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Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major

Received: 4 January 2024     Accepted: 1 February 2024     Published: 20 February 2024
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Abstract

Background: Incomplete donor cell chimerism often occurs in thalassemia transplant due to host cells remain or reappear overtime, which is termed as mixed chimerism (MC). Objective: To compare the immunosuppression withdrawal (ISW) and donor lymphocyte infusion (DLI) in the correction of mixed chimerism (MC) after thalassemia transplantation. Methods: Eighty-seven patients with post-transplant MC admitted in our center from January 2010 to December 2019 were analyzed. Among them donor cells of 90%-95% and 75%-89% were classified as MC1 and MC2 respectively. MC3 donor cells <75%. The incidence and correction rate of MC, the occurrence rate of graft versus host disease (GVHD), timing of DLI were studied. Results: DLI was associated with higher correction rates and higher GVHD than ISW. In MC1 group, higher GVHD occurred in early and intermediate stage (P = 0.024/0.023) than ISW. In MC2 group, DLI in late stages had higher correction rates than ISW (P = 0.001). Conclusion: ISW was the primary strategy for MC1 patients. DLI should be given to the late-stage MC2 patients quickly. The earlier the treatment is provided, regardless of ISW or DLI, the more likely that patients develop GVHD.

Published in American Journal of Pediatrics (Volume 10, Issue 1)
DOI 10.11648/j.ajp.20241001.14
Page(s) 18-25
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Mixed Chimerism, GVHD, Donor Lymphocyte Infusion, Thalassemia, HSCT

References
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[4] Gulsun Tezcan Karasu, M. Akif Yesilipek, Sibel Berker Karauzum, et al. The Value of Donor Lymphocyte Infusions in Thalassemia Patients at Imminent Risk of Graft Rejection Following Stem Cell Transplantation. Pediatr Blood Cancer 2012; 58: 453-458.
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[15] Francesca A, Kinsellaab M, Charlotte F, et al. Very early lineage-specifific chimerism after reduced intensity stem cell transplantation is highly predictive of clinical outcome for patients with myeloid disease. Leukemia Research, 2019, 83: 106-173.
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Cite This Article
  • APA Style

    Liao, J., Liang, S., Chen, J., Liu, X., Xia, Y., et al. (2024). Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major. American Journal of Pediatrics, 10(1), 18-25. https://doi.org/10.11648/j.ajp.20241001.14

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    ACS Style

    Liao, J.; Liang, S.; Chen, J.; Liu, X.; Xia, Y., et al. Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major. Am. J. Pediatr. 2024, 10(1), 18-25. doi: 10.11648/j.ajp.20241001.14

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    AMA Style

    Liao J, Liang S, Chen J, Liu X, Xia Y, et al. Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major. Am J Pediatr. 2024;10(1):18-25. doi: 10.11648/j.ajp.20241001.14

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  • @article{10.11648/j.ajp.20241001.14,
      author = {Jianyun Liao and Shimin Liang and Jingtao Chen and Xiaoting Liu and Yuqian Xia and Jujian He and Weiwei Zhang and Chaoke Pu and Lan He and Yuelin He and Xiaoqin Feng and Xuedong Wu and Chunfu Li},
      title = {Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major},
      journal = {American Journal of Pediatrics},
      volume = {10},
      number = {1},
      pages = {18-25},
      doi = {10.11648/j.ajp.20241001.14},
      url = {https://doi.org/10.11648/j.ajp.20241001.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20241001.14},
      abstract = {Background: Incomplete donor cell chimerism often occurs in thalassemia transplant due to host cells remain or reappear overtime, which is termed as mixed chimerism (MC). Objective: To compare the immunosuppression withdrawal (ISW) and donor lymphocyte infusion (DLI) in the correction of mixed chimerism (MC) after thalassemia transplantation. Methods: Eighty-seven patients with post-transplant MC admitted in our center from January 2010 to December 2019 were analyzed. Among them donor cells of 90%-95% and 75%-89% were classified as MC1 and MC2 respectively. MC3 donor cells P = 0.024/0.023) than ISW. In MC2 group, DLI in late stages had higher correction rates than ISW (P = 0.001). Conclusion: ISW was the primary strategy for MC1 patients. DLI should be given to the late-stage MC2 patients quickly. The earlier the treatment is provided, regardless of ISW or DLI, the more likely that patients develop GVHD.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major
    AU  - Jianyun Liao
    AU  - Shimin Liang
    AU  - Jingtao Chen
    AU  - Xiaoting Liu
    AU  - Yuqian Xia
    AU  - Jujian He
    AU  - Weiwei Zhang
    AU  - Chaoke Pu
    AU  - Lan He
    AU  - Yuelin He
    AU  - Xiaoqin Feng
    AU  - Xuedong Wu
    AU  - Chunfu Li
    Y1  - 2024/02/20
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ajp.20241001.14
    DO  - 10.11648/j.ajp.20241001.14
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 18
    EP  - 25
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20241001.14
    AB  - Background: Incomplete donor cell chimerism often occurs in thalassemia transplant due to host cells remain or reappear overtime, which is termed as mixed chimerism (MC). Objective: To compare the immunosuppression withdrawal (ISW) and donor lymphocyte infusion (DLI) in the correction of mixed chimerism (MC) after thalassemia transplantation. Methods: Eighty-seven patients with post-transplant MC admitted in our center from January 2010 to December 2019 were analyzed. Among them donor cells of 90%-95% and 75%-89% were classified as MC1 and MC2 respectively. MC3 donor cells P = 0.024/0.023) than ISW. In MC2 group, DLI in late stages had higher correction rates than ISW (P = 0.001). Conclusion: ISW was the primary strategy for MC1 patients. DLI should be given to the late-stage MC2 patients quickly. The earlier the treatment is provided, regardless of ISW or DLI, the more likely that patients develop GVHD.
    
    VL  - 10
    IS  - 1
    ER  - 

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Author Information
  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China; Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China

  • Department of Pediatrics, Southwest Medical University, Luzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China; Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China; Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China; Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Nanfang-Chunfu Children’s Institute of Hematology and Oncology, Taixin Hospital, Dongguan, China; Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

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