Quantitative chimerism kinetics in relapsed leukemia patients after allogeneic hematopoietic stem cell transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Chimerism analysis is an important tool for the surveillance of post-transplant engraftment. It offers the possibility of identifying impending graft rejection and recurrence of underlying malignant or non-malignant disease. Here we investigated the quantitative chimerism kinetics of 21 relapsed leukemia patients after allogeneic hematopoietic stem cell transplantation (HSCT).</p><p><b>METHODS</b>A panel of 29 selected sequence polymorphism (SP) markers was screened by real-time polymerase chain reaction (RT-PCR) to obtain the informative marker for every leukemia patient. Quantitative chimerism analysis of bone marrow (BM) samples of 21 relapsed patients and 20 patients in stable remission was performed longitudinally. The chimerisms of BM and peripheral blood (PB) samples of 14 patients at relapse were compared.</p><p><b>RESULTS</b>Twenty-one patients experienced leukemia relapse at a median of 135 days (range, 30 - 720 days) after transplantation. High recipient chimerism in BM was found in all patients at relapse, and increased recipient chimerism in BM samples was observed in 90% (19/21) of patients before relapse. With 0.5% recipient DNA as the cut-off, median time between the detection of increased recipient chimerism and relapse was 45 days (range, 0 - 120 days), with 76% of patients showing increased recipient chimerism at least 1 month prior to relapse. Median percentage of recipient DNA in 20 stable remission patients was 0.28%, 0.04%, 0.05%, 0.05%, 0.08%, and 0.05% at 1, 2, 3, 6, 9, and 12 months, respectively, after transplantation. This was concordant with other specific fusion transcripts and fluorescent in situ hybridization examination. The recipient chimerisms in BM were significantly higher than those in PB at relapse (P = 0.001).</p><p><b>CONCLUSIONS</b>This SP-based RT-PCR assay is a reliable method for chimerism analysis. Chimerism kinetics in BM can be used as a marker of impending leukemia relapse, especially when no other specific marker is available. Based on our findings, we recommend examining not only PB samples but also BM samples in HSCT patients.</p>

Quantitative assessment of hematopoietic chimerism by quantitative real-time polymerase chain reaction of sequence polymorphism systems after hematopoietic stem cell transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Analysis of changes in recipient and donor hematopoietic cell origin is extremely useful to monitor the effect of hematopoietic stem cell transplantation (HSCT) and sequential adoptive immunotherapy by donor lymphocyte infusions. We developed a sensitive, reliable and rapid real-time PCR method based on sequence polymorphism systems to quantitatively assess the hematopoietic chimerism after HSCT.</p><p><b>METHODS</b>A panel of 29 selected sequence polymorphism (SP) markers was screened by real-time PCR in 101 HSCT patients with leukemia and other hematological diseases. The chimerism kinetics of bone marrow samples of 8 HSCT patients in remission and relapse situations were followed longitudinally.</p><p><b>RESULTS</b>Recipient genotype discrimination was possible in 97.0% (98 of 101) with a mean number of 2.5 (1-7) informative markers per recipient/donor pair. Using serial dilutions of plasmids containing specific SP markers, the linear correlation (r) of 0.99, the slope between -3.2 and -3.7 and the sensitivity of 0.1% were proved reproducible. By this method, it was possible to very accurately detect autologous signals in the range from 0.1% to 30%. The accuracy of the method in the very important range of autologous signals below 5% was extraordinarily high (standard deviation <1.85%), which might significantly improve detection accuracy of changes in autologous signals early in the post-transplantation course of follow-up. The main advantage of the real-time PCR method over short tandem repeat PCR chimerism assays is the absence of PCR competition and plateau biases, with demonstrated greater sensitivity and linearity. Finally, we prospectively analyzed bone marrow samples of 8 patients who received allografts and presented the chimerism kinetics of remission and relapse situations that illustrated the sensitivity level and the promising clinical application of this method.</p><p><b>CONCLUSION</b>This SP-based real-time PCR assay provides a rapid, sensitive, and accurate quantitative assessment of mixed chimerism that can be useful in predicting graft rejection and early relapse.</p>

Chronic hepatic damage in acute promyelocytic leukemia patients treated with tetra-arsenic tetra-sulfide / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the chronic hepatic damage in acute promyelocytic leukemia (APL) patients long-term treated with tetra-arsonic tetra-sulfide (As(4)S(4)).</p><p><b>METHODS</b>The periodical liver biochemical examinations and ultrasonography results and hepatic fibrosis indicators (P III NP and type IV collagen) of patients were analysed.</p><p><b>RESULTS</b>106 APL patients treated with As(4)S(4), the median follow-up time was 36 months (6 - 72). The HCV(-) group includes 84 APL patients. During the first course the abnormal rate of the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was 16.7% and 14.5% (higher than the two times of the normal value), the ALT, AST, gamma-glyoxylate aminotransferase (GGT) levels during the first course were statistically higher than As4S4 treatment before (P < 0.05). There were no statistically differences between the ALT, AST, GGT levels after and before treating with As(4)S(4) in half a year, one year, two year, more than three years (P > 0.05). Other biochemical indicators such as ALP, LDH, TBIL, DBIL, TP, ALB, A/G, BUN, CRE, there were no significantly differences before and after As(4)S(4) treatment (P > 0.05). The HCV(+) group includes 22 APL patients, during the first course, the abnormal rate of the ALT, AST were 63.6% and 59.1%, but at the 2 year, more than 3 years there were no significantly differences compared with As(4)S(4) treatment before (P > 0.05). 42 APL patients were treated with As(4)S(4) more than 3 years, in 33 HCV(-) APL patients, two APL patients had splenomegaly, one APL patient's breadth of the portal vein was wider than 1.4 cm, 21 APL patients had fatty liver (63.6%). The hepatic fibrosis indicators of the 16 APL patients were all normal. In 9 HCV(+) APL patients, 4 APL patients had splenomegaly, 2 APL patients, breadth of portal vein were wider than 1.4 cm, 6 APL patients had fatty liver (66.7%). 6 patients were examined with the hepatic fibrosis indicators, 2 patients, were higher than the normal value.</p><p><b>CONCLUSION</b>Long term As(4)S(4) treatment for APL patients had no obvious effects on hepatic function, no obvious hepatic fibrosis and portal hypertension signs at more than 3 years, excepting for the rate of fatty liver was high.</p>

Arsenic absorption and retention in acute promyelocytic leukemia patients treated with tetra-arsenic tetra-sulfide / 中国实验血液学杂志

The objective of this study was to investigate arsenic absorption and retention in acute promyelocytic leukemia (APL) patients treated with tetra-arsenic tetra-sulfide (As(4)S(4)). Arsenic concentrations in samples from APL patients were quantitatively determinated by Hydride Generation Atomic Absorption Spectrometry. The results showed that blood arsenic level was 51.7 +/- 18.7 microg/L (n = 41), urine arsenic level was 2359.1 +/- 1910.6 microg/L (n = 36), and the average daily urinary arsenic excretion was 5.1 +/- 4.06 mg/day (n = 32) on the 7th-9th day after As(4)S(4) administration; blood arsenic level was 61.7 +/- 22.7 microg/L (n = 30), urine arsenic level was 2834.0 +/- 1958.3 microg/L (n = 27), the average daily urinary arsenic excretion was 6.3 +/- 4.98 mg/day (n = 24) on the 10th-12th day after As(4)S(4) administration; blood arsenic level was 62.8 +/- 25.1 microg/L (n = 34), urine arsenic level was 2859.3 +/- 2298.2 microg/L (n = 32) and the average daily urinary arsenic excretion was 6.82 +/- 5.58 mg/day (n = 32) on the 13th-15th day after As(4)S(4) administration. Blood arsenic level was 20.7 +/- 10.9 microg/L (n = 31), urine arsenic level was 525.5 +/- 337.1 microg/L (n = 28), and the average daily urinary arsenic excretion was 1.76 +/- 1.3 mg/day (n = 17) on the 7th-9th day after stop of treatment; blood arsenic level was 16.1 +/- 10.1 microg/L (n = 34), urine arsenic level was 207.1 +/- 164.5 microg/L (n = 28) and the average daily urinary arsenic excretion was 0.42 +/- 0.27 mg/day (n = 22) on the 13th-15th day after stop of treatment. Blood arsenic concentration, urine arsenic concentration and daily urinary arsenic excretion reach a steady state after treatment with As(4)S(4) for 10 days. The average urinary arsenic excretion was 6.82 +/- 5.58 mg/day (n = 32), arsenic absorption level was 9.74 +/- 7.97 mg/day and arsenic absorption efficiency was 0.25 +/- 0.20% during treatment. In conclusion, the majority of absorbed arsenic was excreted from urine and other ways, only a small part of absorbed arsenic was retained in body at the 14th day after therapy was discontinued, blood arsenic concentration, urine arsenic concentration, daily urinary arsenic excretion and hair arsenic concentration could be considered as useful biomarkers for monitoring arsenic absorption and retention in APL patients treated with As(4)S(4).