Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens
AUTOR(ES)
Quiroga, Marcia, Pereira, Noemi Farah, Bitencourt, Marco Antonio, Bonfim, Carmem, Monteiro, Marianna Gendre de Mesquita, Pasquini, Ricardo
FONTE
Hematol., Transfus. Cell Ther.
DATA DE PUBLICAÇÃO
2018-06
RESUMO
ABSTRACT Background: This study investigated the influence of two conditioning regimens on the chimerical status of 104 patients with acquired severe aplastic anemia. Methods: Patients were monitored for at least 18 months after related bone marrow transplantation and reaching partial or complete hematologic recovery. Group I patients (n = 55) received 200 mg/kg cyclophosphamide alone and Group II (n = 49) received 120 mg/kg cyclophosphamide associated with 12 mg/kg busulfan. Patients were classified in three chimerism levels according to the percentage of donor cells in the peripheral blood. Results: Chimerism ≤50% occurred in 36.4% of Group I and none of Group II; chimerism 51–90% was found in 20.0% of Group I and 10.2% of Group II; and chimerism >90% was found in 43.6% of Group I versus 89.8% of Group II. A significant association (p-value < 0.001) was found between conditioning type and chimerism levels. A higher number of infused cells was associated with higher levels of chimerism only in Group I (p-value = 0.013). Multivariate analysis showed that chimerism >90% is associated with the cyclophosphamide plus busulfan conditioning (p-value < 0.001) and higher number of infused cells (p-value = 0.009), suggesting that these factors are predictive of graft outcome. Regarding hematological recovery, higher chimerism levels were associated with higher neutrophil (p-value = 0.003) and platelet counts (p-value < 0.001) in Group I only. These results show that myeloablative conditioning favors full donor chimerism and non-myeloablative conditioning predisposes to mixed chimerism or autologous recovery of hematopoiesis. Conclusion: These data show that autologous recovery depends on the intensity of immunosuppression and that the immunosuppressive function of cyclophosphamide alone can induce this type of hematopoietic recovery.
Documentos Relacionados
- Monosomy 7 in donor cell-derived leukemia after bone marrow transplantation for severe aplastic anemia: report of a new case and review of the literature
- Aplastic anemia: presence in human bone marrow of cells that suppress myelopoiesis.
- Outcomes of autologous transplantation for multiple myeloma according to different induction regimens
- Thymoma followed by aplastic anemia: two different responses to immunosuppressive therapy
- Comment on "Outcomes of autologous transplantation for multiple myeloma according to different induction regimens"