Alpár Donát
Department of Pathology; University of Pécs; Pécs, Hungary.
Chimerism. 2011 Jan;2(1):19-20. doi: 10.4161/chim.2.1.14726.
Allogeneic bone marrow transplantation (allo-BMT) is the treatment of choice for many patients with poor prognosis or refractory leukemia. Chimerism and residual tumor load after allo-BMT are widely monitored to detect impending graft rejection and the early phase of relapse. In most cases, the malignant cell population during post-transplant relapse contains host-derived cells, but the leukemic clone can rarely be of donor-cell origin. Various genetic tests with different strategies, targets and sensitivities are available for donor-host discrimination. However, changes in the genomic material of the dominant host cell population as a result of clonal evolution and/or clonal selection can hamper the correct identification of the origin of aberrant cells after allo-BMT, thus confounding the assessment of the chimeric state. Consequently, a good knowledge of the techniques applied in clinical practice and careful interpretation of their results are essential. A lack of host-specific markers at the time of clinical relapse is not adequate for verifying the presence of donor cell leukemia, and unequivocal demonstration of donor-specific markers is also required.
异基因骨髓移植（allo-BMT）是许多预后不良或难治性白血病患者的首选治疗方法。allo-BMT后的嵌合状态和残留肿瘤负荷受到广泛监测，以检测即将发生的移植物排斥反应和复发的早期阶段。在大多数情况下，移植后复发期间的恶性细胞群体包含宿主来源的细胞，但白血病克隆很少来自供体细胞。有各种不同策略、靶点和灵敏度的基因检测方法可用于区分供体和宿主。然而，由于克隆进化和/或克隆选择导致的优势宿主细胞群体基因组物质的变化，可能会妨碍allo-BMT后异常细胞来源的正确识别，从而混淆嵌合状态的评估。因此，深入了解临床实践中应用的技术并仔细解读其结果至关重要。临床复发时缺乏宿主特异性标志物不足以证实供体细胞白血病的存在，还需要明确证明供体特异性标志物的存在。
