Chimärismusanalyse nach Stammzelltransplantation mit hochsensitiven Methoden

 

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Zusammenfassung

Mit den hochsensitiven Methoden zur Chimärismusanalyse kann ein Rezidiv bedeutend früher prognostiziert werden. Für die Prognose ist hierbei vor allem die Dynamik des Anstiegs im Eigenanteil entscheidend, dies gilt auch schon für sehr niedrige Werte (< 0,1%). KM-Proben können über ihren variablen Eigenanteil durch Stromazellen die Erkennung einer Dynamik im niedrigen Prozentbereich (< 1%) verschleiern und somit das Erkennen eines Rezidives erschweren. Die frühe Erkennung einer Dynamik in den sehr niedrigen Prozentbereichen erlaubt bei der Anwendung der sensitiven Methoden eine Reduktion der Anzahl der KM-Proben, was den Patienten weniger belastet. Durch zellfreie DNA und andere Faktoren kann ein „Grundrauschen“ bei sehr niedrigen Eigenanteilen auftreten, der diagnostische Wert von Eigenanteilen von 0,02% und kleiner ist daher fraglich.

Abstract

Chimerism analysis is important for monitoring engraftment and indicating the recurrence of malignant cells after allogeneic hematopoietic stem cell transplantation. Highly sensitive methods with a detection limit of recipient cells (equivalents) below 0,1%, e. g. quantitative PCR, droplet digital PCR and, most recently, Next-Generation Sequencing, can predict a relapse up to 120 days earlier when compared to less sensitive methods. This review highlights the importance of assessing the dynamics of chimerism in the low percentage range (below 1%) for the prediction of a relapse. Moreover, the authors propose a classification of different chimerism kinetics with their reasonable underlying causal effects. The pros and cons of bone marrow samples versus peripheral blood samples and lineage specific chimerism in the context with high sensitive chimerism analysis methods are discussed.

Publication History

Article published online:
16 November 2022

© 2022. Thieme. All rights reserved.

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