Chimerism status after unrelated donor bone marrow transplantation with fludarabine-melphalan conditioning is affected by the melphalan dose and is predictive of relapse

Nobuhiko Imahashi, Haruhiko Ohashi, Seitaro Terakura, Kotaro Miyao, Reona Sakemura, Tomonori Kato, Masashi Sawa, Emi Yokohata, Shingo Kurahashi, Yukiyasu Ozawa, Tetsuya Nishida, Hitoshi Kiyoi, Koichi Watamoto, Akio Kohno, Masanobu Kasai, Chiaki Kato, Hiroatsu Iida, Tomoki Naoe, Koichi Miyamura, Makoto Murata

Research output: Contribution to journalArticlepeer-review

Abstract

Little is known regarding the chimerism status after reduced-intensity conditioning transplantation when bone marrow is used as a stem cell source. We prospectively analyzed lineage-specific chimerism and retrospectively evaluated clinical outcomes in 80 adult patients who underwent unrelated donor bone marrow transplantation (URBMT) with fludarabine plus melphalan (FM) as the conditioning regimen. Mixed donor chimerism (MDC) was seen in 43 and 10 % of patients at days 14 and 28, respectively. Melphalan at ≤130 mg/m2 was associated with an increased incidence of MDC at day 28 (P = 0.03). Patients with MDC at day 14 showed a marginally increased risk of primary graft failure and a marginally decreased risk of graft-versus-host disease. In multivariate analysis, MDC at day 14 was associated with higher overall mortality (hazard ratio (HR) = 2.1; 95 % confidence interval (CI), 1.1–4.2; P = 0.04) and relapse rate (HR = 3.0; 95 % CI, 1.2–7.5; P = 0.02), but not with non-relapse mortality (HR = 1.8; 95 % CI, 0.70–4.6; P = 0.23). Thus, the FM regimen yields prompt complete donor chimerism after URBMT, but the melphalan dose significantly impacts the kinetics of chimerism. Chimerism status evaluation at day 14 may be instrumental in predicting relapse after URBMT with the FM regimen.

Original languageEnglish (US)
Pages (from-to)1139-1148
Number of pages10
JournalAnnals of hematology
Volume94
Issue number7
DOIs
StatePublished - Jul 18 2015

Keywords

  • Bone marrow transplantation
  • Chimerism analysis
  • Reduced-intensity conditioning regimen
  • Relapse

ASJC Scopus subject areas

  • Hematology

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