BACKGROUND: For children with juvenile myelomonocytic leukemia (JMML) who undergo stem cell transplantation (SCT), the role of immunological interventions including withdrawal of immunosuppressive therapy (IST) and donor lymphocyte infusion (DLI) for treatment of disease recurrence remains uncertain. PROCEDURE: We analyzed serial chimerism status following SCT and evaluated the efficacy of immunological interventions for the management of mixed chimerism (MC) in children with JMML. RESULTS: Chimerism analysis was available in 26 SCT cases following the first and second SCT. MC was observed in 16 cases and withdrawal of IST was performed in 14 cases immediately after identification of MC. Donor lymphocyte infusion (DLI) was performed in five MC cases. Eight MC cases were observed at the time of neutrophil recovery. Following withdrawal of IST, three cases achieved complete chimerism (CC) while the proportion of autologous cells increased rapidly in the remaining five cases. Six MC cases were observed after achievement of hematological remission (HR) and responses to withdrawal of IST were observed in two cases. In the remaining four cases, despite withdrawal of IST, the proportion of autologous cells increased. Five cases received DLI but only one case responded. CONCLUSION: Although the benefits of immunological interventions for MC after SCT in JMML were limited, some patients did achieve HR as a result of these treatment modalities without a second SCT. Close monitoring of donor chimerism and early detection of MC is helpful in guiding treatment after SCT in children with JMML.
BACKGROUND: For children with juvenile myelomonocytic leukemia (JMML) who undergo stem cell transplantation (SCT), the role of immunological interventions including withdrawal of immunosuppressive therapy (IST) and donor lymphocyte infusion (DLI) for treatment of disease recurrence remains uncertain. PROCEDURE: We analyzed serial chimerism status following SCT and evaluated the efficacy of immunological interventions for the management of mixed chimerism (MC) in children with JMML. RESULTS: Chimerism analysis was available in 26 SCT cases following the first and second SCT. MC was observed in 16 cases and withdrawal of IST was performed in 14 cases immediately after identification of MC. Donor lymphocyte infusion (DLI) was performed in five MC cases. Eight MC cases were observed at the time of neutrophil recovery. Following withdrawal of IST, three cases achieved complete chimerism (CC) while the proportion of autologous cells increased rapidly in the remaining five cases. Six MC cases were observed after achievement of hematological remission (HR) and responses to withdrawal of IST were observed in two cases. In the remaining four cases, despite withdrawal of IST, the proportion of autologous cells increased. Five cases received DLI but only one case responded. CONCLUSION: Although the benefits of immunological interventions for MC after SCT in JMML were limited, some patients did achieve HR as a result of these treatment modalities without a second SCT. Close monitoring of donor chimerism and early detection of MC is helpful in guiding treatment after SCT in children with JMML.
Authors: Christopher C Dvorak; Prakash Satwani; Elliot Stieglitz; Mitchell S Cairo; Ha Dang; Qinglin Pei; Yun Gao; Donna Wall; Tali Mazor; Adam B Olshen; Joel S Parker; Samir Kahwash; Betsy Hirsch; Susana Raimondi; Neil Patel; Micah Skeens; Todd Cooper; Parinda A Mehta; Stephan A Grupp; Mignon L Loh Journal: Pediatr Blood Cancer Date: 2018-03-12 Impact factor: 3.167
Authors: Hemalatha G Rangarajan; Marcelo S F Pereira; Ruta Brazauskas; Andrew St Martin; Ashleigh Kussman; Ezgi Elmas; Michael R Verneris; Shahinaz M Gadalla; Steven G E Marsh; Sophie Paczesny; Stephen R Spellman; Stephanie J Lee; Dean A Lee Journal: Transplant Cell Ther Date: 2021-08-15
Authors: Franco Locatelli; Alessandro Crotta; Annalisa Ruggeri; Mary Eapen; John E Wagner; Margaret L Macmillan; Marco Zecca; Joanne Kurtzberg; Carmem Bonfim; Ajay Vora; Cristina Díaz de Heredia; Lochie Teague; Jerry Stein; Tracey A O'Brien; Henrique Bittencourt; Adrienne Madureira; Brigitte Strahm; Christina Peters; Charlotte Niemeyer; Eliane Gluckman; Vanderson Rocha Journal: Blood Date: 2013-08-07 Impact factor: 22.113
Authors: Sachit A Patel; Don W Coulter; Alfred C Grovas; Bruce G Gordon; James L Harper; Phyllis I Warkentin; James L Wisecarver; Warren G Sanger; Peter F Coccia Journal: J Pediatr Hematol Oncol Date: 2014-08 Impact factor: 1.289