autologous blood and marrow transplantation - Blog Science ...

Carella et al.
Evaluation of chimerism
Cytogenetics and DNA polymorphisms by fluorescence-based technology of
multiplexed PCR products (STR) from bone marrow cells were used as a marker
for chimerism. Allogeneic stem cells were monitored with this technique, first by
the multiplex reaction and then by detecting donor/recipient cell population ratios
at 10-day intervals the first month and 15-day intervals in the second and third
month after allografting by evaluating peak areas in singleplexed PCR products of
each informative marker.
RESULTS
The Flu-Cy protocol was well tolerated, with no severe procedure-related
toxicity. No patient required platelet or red cell transfusions. Patients were
discharged from the hospital 16 to 39 days (median 19) after donor stem cell
infusion. There was evidence of >90% donor cell engraftment in eight patients.
Severe acute GVHD (>grade II) was observed in two patients (Hodgkin's disease)
and mild acute GVHD in one patient (accelerated phase CML). In another patient,
there was a suggestion of grade I acute GVHD of the skin (erythema) and diarrhea
(500 mL/day) which disappeared after therapy with octreotide, corticosteroids, and
oral cyclosporine.
Disease response
Two of the Hodgkin's disease patients, who were in PR after autografting,
achieved CR after allografting. One patient is disease-free 10 months later, while
the other died in CR of aspergillus at 4 months. Another patient with Hodgkin's
disease is alive after 12 months but has progressive disease in the liver, and the last
patient died of progressive Hodgkin's disease on day 65. The patient with lowgrade
non-Hodgkin's lymphoma, who achieved PR after autografting, is diseasefree
6 months after allografting. The other patient died of lymphoma 5 months after
allografting. The blastic phase CML patient is in chronic phase 11 months after
allografting but requires hydroxyurea. In contrast, the patient with accelerated
phase, who obtained a second chronic phase after autografting, achieved complete
disappearance of the BCR-ABL hybrid transcript and is now in complete
hematologic and molecular remission with 100% donor cells in the marrow at day
240. The patient with RAEB and the t(l;3) abnormality, who received only an
allograft, obtained complete hematologic and cytogenetic remission with 100%
donor cells for 3 months, and then relapsed with 50% t(l;3) cells and 20% donor
cells. The other patient with RAEB had autologous recovery. To date, nine patients
are alive between 3 and 14 months (median 8 months).
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