spain.
J Pediatr Hematol Oncol. 2011 Apr;33(3):185-9. doi: 10.1097/MPH.0b013e3181f47074.
We conducted a retrospective study assessing the predictive value of early full donor chimerism status for relapse after allogeneic peripheral blood progenitor cell transplantation in 40 children aged between 1 and 16 years (median 8) with leukemia. The only variable that had a significant influence on chimerism status in either univariate or multivariate analysis was the number of CD34 cells infused. We found that the patients who were in complete donor chimerism by day +30 had a lower probability of relapse than those who were not (14% ± 6% versus 54% ± 15%; HR, 5.24; 95% confidence interval, 2.10-43.63; P = 0.003). Mixed chimerism by day +30, absence of chronic GvHD, and advanced disease at transplantation were significant risk factors for relapse in our patients. Children who presented early complete chimerism had a probability of developing chronic graft versus host disease significantly higher than patients with mixed chimerism (P = 0.04). Therefore, the analysis of chimerism kinetic in children undergoing peripheral blood progenitor cell transplantation would permit an early identification of patients at risk of relapse and patients with high risk of developing chronic graft versus host disease.
我们进行了一项回顾性研究，评估了40名年龄在1至16岁（中位年龄8岁）的白血病儿童接受异基因外周血祖细胞移植后，早期完全供体嵌合状态对复发的预测价值。在单变量或多变量分析中，唯一对嵌合状态有显著影响的变量是输注的CD34细胞数量。我们发现，在+30天时处于完全供体嵌合状态的患者复发概率低于未处于该状态的患者（14%±6%对54%±15%；风险比，5.24；95%置信区间，2.10 - 43.63；P = 0.003）。在我们的患者中，+30天时的混合嵌合状态、无慢性移植物抗宿主病以及移植时疾病进展是复发的显著危险因素。早期出现完全嵌合的儿童发生慢性移植物抗宿主病的概率显著高于混合嵌合状态的患者（P = 0.04）。因此，对外周血祖细胞移植儿童的嵌合动力学进行分析，将有助于早期识别有复发风险的患者以及有发生慢性移植物抗宿主病高风险的患者。
