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Hematology, Transfusion and Cell Therapy

versão impressa ISSN 2531-1379versão On-line ISSN 2531-1387

Resumo

QUIROGA, Marcia et al. Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens. Hematol., Transfus. Cell Ther. [online]. 2018, vol.40, n.2, pp.112-119. ISSN 2531-1379.  https://doi.org/10.1016/j.htct.2017.11.011.

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.

Palavras-chave : Severe aplastic anemia; Bone marrow transplantation; Conditioning regimen; Chimerism.

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